When John Bennett, M.D., gives the B.J. Kennedy Lecture at the American Society of Clinical Oncology (ASCO) on June 5th -- titled “Cancer and the Older Patient: Let’s Waltz Together” -- he will declare a conflict of interest that is sure to wake up the crowd: in addition to being 78 years old, Bennett is a recent cancer survivor.
Approximately 18 months ago, with little warning, Bennett suffered a serious gastrointestinal bleed and was rushed into emergency treatment. Doctors found a small, low-grade GIST (gastrointestinal stromal tumor), a rare cancer of the digestive tract. They completely resected it, and he required no further therapy. In just two weeks Bennett was back at work, diagnosing others by reading the 50 pathology slides a week that he routinely sees as an international expert in oncology and pathology.
His experience as both a doctor and patient gives him new insight, particularly toward cancer in the elderly. At ASCO, Bennett will be honored for a lifetime of innovative ideas and achievement in geriatric oncology, derived from studies of older patients with malignancies. Typically, however, the elderly population has been underrepresented in clinical trials, and Bennett and other experts in geriatric oncology warn that the lack of data is resulting in physicians being ill-prepared for a demographic shift toward a quickly aging population. By the year 2030, estimates are that 20 percent of adults will be 65 or older, and 1.5 million new cases of cancer will be diagnosed among them.
Advances in cancer treatment – including less invasive surgery and drugs that target certain pathways and thus have fewer side effects – are giving adults in their 70s, 80s, and even 90s the option of choosing treatment rather than believing that nothing can be done, Bennett said.
“The scenery is changing as we move toward individualized treatments and a better understanding of aging,” said Bennett, a professor emeritus of oncology in Medicine, Laboratory Medicine and Pathology at the James P. Wilmot Cancer Center at the University of Rochester Medical Center (URMC). “I’ve been saying for years that in addition to concerns about treatment toxicity, we should be evaluating older patients for coping ability and psychological makeup, functional capacity, and co-morbidities. All of this should be woven into the treatment decision.”
Bennett’s ASCO presentation will reflect his profound interest in overcoming the barriers to managing cancer in the elderly. Some of these barriers are rooted in fears and notions that “treatment is always worse than the disease,” he said, despite the availability of newer, targeted therapies with less toxicity than a traditional, shotgun approach.
“Cancer is traumatic,” Bennett said. “But I wonder – is it any more traumatic than surviving a massive coronary? A lot of health problems are rampant among older people and I want them to know that in many cases, they can still move forward with their lives.”