# Preserving Physical Function in Older Adults with Cancer: Impact of an Optimizing Nutrition Intervention Applied Before and After Surgery

> **NIH VA I01** · DURHAM VA MEDICAL CENTER · 2024 · —

## Abstract

Cancer is a common cause of [functional decline and morbidity] in older adults, with more than two-thirds of
new cases occurring in adults aged 60 years or more. Surgery is the most effective cancer treatment, but it
brings many risks that threaten recovery of physical function in older patients. Older adults needing surgical
treatment face the threats of age-related loss of muscle [quality, strength and endurance, malnutrition
(including cancer-related nutrition impact)], inflammation, and cachexia [caused by cancer and its
treatments]. Further, older adults often experience marked deterioration of functional abilities and reduced
physical reserve and may never regain their baseline level of physical function. This proposal addresses a gap in
knowledge on perioperative interventions to maximize restoration of functional capacity, minimize muscle loss
due to catabolic circumstances, and prevent malnutrition for these patients. Because a treatment using several
nutrients aimed at multiple mechanisms (targets) is expected to be strongly superior to single nutrient
treatment, we will use this approach to target a number of factors involved in cancer cachexia, including
anorexia, alterations in fat and protein metabolism, and systemic inflammation, as well as to prevent or correct
nutritional deficiencies. We expect this intervention to provide superior recovery of physical function and to
improve [physiologic, metabolic] and Veteran-centered outcomes versus a [typical] treatment. Thus, in a
pragmatic clinical trial, we will test a multi-targeted nutrition intervention, applied in a biphasic pattern (pre-
and post-operatively) in older Veterans newly referred for surgical cancer treatment.
In a two-armed 1:1 randomized controlled trial, we will test this nutrition-optimized treatment for senior health
(NOSH), a multi-targeted treatment provided in biphasic intervals (8 weeks before and 24 weeks after
discharge from surgery), and compare it to a [typical nutrition regimen (Typical )] with regards to (Primary
Aim 1) physical function, [(Secondary Aim 2) physiologic and metabolic outcomes], and (Exploratory Aim 3)
Veteran-centered outcomes, including quality of life (QoL), cancer-related nutrition impact symptoms, and
postoperative outcome measures. Older Veterans approaching surgery for [Stage II-III] gastrointestinal or
genitourinary cancer who are at high risk for having their physical abilities markedly decline during treatment
will be enrolled and randomized to NOSH or the [Typical regimen], with both groups prescribed low-intensity
resistance exercise thrice weekly. The NOSH intervention will include generous high-quality protein (30
g/meal; 1.5 g/kg/d) and other key nutrients linked with muscle preservation, namely b-hydroxy-b-
methylbutyrate, a metabolite of the amino acid leucine (HMB; 3 g/d), and vitamin D and a daily multivitamin
supplemented to a vitamin D level of 800 IU/d). Aim 1 will evaluate changes in physical function in the NOSH
inter...

## Key facts

- **NIH application ID:** 10877741
- **Project number:** 5I01RX003981-02
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** CONNIE W BALES
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-07-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10877741

## Citation

> US National Institutes of Health, RePORTER application 10877741, Preserving Physical Function in Older Adults with Cancer: Impact of an Optimizing Nutrition Intervention Applied Before and After Surgery (5I01RX003981-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10877741. Licensed CC0.

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