Program Targets Needs of Older Cancer Patients

older patient with doctorThough the practice of geriatric oncology is in its early stages, physicians and researchers at the James P. Wilmot Cancer Center are pioneers in the quest to advance the treatment of the growing population of older adults diagnosed with cancer.

Data compiled by the American Cancer Society shows that 77 percent of all cancers are diagnosed in individuals over the age of 50. Seventy percent of all cancer-related deaths occur in people 65 and older.

“As people age, they naturally develop a variety of co-existing conditions that can make their cancer treatment more complex,” said Supriya Mohile, M.D., M.S., who directs the Wilmot Cancer Center Geriatric Oncology Clinic, one of the few of its kind in the country. “For older patients, we need better data on how to both manage and cure cancer.”

Mohile presented at the annual American Society of Clinical Oncology (ASCO) meeting in 2011 and was selected by ASCO to organize the geriatric oncology sessions at this year’s meeting.

Twenty percent of Americans will be older than age 65 by 2030. While there are some overlaps in care models for oncology and geriatrics, no standards of care exist for this group. The collaborative approach that geriatric oncologists bring melds the fields and ultimately evaluates when the benefits of therapy outweigh the risks given the underlying health status of the patient.

“We are seeing very healthy patients, well into their 80s, who are still working, traveling, playing golf and swimming – and then they get cancer,” Mohile said. “Unfortunately, many of these patients are not treated for their cancers, solely due to their age. We are trying to educate the thought leaders in oncology of the need for hard data to address the unique situations of older people with cancer.”

The Specialized Oncology Care and Research for the Elderly (SOCARE) clinic, which Mohile founded and runs at both the Wilmot Cancer Center and Highland Hospital, is one of only three such programs on the east coast. SOCARE offers a comprehensive assessment and multidisciplinary approach to the care of the older person with cancer. It aims to help with decision-making for cancer treatment and maintaining function and quality of life during treatment.

Board certified in both geriatrics and oncology, Mohile is one of a handful of geriatric oncologists in the United States. She is also a member of the Cancer and Aging Research Group, a cadre of 15 researchers whose mission is to link new and senior geriatric oncology researchers in an effort to design and implement clinical trials to improve the care of older adults with cancer, and to promote the development of academic geriatric oncologists.

Mohile follows a trail blazed at URMC by John M. Bennett, M.D., whose groundbreaking work in the field of geriatric oncology was recognized by ASCO with the B.J. Kennedy Award and Lecture for Scientific Excellence in Geriatric Oncology. An early advocate for the integration of geriatrics into the study and practice of oncology, Bennett and geriatric expert William Hall, M.D., got funding to train fellows at several institutions across the country, including URMC.

“One of the main reasons I came to Rochester was the work and leadership of John Bennett and Bill Hall,” Mohile said.

URMC’s geriatric oncology program, one of 10 in the U.S., includes consultative clinics, which Mohile piloted at Highland Hospital, and comprehensive assessments at the Wilmot Cancer Center, where the majority of treatment is offered.

“We offer a comprehensive assessment that helps us to look past the chronological age of an individual and identify an approximate physiological age by looking at other variables such as frailty, cognitive function, nutritional and psychological status, social support and co-morbid medical conditions. Approximately 80 percent of the patients we see have co-morbidities that can influence the approach to their cancer treatment,” Mohile said.

Through the complete geriatric assessment (CGA), the patient is classified into one of three stages of aging: fit, vulnerable or frail. The CGA helps anticipate toxicities from treatment, and identify predictable needs for and sources of extra support for treatment.

 “We face nuances every day in the clinic that need to be addressed with research – such as the seemingly fit individual whose unseen medical problems might put him at risk for life-threatening toxicities, versus the apparently frail person who could actually tolerate aggressive treatment,” Mohile said. “It is critically important that oncologists learn to assess elderly people correctly. We are proud that our studies and our educational seminars begin to fill this gap in knowledge.”

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