Study design and methods for the physical activity index (PAI) feasibility pilot trial for breast and colon cancer survivors in North Carolina.

The majority of the 18 million US adults with cancer history ("survivors") do not meet recommendations for obtaining regular physical activity (PA) or limiting sedentary behavior in their daily lives. Breast cancer survivors (BCS) and colon cancer survivors (CCS) are particularly at risk of insufficient PA and excessive sedentary behavior (i.e.

Frailty phenotype state transitions among older adults with a history of cancer and diabetes.

Background: Frailty is a multi-faceted, aging-related syndrome characterized by reduced physiologic reserve and increased vulnerability to adverse health outcomes. Frailty is dynamic and can improve or worsen over time. Cancer and diabetes are prevalent comorbid conditions in older adults that are independently associated with frailty.

Pilot study of an inpatient physical activity intervention for older adults treated intensively for acute myeloid leukemia.

Interventions to maintain physical function during treatment may improve outcomes for older adults with AML. We tested the feasibility of a randomized physical activity (PA) intervention among older adults (aged ≥60y) receiving induction chemotherapy for newly diagnosed AML and estimated the effect on physical function, quality of life (QOL) and symptoms. Intervention participants were offered PA sessions five days/week tailored daily to symptoms during the induction hospitalization coupled with weekly behavioral counseling sessions that continued monthly by phone for 6 months.

Patient-reported pain severity is associated with shorter survival in older adults with newly diagnosed cancer.

Purpose: Pain is a prevalent and often undertreated symptom among older adults with cancer. This study examined whether self-reported pain levels are associated with overall survival (OS) in older adults newly diagnosed with cancer receiving chemotherapy.

Methods: This retrospective cohort study included patients aged ≥ 65 years with newly diagnosed lung, colorectal, or breast cancer between 2017 and 2020, identified via a cancer registry at an academic medical center.

Racial disparities in longitudinal frailty state transitions among older cancer survivors.

Introduction: Black older patients with cancer are at high risk of frailty during cancer treatment, yet racial disparities in long-term frailty state transitions during the survivorship phase are understudied.

Materials And Methods: We conducted a longitudinal analysis of older cancer survivors (≥65 years) using rounds 1-9 (2011-2019) of the National Health and Aging Trends Study. A multistate Markov model assessed one-year transitions across Fried frailty phenotypes states (robust, prefrail, frail) and death, stratified by self-reported race (Black vs.

Impact of comorbidity on immune-related adverse events and survival in older cancer patients treated with immunotherapy.

Background: Nearly half of patients with cancer are diagnosed at 70 years or older, which presents challenges in cancer care due to their high comorbidity burden and the underrepresentation of this age group in clinical trials. This retrospective study evaluated the association between comorbidity burden and immune checkpoint inhibitors (ICIs) treatment outcomes among older adults.

Methods: Data were collected from patients aged 70 years or older at the time of diagnosis who were treated with ICIs from 2011 to 2022.

Frailty Trajectories Following Adjuvant Chemotherapy and Mortality in Older Women With Breast Cancer.

Importance: Frailty assessed at a single time point is associated with mortality in older women with breast cancer. Little is known about how changes in frailty following cancer treatment initiation affect mortality.

Objective: To evaluate the association between claims-based frailty trajectories following adjuvant chemotherapy initiation and 5-year mortality in older women with stage I to III breast cancer.

Proceedings of the Alzheimer's Diagnosis in Older Adults With Chronic Conditions Network Inaugural Annual Conference.

The Alzheimer's Disease in Older Adults with Chronic Conditions (ADACC) Network is funded by the National Institute on Aging as a U24 cooperative agreement. ADACC is an inclusive, multidisciplinary group across multiple institutions that is charged with the task of developing evidence-based strategies for the use and implementation of Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) biomarkers among older adults with cognitive impairment and multiple chronic conditions (MCCs). This report summarizes highlights of the First Annual Symposium of ADACC, which was held in Winston-Salem, North Carolina, in April 2024.

Oncology Provider and Patient Perspectives on a Cardiovascular Health Assessment Tool Used During Posttreatment Survivorship Care in Community Oncology (Results from WF-1804CD): Mixed Methods Observational Study.

Background: Most survivors of cancer have multiple cardiovascular risk factors, increasing their risk of poor cardiovascular and cancer outcomes. The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association's Life's Simple 7 cardiovascular health metrics to promote cardiovascular health assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors.

Protocol of a decisional intervention for older adults with newly diagnosed acute myeloid leukemia and their caregivers: UR-GOAL 3.

Introduction: Therapeutic advances have allowed more adults aged ≥60 years with acute myeloid leukemia (AML) to receive life-prolonging treatments, with improvement in overall survival. In contrast to other cancers, the onset of AML is often sudden, high-risk treatment decisions must be made quickly, and survival is often compromised due to aging-related conditions (e.g.

Effectiveness of a Cardiovascular Health Electronic Health Record Application for Cancer Survivors in Community Oncology Practice: Results From WF-1804CD.

Purpose: Guidelines recommend cardiovascular (CV) risk assessment and counseling for cancer survivors. This study evaluated the automated heart-health assessment (AH-HA) clinical decision support tool to promote provider-patient CV health (CVH) discussions in outpatient oncology.

Methods: The AH-HA trial (WF-1804CD), coordinated by the Wake Forest National Cancer Institute Community Oncology Research Program Research Base, randomized practices to the AH-HA tool or usual care (UC) and enrolled survivors receiving routine care ≥6 months after curative cancer treatment.

Big Data for Geriatric Oncology Research.

Cancer is the second leading cause of death in North Carolina and approximately half of cancers are diagnosed in older adults (≥65 years). Cancer clinical trials in older adults are limited and there is a lack of evidence on optimal care strategies in this population. We highlight how big data can fill in gaps in geriatric oncology research.

Geriatric assessment for the practicing clinician: The why, what, and how.

Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.

The impact of non- and anthracycline-based chemotherapy on fatigue in breast cancer survivors: results from WF-97415.

Purpose: To examine the differential effect of non- and anthracycline-based chemotherapy on fatigue over 12 months post-diagnosis among breast cancer survivors.

Methods: This study is based on a prospective Wake Forest NCI Community Oncology Research Program (NCORP) multicenter cohort study (WF-97415) of women with stage I to III breast cancer and non-cancer controls. Analyses compared those: 1) receiving, or 2) not receiving anthracycline chemotherapy, 3) receiving aromatase inhibitors (AIs) without chemotherapy, with 4) a comparator group without a history of cancer.

The relationship between body composition and left ventricular performance in women with breast, lymphoma, or sarcoma cancer.

Background: To understand how body composition in those with elevated body mass index impacts left ventricular function decline during cancer treatment, we determined the association between baseline body mass index (BMI), intra-abdominal adipose tissue (IAT) and subcutaneous adipose tissue (SAT) with baseline to 3-month left ventricular ejection fraction (LVEF) change among women receiving potentially cardiotoxic chemotherapy for breast cancer, lymphoma, or sarcoma.

Methods: Women underwent potentially cardiotoxic chemotherapy, such as doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab, for treatment of breast cancer, lymphoma, or sarcoma. We obtained magnetic resonance images (MRIs) of body composition and cardiac function prior to treatment, and then a repeat MRI for cardiac function assessment at three months into treatment.

Phase III Randomized, Placebo-Controlled Clinical Trial of Donepezil for Treatment of Cognitive Impairment in Breast Cancer Survivors After Adjuvant Chemotherapy (WF-97116).

Purpose: To test efficacy of donepezil, a cognitive enhancer, to improve memory in breast cancer survivors who report cancer-related cognitive impairment 1-5 years postchemotherapy.

Patients And Methods: Adult female BCS exposed to ≥4 cycles of adjuvant chemotherapy 1-5 years before enrollment who reported cancer-related cognitive impairment were eligible. Participants, enrolled at sites affiliated with the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base, were randomly assigned to receive 5 mg of donepezil once daily for 6 weeks titrated to 10 mg once daily for 18 weeks or placebo.

Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study.

Purpose: This study aimed to assess whether physical functional decline in older women with early-stage breast cancer is driven by cancer, chemotherapy, or a combination of both.

Methods: We prospectively sampled three groups of women aged ≥ 65: 444 with early-stage breast cancer receiving chemotherapy (BC Chemo), 98 with early-stage breast cancer not receiving chemotherapy (BC Control), and 100 non-cancer controls (NC Control). Physical function was assessed at two timepoints (T1 [baseline] and T2 [3, 4, or 6 months]) using the Physical Functioning Subscale (PF-10) of the RAND 36-item Short Form.

A scoping review of racial, ethnic, socioeconomic, and geographic disparities in the outcomes of older adults with cancer.

Introduction: Cancer health disparities are widespread. Nevertheless, the disparities in outcomes among diverse survivors of cancer ages 65 years and older ("older") have not been systematically evaluated.

Methods: We conducted a scoping review of original research articles published between January 2016 and September 2023 and indexed in Medline (Ovid), Embase, Scopus, and CINAHL databases.

Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives.

Background: Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We aimed to (1) Assess survivor CVH profiles, (2) compare self-reported and EHR-based categorization of CVH factors, and (3) describe perceptions regarding addressing CVH during oncology encounters.

Exercise and inflammatory cytokine regulation among older adults with myeloid malignancies.

Tumor necrosis factor (TNF)α is a major regulator of inflammation. However, the epigenetic regulation of TNFα in the context of an exercise intervention among older adults with cancer is understudied. In this exploratory analysis, we used data from a single-arm mobile health (mHealth) exercise intervention among older adults with myeloid malignancies to 1) assess changes in TNFα promoter methylation, TNFα mRNA expression, serum TNFα and other related-cytokine levels after intervention; and 2) assess correlations between blood markers and exercise levels.

Strategies to Assess and Manage Frailty among Patients Diagnosed with Primary Malignant Brain Tumors.

Frailty refers to a biologic process that results in reduced physiologic and functional reserve. Patients diagnosed with primary malignant brain tumors experience high symptom burden from tumor and tumor-directed treatments that, coupled with previous comorbidities, may contribute to frailty. Within the primary malignant brain tumor population, frailty is known to associate with mortality, higher healthcare utilization, and increased risk of postoperative complications.

Determining treatment tolerance and fitness for intensive chemotherapy in older adults with AML: a call to action.

Determining fitness for intensive chemotherapy in an older adult with acute myeloid leukemia (AML) is an unanswered age-old question. Geriatric assessment captures any variation in multidimensional health, which can influence treatment tolerance. A prospective study is necessary to validate fitness criteria, determine whether geriatric assessment-based fitness performs superiorly to other criteria, and what components of geriatric assessment are associated with treatment tolerance.

Geriatric Assessment in Acute Myeloid Leukemia.

Background: Acute myeloid leukemia (AML) is a heterogenous disease that affects mostly older adults with varying baseline health and functional status. Treatment options have expanded for older adults, ranging from less intensive chronic therapies to intensive induction strategies with curative intent. Despite this, outcomes remain poor with advancing age due to underlying disease biology and variability in treatment tolerance.