Reducing Disability in Older Adult Cancer Survivors

Therapuetic Areas:Oncology
Age Range:65 - Any
Start Date:February 2013
End Date:June 2016

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A Phase I Randomized Controlled Trial of a Problem-solving Occupational Therapy Intervention for Older Adult Cancer Survivors

Older adults who are treated for cancer are at risk of developing disabilities due to the
symptoms of cancer and the side effects of treatment. Disability occurs when a person has
trouble performing the activities he or she needs to do in everyday life. For example,
fatigue and pain can make it difficult for an older adult to do housework, leisure, or
volunteer activities. Disability makes it harder for older adults to stay active and be
productive members of the community, and it can increase the costs of healthcare.

Current approaches to cancer rehabilitation focus on using exercise, education, and social
support to reduce cancer treatment side effects. These are important strategies to reduce
disability, yet some side effects persist despite best efforts to resolve them. To fully
reduce disability, people often need to adapt their activities or the environments in which
they are performed.

The goal of this study is to test an occupational therapy (OT) intervention that teaches
activity planning skills to foster survivors' ability to adapt activities, routines, and
environments in order to minimize disability. The project targets adults over the age of 65
who are experiencing disability during or after cancer treatment. The project has two stages.
First, twelve older adult cancer survivors will individually participate in the
community-based intervention. After they have completed the program the investigators will
revise the intervention to emphasize what they found most effective and helpful, and to
eliminate aspects of the intervention that are perceived as unhelpful or redundant. The
research question for this first stage of the project is, "To what degree is it feasible for
survivors to enroll in the study, complete the six-week intervention, and complete the three
outcome assessments?" In the second stage of the project, the investigators will test the
revised intervention, comparing it to conventional care. The research question for the second
stage of the project is, "Do the people receiving the intervention have higher activity
levels, greater behavioral activation, lower levels of disability, and better quality of life
compared to those people who receive traditional cancer care?" The intervention is
appropriate for people who have been diagnosed with any type of cancer. It is designed to
focus on whatever activities are most important to each participant. The novelty of the
proposed intervention lies in the combination of the OT strategies of activity and
environmental adaptation with explicit training in activity planning to teach survivors to
find creative ways to engage in valued activities (e.g., taking care of one's home and family
members, and participating in leisure, community, social and work activities). If the
intervention is effective in reducing disability, it will give us another tool to reduce the
impact of cancer on the daily lives of cancer survivors.

Inclusion Criteria

1. Age 65 years or older.

2. Experiencing disability as indicated by a score of > 3 on the Vulnerable Elders Survey
or an answer of "yes" to the question "Do health problems interfere with your ability
to carry out your social or day to day activities?"

3. Either: a. Diagnosed with any solid or hematological cancer, undergoing treatment for
curative intent or within six months of completion of therapy with absence of disease
recurrence; or b.Diagnosed with metastatic breast cancer or chronic hematologic
malignancies with a life expectancy of > 2 years

Exclusion Criteria

1. Moderate or worse cognitive impairment as indicated by a score of 3 or less on the
Callahan six-item cognitive screening tool.

2. Medical record documentation of severe mental illness (i.e., schizophrenia or bipolar
disorder), active suicidal ideation, or active substance use disorder.
We found this trial at
1 Medical Center Dr
Lebanon, New Hampshire 03756
 (603) 650-5000
Principal Investigator: Kathleen D Lyons, ScD
Phone: 603-653-9128
Dartmouth Hitchcock Medical Center Dartmouth-Hitchcock is a national leader in patient-centered health care and building...
Lebanon, NH
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