Mitigating Physical Function Decline in Older Adults with Gastroesophageal Cancer

PROJECT SUMMARY/ABSTRACT Older adults with gastroesophageal cancer (GEC) face a significant challenge: treatments that extend life can come at the cost of reduced physical function, which can diminish independence and quality of life. Indeed, GEC treatments are often aggressive, involving systemic chemotherapy, chemoradiotherapy, and/or immunotherapy, which can be particularly taxing on older patients. There is a pressing need to understand how these treatments affect key outcomes like physical function to better support this vulnerable population. Despite this, no study has prospectively evaluated how GEC treatments affect physical function or identified risk factors for decline. Moreover, no study has explored the lived experiences of older adults undergoing these grueling treatments, the challenges the older patient faces in maintaining physical function during treatment, or their perceptions of whether treatment was worthwhile upon completion. This study aims to fill these critical gaps by prospectively evaluating how GEC treatments impact physical function in older adults, identifying the barriers and facilitators for maintaining function during treatment, and eliciting patient perceptions of treatment worthwhileness. To do this, I will conduct a prospective cohort study of older adults (aged ≥60 years) with GEC starting systemic treatment (i.e., chemotherapy, chemoradiotherapy, and/or immunotherapy). Participants will undergo serial geriatric assessment prior to starting treatment (baseline) and at 2, 4, and 6 months, which will include measures of physical, cognitive, and psychological function. The primary outcome will be the change in physical function, measured using the Short Physical Performance Battery, from baseline to 6 months. Secondary outcomes will include change in other measures of physical (grip strength, TUG, ADL/iADL), cognitive, and psychological function as well as frailty. The change in these measures will also be evaluated from baseline to 2 and 4 months. Additionally, I will perform a qualitive sub-study, where I will invite 20-30 participants, using stratified sampling, to participate in semi-structured interviews at baseline and 6 months to explore how treatment affected their function and elicit treatment worthwhileness. Aim 1 will assess the patterns and determinants of physical function decline. Aim 2 will explore the barriers and facilitators of maintaining physical function, focusing on motivation and prioritization of health. An Exploratory Aim will capture patients’ reflections on the worthwhileness of treatment, particularly in relation to its impact on function. By the end of this study, I will generate both quantitative and qualitative data to offer a comprehensive understanding of how GEC treatments affect physical function in older adults. These findings will not only inform personalized, patient-centered treatment decisions but could also guide the development of targeted interventions aimed at optimizing care for this vulnerable population. Ultimately, this work will provide the foundation for my NIA K76 application to pilot test a rehabilitation intervention designed to help older adults with GEC maintain physical function during and after systemic treatment, shifting our focus in oncology from survival alone to ensuring that patients can live robust lives after treatment.