PROJECT SUMMARY/ABSTRACT Treatment for ovarian cancer begins with complex radical surgery in women who often are older with high rates of frailty and comorbid conditions. This results in postoperative complications and the highest mortality amongst all gynecologic cancers. Postoperative adverse events, such as surgical complications and hospital readmissions, can delay the initiation of post-operative chemotherapy, leading to decreased survival. Given the increased risk of postoperative morbidity and inferior cancer-specific survival for older women with ovarian cancer, targeted interventions are needed to improve their outcomes. Prehabilitation refers to enhancing functional capacity prior to an upcoming stressor, such as surgery, with the goal of improving postoperative outcomes. Physical activity, specifically, has been found to have myriad health benefits and is a component of many prehabilitation interventions. However, prehabilitation interventions often use prescriptive static goals of high intensity activity delivered by health care professionals which may not be scalable and may not be appropriate for an older frail patient population receiving chemotherapy. To address these issues, this proposal pilot tests a home-based, symptom-tailored, physical activity intervention (Fit4Surgery) among older women with ovarian cancer undergoing neoadjuvant chemotherapy. Interventions such as this are effective in patients with chronic diseases and in this proposal will be tested in a novel setting and a high-risk population. By increasing the amount of physical activity older women with ovarian cancer perform in the months prior to debulking surgery, we aim to improve functional status and quality of life while decreasing frailty, postoperative complications, and time to adjuvant cancer therapy, ultimately improving long-term cancer survival. As a gynecologic oncologist with formal epidemiology training, I have a solid foundation in clinical research with a focus on surgical quality and outcomes in women’s health. Through my research, I have identified older women with ovarian cancer as a high-risk population and the mechanisms of physiologic aging are prevalent in women with cancer and those undergoing chemotherapy. In order to fulfill my career goal to improve the quality of life and survival of older women with gynecologic cancers, I am in need of further training and mentorship in aging, geriatric assessment, and frailty assessment. This proposal will help me fill these gaps directly through formal coursework, seminars, and mentorship by Dr McKoy (geriatrics, geriatric oncology), Dr Simon (gynecologic malignancies and aging), Dr Phillips (physical activity in cancer, physical activity in older adults) and Dr Kocherginsky (clinical trials of behavioral interventions). The skills, knowledge and preliminary data, that I acquire as a result of this award will allow me examine the efficacy of the Fit4Surgery intervention in improving surgical outcomes for older women with ovarian cancer and will substantively contribute to my transition to an independent surgeon-scientist studying aging and gynecologic cancers.

PROJECT NARRATIVE Ovarian cancer treatment requires complex radical surgery often in women with older age with resulting high rates of postoperative complications and decreased survival. Many older women are treated with neoadjuvant chemotherapy for 9-12 weeks prior to surgery and this time period is a window of opportunity to intervene to improve patient outcomes. This study examines a home-based, patient-tailored physical activity prehabilitation intervention in this high-risk population during this important time.