Predicting trajectories of function, cognition, and quality of life among older adults with advanced lung cancer - PROJECT SUMMARY/ABSTRACT Older adults with non-small cell lung cancer (NSCLC), the leading cause of cancer mortality, are at increased risk for treatment toxicity, which can lead to impairments in physical function, cognition, and quality of life (QOL). Maintaining function, cognition, and QOL is critically important to older adults with cancer, especially as they are living longer with advanced cancer where toxicity is often cumulative. Older adults with advanced NSCLC currently lack vital information about how systemic treatment will affect these patient- centered survivorship outcomes that they need to make informed decisions about their cancer care. The overarching goal of this proposal is to develop and validate prediction models for trajectories of function (Aim 1), cognition (Aim 2), and QOL (Aim 3) among adults aged >65 with advanced NSCLC during up to 6 months of chemotherapy and/or immunotherapy with non-curative intent. These outcomes were selected by older cancer patient stakeholders based on which outcomes matter most to them. This proposal builds directly upon our ongoing observational cohort study of older adults with advanced NSCLC starting a new systemic therapy (130 patients received chemotherapy and/or immunotherapy). Our preliminary work suggested distinct groups of trajectories for function (instrumental activities of daily livings, life-space mobility, Short Physical Performance Battery), cognition (Montreal Cognitive Assessment, which is sensitive to change in this population), and QOL (EORTC QLQ-C30). To further assess memory and executive function, we piloted the addition of two tablet-based cognitive assessments, Favorites and Match. We now propose to conduct the largest prospective comprehensive evaluation of older adults with advanced NSCLC through a Cancer and Aging Research Group collaboration between Kaiser Permanente Northern California, Ohio State University, and University of Rochester. Together, we will recruit an additional 714 older adults with advanced NSCLC for a total sample of 844 (estimated 700 evaluable patients; the first 400 for the development cohort, the last 300 for the validation cohort). Participants will complete serial geriatric assessments prior to treatment initiation and at 1, 2, 4, and 6 months (or until treatment discontinuation, whichever occurs earlier). Our uniquely qualified multidisciplinary team has significant expertise in geriatric oncology, geriatrics, rehabilitation science, neuropsychology, epidemiology, palliative medicine, and biostatistics and includes two patient and caregiver stakeholder boards. This study will provide generalizable evidence to predict individualized trajectories for important patient- centered outcomes that oncologists can use to a) describe how a recommended NSCLC treatment will likely impact an older adult’s function, cognition, and/or QOL depending on which outcomes are most important to the patient and b) compare outcomes for different options during shared decision making. With this information, older adults with NSCLC and oncologists can optimize supportive care for those at highest risk.
