A Comprehensive Cancer Center Designated by the National Cancer Institute

Pathways to Discovery: Winter 2013

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Clinic Provides Cancer Care for Older Adults

Cancer is predominately a disease of older adults, yet the majority of participants enrolled in most clinical trials fall into much younger age groups. As a result, a lack of evidence-based data exists to guide oncologists in properly tailoring therapy for patients in their sixties, seventies, and even older. This limitation is especially troubling, since the population of older patients with cancer is expected to grow rapidly in the next 20 years.

“Despite a robust outpouring of studies on cancer and a similar number on aging separately, it’s remarkable and concerning how little we still know about the intersection of the two,” said William Dale, MD, PhD, associate professor of medicine and chief of the Section of Geriatrics & Palliative Medicine.

To address these limitations, Dr. Dale founded the UCCCC Specialized Oncology Care and Research in the Elderly (SOCARE) Clinic in 2006. SOCARE is staffed with professionals with expertise in oncology, geriatrics, and palliative care who coordinate and individualize care for older patients diagnosed with cancer. He explained that, because many older patients have multiple conditions in addition to cancer, their overall medical situation must be factored into treatment decisions. For example, if a patient diagnosed with lung cancer also has heart disease, osteoporosis, and recently fell, physicians must determine if needed chemotherapy can be tolerated.

“As people get older, two of their main health risks are physical frailty and cognitive impairment,” said Dr. Dale. “Those can both be affected by many standard cancer treatments.” SOCARE evaluates the fitness of older patients in tolerating treatments to help inform treatment decisions.

Adequate social support is another consideration, he said, since dehydration, muscle weakness, or memory loss may make it unsafe for patients to be at home alone during cancer treatments like chemotherapy. At SOCARE, vulnerable older patients are connected with community resources to aid with transportation, safety evaluations, and home care services. In fiscal year 2012 alone, the clinic served over 1,300 patients.

Along with providing clinical care, Dr. Dale focuses his research on improving the enrollment of older adults in cancer clinical trials. “We want to include as many patients as possible in potentially curative therapies,” he said. In 2010, with funding support from the National Institutes of Health1 and the UCCCC, Dr. Dale and other geriatric oncology leaders held a conference in Chicago with national leaders to discuss methods for generating the highest quality research in older adults with cancer. Based on the success of this conference, a second meeting was recently held in Chicago to propose trials for older, frailer adults with a number of types of cancer.

Dr. Dale’s research also focuses on improving treatment decision-making strategies for older men with prostate cancer. One study found that an increasing number of older men elect to start receiving hormone therapy primarily because they are anxious about their prostate cancer, despite a lack of clinical benefit for starting hormone therapy early. Dr. Dale is currently testing decision aids —such as an interactive video—to help patients understand the side effects of hormone therapy. He is also studying the benefits of physical therapy before patients undergo such therapies.

“We’ve reduced overtreatment in the elderly by just realizing that they’re often overly nervous and need more explanation about the tradeoffs,” said Dr. Dale. Overall, he and his colleagues are helping maintain function and quality of life by matching therapy to the patient’s situation. He envisions SOCARE helping to increase the recruitment of older patients into UCCCC-based clinical studies and implementing social support initiatives, such as a program that places older patients who live alone into supervised long-term care settings while undergoing treatments, thereby extending the group who can benefit from cancer therapy.

1This project was supported by grant number U13 AG038151 from the National Cancer Institute of the National Institutes of Health.

Ernst Lengyel