Cancer and Aging: Reflections for Elders (CARE): A pilot randomized controlled trial of a psychotherapy intervention for older adults with cancer.

OBJECTIVE: Cancer and Aging: Reflections for Elders (CARE) is a novel, telephone-delivered intervention designed to alleviate distress in older cancer patients. This pilot randomized controlled trial tested the feasibility and initial efficacy of CARE, drawing from age-appropriate developmental themes and well-established coping theory. METHOD: Eligible patients were ≥70 years old; ≥6 months post-diagnosis of lung, prostate, breast, lymphoma, or gynecological cancer; on active cancer treatment or within 6 months of ending cancer treatment; and had elevated scores on the Distress Thermometer (≥4) or Hospital Anxiety and Depression Scale (≥6). Participants completed five sessions of psychotherapy over 7 weeks with assessments at study entry, post-intervention, and 2 months post-intervention. Primary outcomes were feasibility and initial efficacy on anxiety and depression; secondary outcomes included demoralization, coping, loneliness, and spiritual well-being. RESULTS: Fifty-nine participants were randomized to either the CARE arm (n = 31) or the enhanced Social Work Control arm (n = 28). The intervention was feasible and tolerable, meeting a priori criteria for rates of eligibility, acceptance, retention, assessment, and treatment fidelity. Upon completion of the intervention, participants in the CARE arm demonstrated lower mean depression scores (d = 0.58 [CI: 0.04-1.12], P = 0.01) and trended towards increased coping-planning (d = 0.30 [CI: -0.83 to 0.24], P = 0.18). Promising trends in anxiety (d = 0.41 [CI: -0.17 to 0.98], P = 0.10) emerged at 2 months post-intervention; effects for coping-planning dissipated. CONCLUSION: These pilot data suggest the CARE intervention is feasibly delivered, potentially impacts important psychosocial variables, and is accessible for older, frail patients with cancer. Future research will evaluate this intervention on a larger scale.

Developing a multidisciplinary geriatric oncology program in a community cancer center.

Cancer is a disease of older adults, and with unprecedented growth in the number of people entering late adulthood, an increasing need exists for specialized services and programs to address the needs of older adults with cancer. Few examples in the literature detail development of a geriatric oncology program. This article describes a pilot project undertaken by a community cancer center to develop a specialized program for older adults with cancer by identifying local demographics and population needs. It also describes a replicable plan for the development of a geriatric oncology program, which demonstrates how nursing can benefit from collaboration with other disciplines such as social work and psychology in service provision.

Chemotherapy follow-up in older adults: results of a quality-improvement project.

Caring for older adults with cancer receiving chemotherapy may present a number of challenges. Complications from chemotherapy are more common among older patients, and prevention and early detection of toxicities can improve treatment adherence, decrease costs, and improve treatment outcomes in this population. Over 12 months, 18 older adults with cancer (aged 65 years or older) participated in a quality-improvement project that provided telephone follow-up and intervention after chemotherapy administration; first-time chemotherapy recipients received telephone calls that followed assessment and referral guidelines over 10 days. Several characteristics of patients with increased toxicity were noted, including poor functional status, limited support at home, and significant comorbid disease. Recommendations for identifying patients at high risk are included so that services may be targeted for the most appropriate use of resources.