Table 3. Research Gaps and Mechanisms to Close the Gaps *.
| Research Priority | Research Gaps | Mechanisms to Close the Gaps |
|---|---|---|
| Function | Which specific pre-treatment functional measures best predict toxicity to cancer treatment? | Capture measures of function prior to starting treatment |
| How can we develop interventions to improve outcomes in patients with functional impairment? | Develop and test interventions (mobility, fall prevention, and exercise) tailored for older patients with cancer | |
| How do specific cancers and treatment regimens influence long-term functional outcomes? | Capture measures of function longitudinally after or during treatment | |
| Comorbidity | How do specific comorbidities and their interactions influence cancer treatment toxicity, cancer outcomes, survivorship? | Capture changes in comorbidity over the course of treatment and in survivorship period |
| How do we estimate life expectancy in older patients with cancer and comorbidities, with or without cancer treatment? | Develop and test measures of remaining life expectancy prospectively in patients with cancer and comorbidities who are and who are not receiving treatment | |
| How do we develop and successfully complete clinical trials for patients with comorbidities? | Consider alternate trials designs such as pragmatic and extended trial designs | |
| Polypharmacy | How can we identify polypharmacy and measure risk of adverse events due to drug interactions, including chemotherapy, in older cancer patients? | Include older patients in early phase clinical trials and capture medication changes over the course of study in order to determine relationships with toxicity |
| How do we tailor medication lists to best reduce risk in older patients receiving treatment for cancer? | Develop and test interventions incorporating pharmacists and that offer care coordination with primary care | |
| Cognition | How should we assess cognition and decision-making capacity for oncology clinical trials? | Evaluate utility of cognitive measures for identifying patients at high risk for cancer treatment |
| What are the side effects of cancer treatment in older patients with cognitive impairment? | Capture measures of cognition before initiation of treatment and follow outcomes in prospective, observational cohort studies | |
| Psychological Status | How does depression/anxiety affect treatment choices and compliance in cancer patients? | Examine the impact of depression and anxiety in decision-making for treatment and medication compliance |
| Are there interventions that could help patients and caregivers with depression/anxiety or fear of cancer recrurrence? | Develop and test multidisciplinary interventions to intervene on depression/anxiety and fear of recurrence in older patients with cancer and their caregivers | |
| Nutritional Status | How does nutritional status and weight loss affect prognosis in older patients? | Examine the effects of nutritional status on outcomes, including efficacy and safety of cancer treatment, in older patients |
| Are there supportive care interventions that could help mediate nutritional problems in older patients with cancer? | Develop and test nutritional interventions tailored for older patients with cancer | |
| Social Support | How does the perceived quality of social support relate to treatment practice patterns in older adults with cancer? | Examine the perceived quality of social support as a predictor of treatment practice patterns and outcomes |
| Can infrastructure be strengthened to address social support issues of older cancer patients and caregivers? | Test the efficacy of clinical teams (including social work, care managers, or navigators) for assisting older patients with cancer and their caregivers |
*
Updated from Dale et al. JNCI, 20115