QUESTION ASKED: Does a computer-based approach for collecting geriatric assessment information provide a practical and efficient means of obtaining reliable and reproducible data from older adults with cancer?SUMMARY ANSWER: Computer-based geriatric assessment provides a feasible, reliable, and valid approach in older adults with cancer. WHAT WE DID:Older patients ($ 65 years) with cancer were randomly assigned to one of four treatment arms to compare the feasibility, reliability, and validity of two computer-based platforms for geriatric assessment with traditional paper-and-pencil data capture.WHAT WE FOUND: Completion times were similar for computer-based and paper-and-pencil assessments (Fig), and data gathered via computer-based assessment showed high test-retest reliability as well as internal consistency. BIAS, CONFOUNDING FACTOR(S), REAL-LIFE IMPLICATIONS:Many of the patients in our study were white, non-Hispanic, and college-educated older adults. This patient population may be more comfortable using computer technologies than other demographic groups; thus our results may not be generalizable to other segments of the patient population. Older patients with cancer are at increased risk for treatment toxicity. Geriatric assessment captures a range of physiological and psychological metrics that predict toxicity and survival, and thus have high utility in guiding interventions. In the current study, we found that computer-based geriatric assessment provides an efficient method for acquiring reliable and valid data. Adoption of computer-based geriatric assessment into oncology practice thus can provide a cost-and time-efficient approach for acquiring high-value data to be used in formulating treatment decisions for older adults with cancer. Completion Time (minutes) Abstract PurposeThe goal of this study was to evaluate the feasibility, reliability, and validity of a computerbased geriatric assessment via two methods of electronic data capture (SupportScreen and REDCap) compared with paper-and-pencil data capture among older adults with cancer. MethodsEligible patients were $ 65 years old, had a cancer diagnosis, and were fluent in English.Patients were randomly assigned to one of four arms, in which they completed the geriatric assessment twice: (1) REDCap and paper and pencil in sessions 1 and 2; (2) REDCap in both sessions; (3) SupportScreen and paper and pencil in sessions 1 and 2; and (4) SupportScreen in both sessions. The feasibility, reliability, and validity of the computer-based geriatric assessment compared with paper and pencil were evaluated. ResultsThe median age of participants (N = 100) was 71 years (range, 65 to 91 years) and the diagnosis was solid tumor (82%) or hematologic malignancy (18% ). There were no significant differences in completion times between SupportScreen and paper and pencil (P = .50). The computer-based geriatric assessment was feasible. Few participants (8%) needed help with completing the geriatric assessment (REDCap, n = 7 and SupportScreen, n = 1), 89% reported th...

BACKGROUND/OBJECTIVES Caregivers of older adults with cancer assist both with cancer care and other health issues, which may make them vulnerable to consequences of caregiving. Hospitalization may represent a time when a caregiver's ability to provide care at home is exceeded. We sought to characterize caregivers of hospitalized older adults with cancer, determine their quality of life (QOL), and identify factors associated with caregiver QOL. METHODS Patients (n = 100), aged 65 years and older, with an unplanned hospitalization and their caregivers were included. Caregivers completed a questionnaire about their health, social support, caregiving relationship, QOL (Caregiver Quality of Life Index‐Cancer [CQOLC] tool), and patient function. Patient medical history was obtained via chart review. The association between patient, caregiving, and caregiver factors and CQOLC was determined using multivariate linear regression. RESULTS Most patients (73%) had metastatic/advanced disease, and 71% received treatment for their cancer within 30 days of hospitalization. Median Karnofsky Performance Status (KPS) was 60%, and 89% required help with instrumental activities of daily living, as reported by caregivers. Median caregiver age was 65 years (range = 29‐84 years). The majority (60%) had no major comorbidities and rated their health as excellent/good (79%), though 22% reported worsening health due to caregiving. Caregivers had a median Mental Health Inventory‐18 score of 70 (range = 0–97), a median Medical Outcomes Study (MOS)‐social activity score of 56 (range = 0–87.5), and a median MOS‐Social Support Survey score of 68 (range = 0–100). Caregivers provided a median of 35 hours of care per week (range = 0‐168 hours of care per week). Mean CQOLC was 84.6 ± 23.5. Lower caregiver QOL was associated with poorer caregiver mental health, less social support, and poorer patient KPS (P < .05). CONCLUSION Caregivers of hospitalized older adults with cancer are older but generally in good health. Those with poorer mental health, less social support, and caring for patients with poorer performance status are more likely to experience lower QOL. J Am Geriatr Soc 67:978–986, 2019.

Engineered neural stem cells (NSCs) intrinsically migrating to brain tumors offer a promising mechanism for local therapeutic delivery. However, difficulties in quantitative assessments of NSC migration and in estimates of tumor coverage by diffusible therapeutics have impeded development and refinement of NSC‐based therapies. To address this need, we developed techniques by which conventional serial‐sectioned formalin‐fixed paraffin‐embedded (FFPE) brains can be analyzed in their entirety across multiple test animals. We considered a conventional human glioblastoma model: U251 glioma cells orthotopically engrafted in immunodeficient mice receiving intracerebral (i.c.) or intravenous (i.v.) administrations of NSCs expressing a diffusible enzyme to locally catalyze chemotherapeutic formation. NSC migration to tumor sites was dose‐dependent, reaching 50%–60% of total administered NSCs for the i.c route and 1.5% for the i.v. route. Curiously, the most efficient NSC homing was seen with smaller NSC doses, implying existence of rate‐limiting process active during administration and/or migration. Predicted tumor exposure to a diffusing therapeutic (assuming a 50 µm radius of action) could reach greater than 50% of the entire tumor volume for i.c. and 25% for i.v. administration. Within individual sections, coverage of tumor area could be as high as 100% for i.c. and 70% for i.v. routes. Greater estimated therapeutic coverage was observed for larger tumors and for larger tumor regions in individual sections. Overall, we have demonstrated a framework within which investigators may rationally evaluate NSC migration to, and integration into, brain tumors, and therefore enhance understanding of mechanisms that both promote and limit this therapeutic modality. Stem Cells Translational Medicine 2017;6:1522–1532