Experts confront cancer trend: aging population, new challenges

A growing cadre of specialists - geriatric oncologists - is the latest group of medical pioneers to meet the challenge of a rising cancer incidence among older adults. They are investigating how to fill the gaps in the way oncology is practiced today, which sometimes neglects the special needs of the elderly.

"Most oncologists are not trained to think about potential falls at home, or cognitive decline, loss of independence from treatment or even some of the inherent biologic differences in tumors among older people," said Supriya Mohile, M.D., of the University of Rochester's James P. Wilmot Cancer Center, and one of a handful of geriatric oncologists in the United States. "In older patients, cancer impacts their lifestyles much more dramatically, starting with the day they are diagnosed."

Mohile presided over a group of formally trained junior geriatric oncology researchers, and their senior mentors, for an important scholarly meeting in Rochester, N.Y., on Sept. 27^th and 28^th. The group discussed better ways to assess older patients for the risks and benefits of cancer treatment, to design new studies and conduct bench research on age-related issues such as drug toxicity and interactions with other medications, and to boost the number of older people in clinical trials.

Conference participants came from a range of academic medical centers, including the University of California, Los Angeles; the H. Lee Moffitt Cancer Center and Research Institute, Tampa; University of Arizona in Tucson; and The Cleveland Clinic.

Meeting sponsors were the James P. Wilmot Cancer Center; the University of Rochester Clinical and Translational Science Institute; a grant to the American Society of Clinical Oncology from the Association of Subspecialty Professors; The John A. Hartford Foundation; City of Hope Comprehensive Cancer Center in Los Angeles; and Memorial Sloan-Kettering Cancer Center in New York City.

Consider these facts about cancer: two-thirds of diagnoses and 70 percent of all deaths occur in people 65 and older. People 85 and older are growing four times as fast as any other subgroup of people receiving cancer treatment. And by 2030, as baby boomers age, cancer incidence is expected to rise dramatically.

The URMC has a long history of supporting geriatric care and research, through the Department of Medicine, Division of Geriatrics & Aging, led by Paul R. Katz, M.D. Approximately five years ago William J. Hall, M.D., the Paul Fine professor of Medicine in the Division of Geriatrics & Aging, and John Bennett, M.D., professor of Oncology in Medicine, Laboratory Medicine and Pathology, obtained funding to train fellows in geriatric oncology at URMC.Before then physicians were free to pursue the field, but no formal program existed for training in geriatric oncology.

Other leading geriatricians in the U.S. were impressed with the idea of supporting a formalized training program, and as a result started programs of their own modeled after the URMC's program, said Mohile, who joined the University of Rochester and the James P. Wilmot Cancer Center in 2007, recruited by the Wilmot Center director, Richard Fisher, M.D.

Mohile conducts interdisciplinary research and sees patients on a weekly basis who have survived cancer and are up to 95 years old. "When people are over the age of 70, geriatrics is no longer a bad word," Mohile said. "My patients recognize that geriatric oncologists are asking them the questions they want to be asked - but don't expect to be asked - and they appreciate that very much."

"It's clear there are not enough doctors available today to care for the tremendous number of older adults with cancer and the expected rise in patients," added Hall. "This group of excellent junior faculty will bring the critical perspective of what older adults need while facing cancer. What they are doing is admirable and very important to the field of medicine as we move forward in this aging society."