Pilots

The Claude D. Pepper Older Americans Independence Center develops pilot projects at the Icahn School of Medicine at Mount Sinai to inform future research on illness and palliative care that will best serve our aging population.

Project 1: Describing treatment-related symptom burden and determining patient- and provider-level factors associated with palliative care referral in older patients with advanced cancer undergoing palliative radiation therapy

Principal Investigator: Kavita V. Dharmarajan, MD, MSc, Assistant Professor, Radiation Oncology and Palliative Medicine Department of Radiation Oncology, Mount Sinai Hospital

Abstract: Palliative radiation treatment (RT) is commonly used in the setting of advanced cancer to alleviate cancer-related symptoms, improve function, and allow better quality of life. It may, however, also be associated with temporary periods of worsened symptoms as a result of acute treatment-related side effects. This may be particularly challenging in older patients leading to a higher number of emergency department (ED)visits, hospitalizations, and decreased quality of life. Access to palliative care resources within the timeframe of acute symptom development may add a layer of support that helps lesson the burden of symptoms related to palliative RT in these individuals, yet little is known about the characteristics and severity of symptoms experienced among older patients shortly after treatment or the current referral patterns to palliative care. In this proposal, we outline a descriptive pilot study to ascertain the burden of symptoms leading to ED visits and hospitalizations among older patients after a course of palliative RT, as well as the factors impacting referral to palliative care services among these patients. Findings from these projects will inform future work that leads to designing and testing pilot interventions, in the context of NIH-funded K23 and later R01 trials, which lead to better quality of life of older patients with advanced cancer receiving palliative RT. Our goal is to become independent clinician-investigators at the intersection of aging, palliative care, and radiation oncology whose work improves the lives of older, advanced cancer patients undergoing palliative RT.

Project 2: Palliative Care for Patients with Hepatocellular Carcinoma

Principal Investigator: Christopher Woodrell,MD, Brookdale Department of Geriatrics and Palliative Medicine

Abstract: The specific palliative care needs of patients with end-stage liver disease have not been well described. Patients with hepatocellular carcinoma (HCC) are an important subgroup of this population, as HCC is difficult to treat, carries a high rate of mortality, and has a rapidly rising incidence. Because most of these patients also have cirrhosis, the disease trajectory is difficult to predict. Further studies are needed to design models of care to meet the unique palliative care needs of this population. The Mount Sinai Hospital, with a robust palliative care service and the largest HCC program in the country, provides the ideal platform to carry out this study. A secondary analysis of clinical databases will be performed to determine which HCC patients were seen by palliative care and the demographic and disease severity characteristics associated with a palliative care consult. Rates of healthcare utilization will be measured for HCC patients who received an inpatient palliative care consult and for a matched group of patients who did not. Hospital readmission, intensive care unit admission, and emergency department visits will be measured at 30 days for comparison. This pilot study will aid in the design of a future prospective palliative care intervention for HCC patients. The work will be accompanied by career development activities, including mentorship and focused coursework, to facilitate the principal investigator’s development as an independent researcher.