# Advancing patient-centered decision making in older adults with lung cancer: Incorporating risk of functional decline into treatment discussions

> **NIH NIH K76** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $242,992

## Abstract

PROJECT SUMMARY/ABSTRACT
This is a Beeson K76 career development award for Dr. Melisa Wong, a thoracic oncology clinician-
investigator dually trained in medical oncology and aging research. Dr. Wong’s long-term goal is to become a
national leader in geriatric oncology research, improving cancer care for older adults by aligning treatments
with individualized patient goals. More than 72% of older adults with cancer report that they would not choose
a treatment that results in functional impairment, even if it improves survival. Yet, oncologists traditionally make
treatment decisions based on cancer characteristics, often without discussing how treatment might affect
function or eliciting patients’ goals and values. To move from cancer-centered to patient-centered decision
making, oncologists must both predict which older adults are at highest risk for functional decline and
communicate complex information about benefits and harms to patients in a way that aligns treatments with
their goals for function, quality of life, longevity, and other priorities. This proposal aims to 1) identify risk factors
for functional decline in daily activities, physical performance, and life-space mobility during chemotherapy
and/or immunotherapy in older adults with metastatic lung cancer; 2A) adapt the Best Case/Worst Case
(BC/WC) communication tool; and 2B) test its feasibility for use during treatment discussions with older adults
with lung cancer. In Aim 1’s multi-site cohort study, patients age 65 and older with metastatic lung cancer will
undergo serial geriatric assessments to measure functional status during chemotherapy and/or
immunotherapy. In Aim 2A’s focus group study, older adults with lung cancer, caregivers, and oncologists will
participate in focus groups to elicit feedback aimed at adapting the BC/WC tool to incorporate function and
other patient priorities into patient-centered decision making. In Aim 2B’s pre-post pilot study, oncologists will
be trained to use the adapted BC/WC tool; treatment discussions with older adults with lung cancer before and
after training will be analyzed. Dr. Wong’s exceptional multidisciplinary mentoring team is led by Dr. Louise
Walter, an internationally recognized expert on individualized decision making for cancer screening in older
adults. This award will support Dr. Wong’s transition to research independence through dedicated training in 1)
longitudinal modeling and risk prediction for functional decline in older adults with cancer; 2) shared decision
making and decision-making interventions for older adults with functional or cognitive impairment; 3) clinical
trial design to test decision-making interventions for older adults with cancer; and 4) leadership skills to direct
multicenter research to transform geriatric oncology care. The results from this proposal will serve as the
foundation for a multicenter cohort study to develop and validate a risk prediction score for functional decline
during lung cancer t...

## Key facts

- **NIH application ID:** 10114183
- **Project number:** 5K76AG064431-03
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Melisa L Wong
- **Activity code:** K76 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $242,992
- **Award type:** 5
- **Project period:** 2019-07-15 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10114183

## Citation

> US National Institutes of Health, RePORTER application 10114183, Advancing patient-centered decision making in older adults with lung cancer: Incorporating risk of functional decline into treatment discussions (5K76AG064431-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10114183. Licensed CC0.

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