“The biggest risk for cancer development is age,” said Maria Carney, MD, chief of geriatric and palliative care for the North Shore-LIJ Health System and co-director of the Cancer Institute’s Supportive Oncology Center. “And as we age, we are also apt to have more health issues that need to be managed.”
To better address mature cancer patients’ complex needs, a new multidisciplinary program has been established: the Cancer and Aging Program at the Monter Cancer Center. This collaboration between the North Shore-LIJ Cancer Institute and the health system’s Division of Geriatrics and Palliative Medicine is the first program of its kind in the Northeast. Its first task: evaluating the quality of life in breast cancer patients 65 and up. Ruby Sharma, MD, a medical oncologist at the Monter Cancer Center, is the clinical lead and principal research investigator of the Cancer and Aging Program.
The number of mature cancer patients – and mature cancer survivors – is growing. In fact, 60 percent of all cancers occur in people over 65 years of age. As the US population ages, the American Society of Clinical Oncology projects that the number of this group of cancer patients will grow by 67 percent by 2030.
“It gets complex for an oncologist to manage aging patients alone,” said Dr. Carney. “We hope that by offering patients this comanagement program, we can better help them and really promote longevity, independence and improved quality of life.”
“What makes this new program unique is that it is centered around clinical research questions and we’re truly collaborative, with the whole team seeing patients together under one roof,” said Myra Barginear, MD, who initiated the program. “Patients can see the interdisciplinary team, in the setting of this clinical trial, in one visit, which enhances complete, comprehensive care. We believe our older patients with breast cancer may benefit, because their functionality, comorbidities, social support, medications and other health issues are very different compared to younger patients.”
Dr. Sharma also collaborates with Gisele Wolf-Klein, MD, director of geriatric education at LIJ Medical Center, on each patient enrolled in the clinical trial. Initial patient visits usually take 60 to 90 minutes, and follow-up visits 20 to 30 minutes. Renee Pekmezaris, PhD, an investigator at The Feinstein Institute for Medical Research, and vice president of community health and health services research for North Shore-LIJ, collaborated for more than a year with Drs. Barginear and Wolf-Klein to establish this initiative.
Clinical trials provide the evidence-based research that leads to new and improved standards of patient care. This research is vital, because older patients are under-represented in national cancer clinical trials.
“In many earlier studies, age was often an exclusion criteria. If you were 70 years old, you may have been excluded,” said Dr. Sharma. She added that the criteria were also counter-intuitive. “As a breast cancer specialist, I must extrapolate from the data based on younger patients. But a 70-year-old woman is often very different than a 50-year-old for multiple reasons.”
The Cancer and Aging Program’s first clinical trial, entitled “Improving the Quality of Life for Older Adults with Breast Cancer: An Outpatient Collaborative Team Model for an Innovative Breast Cancer and Aging Program” began in January with the generous support of The Manhasset Women’s Coalition Against Breast Cancer and The Fan Fox and Leslie R. Samuels Foundation, Inc. The trial focuses on four research questions: (1) quality of life; (2) depression; (3) emergency department visits; and (4) the value of having a formal geriatric assessment. To do so, women will be evaluated at the time of their initial diagnosis and again three to four months later.
The study will last 18 months to two years; research coordinators hope to enroll 240 patients. As with other clinical research, the investigators will evaluate the data and discuss the results at national medical conferences and in internationally recognized medical journals.
The team hopes to attract additional research and funding for the Cancer and Aging Program. “We are already seeing that our patients are eager and happy to be a part of this study,” Dr. Sharma said. “This is only the start of our long-term efforts to transform the approach to cancer prevention and treatment in mature women with breast cancer.”
“The potential to expand this approach to other cancer patients 65 and older is enormous,” said Dr. Carney. “This study is helping us to monitor our impact and see how we might be able to move forward in the future.”
Learn more about the clinical trial by calling Dr. Sharma at (516) 734-8745.