Gaps in nutritional research among older adults with cancer

Abstract

Nutritional issues among older adults with cancer are an understudied area of research despite significant prognostic implications for treatment side effects, cancer-specific mortality, and overall survival. In May of 2015, the National Cancer Institute and the National Institute on Aging co-sponsored a conference focused on future directions in geriatric oncology research. Nutritional research among older adults with cancer was highlighted as a major area of concern as most nutritional cancer research has been conducted among younger adults, with limited evidence to guide the care of nutritional issues among older adults with cancer. Cancer diagnoses among older adults are increasing, and the care of the older adult with cancer is complicated due to multimorbidity, heterogeneous functional status, polypharmacy, deficits in cognitive and mental health, and several other non-cancer factors. Due to this complexity, nutritional needs are dynamic, multifaceted, and dependent on the clinical scenario. This manuscript outlines the proceedings of this conference including knowledge gaps and recommendations for future nutritional research among older adults with cancer. Three common clinical scenarios encountered by oncologists include (1) weight loss during anti-cancer therapy, (2) malnutrition during advanced disease, and (3) obesity during survivorship. In this manuscript, we provide a brief overview of relevant cancer literature within these three areas, knowledge gaps that exist, and recommendations for future research.

Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer

“…Finally, participants reporting appetite loss at baseline were less likely to be resilient. Poor appetite could be a marker of malnutrition risk and depression, which in turn have been found to be associated with worse functional status and QOL in older adults …”

“…Poor appetite could be a marker of malnutrition risk and depression, which in turn have been found to be associated with worse functional status and QOL in older adults. [33][34][35] The significance of functional limitations and lack of resilience in older adults highlights the importance of designing and evaluating interventions for those at risk. Randomized studies in older (65) cancer survivors have focused on the benefits of home-based diet and exercise programs.…”

Engaging older patients with cancer and their caregivers as partners in cancer research

“…Seven SCOREboard members were funded by the U13 grant to attend the 2015 conference entitled "Design and Implementation of Intervention Studies to Maintain or Improve the Quality of Survival of Older and/or Frail Adults with Cancer" and served as coauthors on 7 articles. [15][16][17][18][19][20][21] At this meeting, SCOREboard members also helped to guide future research priorities in the field of geriatric oncology.…”

“…The overarching mission of the conferences was: to provide a forum for a multidisciplinary team of investigators in geriatrics and oncology to review the present level of evidence in geriatric oncology, identify areas of highest research priority, and develop research approaches to improve clinical care for older adults with cancer within the next ten years. Seven SCOREboard members were funded by the U13 grant to attend the 2015 conference entitled “Design and Implementation of Intervention Studies to Maintain or Improve the Quality of Survival of Older and/or Frail Adults with Cancer” and served as coauthors on 7 articles . At this meeting, SCOREboard members also helped to guide future research priorities in the field of geriatric oncology.…”

Lessons Learned from Arti—Collaborating to Improve Care: the Past, Present, and Future of the Cancer and Aging Research Group

“…We led a U13 grant (U13 AG038151), in close collaboration with the National Institute of Aging (NIA), the National Cancer Institute (NCI), and other major organizations (AGS, Gerontological Society of America, and the Alliance), which coordinated three research conferences composed of top leaders at the interface of aging and cancer research. The resulting series of 16 articles, including 4 major white papers, summarized the essential research priorities in geriatric oncology and identified that a coordinated research infrastructure and expertise to develop and prioritize these studies was desperately needed (Table ) . We also collaborated as principal investigators and coinvestigators on several other grants from the Patient‐Centered Outcomes Research Institute (PCORI), NCI, and NIA; hosted several conferences, bringing national leaders together; and coauthored dozens of other articles together.…”