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Research Projects

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Understanding Treatment Tolerability in Older Patients with Cancer

The overarching goal of this five-year project is to evaluate whether items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) are associated with tolerability of treatment for advanced cancer in older patients with age-related conditions (i.e., disability, comorbidity, and geriatric syndromes). This new research will stimulate the development of new methods to analyze symptomatic AEs from PRO-CTCAE longitudinally and will examine the association between baseline and emerging symptomatic AEs with treatment tolerability. 

Funding: U01CA233167

PI: Supriya G. Mohile

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Implementing Palliative Care: Learning Collaborative vs. Technical Assistance (ENABLE)

Despite the widespread use in healthcare, few studies have evaluated Virtual Learning Collaborative (VLC) effectiveness for increasing the reach, implementation, and maintenance of evidence-based early palliative care (EPC). Effective EPC interventions, such as ENABLE (Educate, Nurture, Advise, Before Life Ends), have not been routinely incorporated into newly diagnosed advanced cancer patients’ care. This study applies Proctor’s Implementation Outcomes framework11 to compare the effect of two implementation strategies (VLC and TA) on Implementation, Service, and Client outcomes of the ENABLE EPC program. ENABLE is the only evidence-based, scalable EPC program promoted by the National Cancer Institute (NCI) Research-Tested Intervention Program.

About the Tolerability Consortium | Division of Cancer Prevention

Funding: R01CA229197, UG1CA189961 identifier: NCT04062552
PIs: Supriya G. Mohile (subcontract PI), Lisa Zubkoff

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GEM-S - Geriatric Evaluation and Management for Survivorship

This study will evaluate whether a standardized intervention-Geriatric Evaluation and Management (GEM) directed by an Advanced Practice Practitioner (APP) combined with Survivorship Health Education (GEM-Survivorship intervention)-can optimize outcomes important to the older cancer survivor after chemotherapy and his/her caregiver. A total of 780 cancer survivors and 780 caregivers (maximum) will be enrolled in the study.

Funding:  R01CA249467, UG1CA189961 identifier: NCT05006482
PIs: Supriya G. Mohile, Michelle Janelsins, and Karen Mustian

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Digital health technologies to promote supportive care interventions and care delivery

The increasing adoption of technologies in older adults can help improve access to supportive care interventions in older adults with cancer. We are interested in studying the use of various digital health technologies to deliver care in the geriatric hematology/oncology population. For example, we are studying how to leverage the use of a mobile health technology platform to deliver a home-based exercise intervention in older adults with myeloid malignancies. In addition, we are also evaluating the use of technology platforms to obtain health information (i.e., geriatric assessment) that are important for patients, caregivers, and providers to make decision.

Funding: National Cancer Institute, Wilmot Cancer Research Fellowship Award identifier: NCT04035499NCT04824859
PI: Kah Poh (Melissa) Loh

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Treatment decision-making in older adults with acute myeloid leukemia

Despite the increasing availability of treatment options, many older adults with acute myeloid leukemia (AML) do not receive leukemia-directed therapies. Given the heterogeneous health status of older adults, it is often challenging for oncologists to identify older patients with AML who are fit enough for intensive treatment, or fit enough to receive treatment at all. Practice patterns therefore vary. We are interested to study decision-making among older adults with AML, their caregivers, and oncologists, and hope to develop tools to support conversation surrounding decision-making and ultimately improving outcomes in this population. identifier: NCT04625413
PI: Kah Poh (Melissa) Loh

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Decreasing Polypharmacy in Older Adults with Curable Cancers

Polypharmacy (PP), or the concurrent use of multiple medications, affects up to 92% of older adults with cancer. “Deprescribing,” or the planned discontinuation of medications has not been studied in older adults with cancer receiving chemotherapy. This proposal builds upon the prior work demonstrating that PP is prevalent in older adults receiving chemotherapy and that a pharmacist-led deprescribing intervention is feasible to implement in an oncology clinic with high patient satisfaction. The proposal describes a comprehensive mentorship and training plan to develop complementary skills in clinical trial design, implementation science, and data science (encompassing informatics and statistics).

RSRB Number: UMLT19186
PI: Erika Ramsdale

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Nutraceutical Interventions to treat frailty in older adults with cancer

Frailty, an aging-related clinical syndrome associated with low physiologic reserve, is a significant problem for older adults with cancer. Inflammation is a major contributor to frailty and a predictor of post-treatment frailty in patients with cancer. Due to the strong association between inflammation and frailty, interventions aimed at reducing inflammation may ultimately reduce frailty and improve post-treatment outcomes for older adults with cancer.Epigallocatechin-3-gallate (EGCG), the major catechin in green tea, is a promising intervention for frailty. Numerous studies are evaluating non-steroidal anti-inflammatory drugs to treat cancer-related toxicities, but its long-term use is contraindicated in older adults. Thus, anti-inflammatory agents with low toxicity risk to treat frailty in older survivors are needed. EGCG is a tolerable anti-inflammatory dietary supplement and is a promising intervention for frailty but has not been systematically studied. We are investigating the safety, feasibility, and efficacy for EGCG on reducing frailty and immune responses in older survivors of cancer.

Funding: National Institute of Health, University of Rochester Clinical and Translational Science Award identifier: NCT04553666 
PI: Nikesha Gilmore

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Mitigating Cancer-Related Cognitive Impairment in Older Adults with Breast Cancer Receiving Chemotherapy: Memory and Attention Adaptation Training-Geriatrics (MAAT-G)

Cancer-related cognitive dysfunction (CRCD) affects up to 75% of patients receiving cancer treatment and can create difficulties in attention, processing speed, executive function, and memory. Older adults are at greater risk of developing CRCD, which can compromise their functional independence and quality of life. Memory and Attention Adaptation Training (MAAT) is a promising treatment for CRCD that has shown to improve self-perceived cognition, verbal memory, and processing speed in younger cancer survivors. By adapting MAAT to address the unique needs of older adults, we hope to mitigate the development of CRCD (during systemic cancer treatment when risk is highest) and CRCD-related effects on functional independence for older adults with breast cancer.

Funding: National Institute of Aging

Relevant studies: NCT04230941
PI: Allison Magnuson

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Specialized Oncology Care and Research for the Elders (SOCARE) research database

The Wilmot Cancer Institute has one of the largest geriatric oncology programs in the United States. The SOCARE clinic is staffed by a multidisciplinary team that includes nursing, social work, cognitive specialists, occupational therapy, and physical therap.  Older patients referred to the SOCARE clinic undergo a comprehensive geriatric assessment. Information generated are stored in a database and it serves as a resource for investigators to study research questions in geriatric oncology. We have used this resource to understand physical function, sarcopenia, sleep disturbance, and symptom burden in older adults with cancer.

PI: Kah Poh (Melissa) Loh

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Advance care planning in older adults with hematologic malignancies

Compared to patients with solid tumors, those with hematologic malignancies are more likely to utilize visit the emergency department, be hospitalized, be admitted to intensive care unit, and to receive life-sustaining treatment, transfusions, and chemotherapy at the end-of-life. In addition, they are less likely to complete advance care planning in a timely fashion, less likely to receive palliative care and hospice services, and more likely to die in the hospital. We are interested in developing and adapting interventions promote early advance care planning. To improve access to advance care planning, we are studying the use of telehealth to facilitate conversation about advance care planning and promote care that is concordant with patients’ wishes and goals.

Funding: Cancer and Aging Research Group/National Institute of Aging identifier: NCT04745676
PI: Kah Poh (Melissa) Loh

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Geriatric Assessment Intervention for Reducing Toxicity in Older Patients with Advanced Cancer (GAP-70+)

Geriatric assessment (GA) evaluates aging-related domains associated with cancer treatment toxicity. In this cluster randomized clinical trial, we examined if a GA intervention can reduce serious toxicity. From 2014-19, we enrolled 718 patients aged > 70 with incurable solid tumors or lymphoma and > one impaired GA domain from 40 clusters. A GA intervention reduced serious toxicity from palliative cancer treatment and improved geriatric outcomes, without compromising OS.

Funding: R01CA177592UG1CA189961 identifier: NCT02054741
PI: Supriya G. Mohile

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Improving Communication in Older Cancer Patients and Their Caregivers (COACH)

Older patients with cancer and their caregivers worry about the effects of cancer treatment on aging-related domains (eg, function and cognition). Quality conversations with oncologists about aging-related concerns could improve patient-centered outcomes. This cluster-randomized clinical trial enrolled 541 participants and 414 caregivers from 31 community oncology practices. Including GA in oncology clinical visits for older adults with advanced cancer improves patient-centered and caregiver-centered communication about aging-related concerns.

Funding: PCORI CD-12-11-4634 identifier: NCT02107443
PI: Supriya G. Mohile

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Development of a Personalized Discussion Prioritization Tool for Older Adults Considering Adjuvant Chemotherapy for Breast Cancer

Patient goals and preferences are an important component in developing treatment plans for early stage breast cancer. With this in mind, we have developed a Discussion Prioritization Tool (DPT) for older adults considering adjuvant chemotherapy that utilizes Conjoint Analysis (CA) methodology. The objective of the study is to assess the usability of this DPT in older adults considering treatment options for early stage breast cancer and to adapt the tool to optimize usability for our target population.

PI: Allison Magnuson