If cancer is a disease of aging, then the guidelines for treating those over age 65 should be well known, especially given the rapidly aging population in the U.S. Unfortunately, however, that’s not always the case. Older adults are typically excluded from clinical trials and, as a result, outcomes data is lacking.
“There is a dearth of data for older individuals,” says Erika Ramsdale, MD. “We just don’t know exactly how they will react to some cancer treatments.”
Ramsdale, one of Virginia’s only geriatric oncologists, has made it her career objective to change that. She recently launched the Geriatric Oncology Clinic at UVA Cancer Center, utilizing her dual training in geriatrics and oncology to provide not only more information for clinicians but also better care to older patients facing a cancer diagnosis.
Her primary objective is to assist other specialists as they determine which treatments are the best fit for aging patients. “When a referring physician refers to me, I help with clinical decision-making for older patients with complex health issues, such as frailty or other illness or conditions. These issues, if present, can impact how we think about treatment strategies,” says Ramsdale.
“Often patients can be denied aggressive treatment solely because of age, so they are undertreated. On the flip side, some are at greater risk for toxicity and drug interactions, so may be over treated,” she adds.
The key is individualized assessment. There is significant variability among patients of the same age, so Ramsdale encourages looking beyond the number. “You don’t know based on age alone where a patient falls on the spectrum,” she says. “Some patients may be very sick from their cancer, but are still active and physiologically young. Others are very frail and not able to do what they used to do.”
Ramsdale performs a comprehensive geriatric assessment to determine a patient’s overall health, functioning and cognitive ability. She meets with patients and family members to discuss a patient’s goals and wishes, existing health conditions and prescribed medications, home environment and caregiver situation, all of which may influence which treatment is best for the individual.
With this information, Ramsdale provides a tailored report outlining patient status, as well as recommendations for treatment. “Ultimately, it is up to the oncologist and the patient as to how to best incorporate these recommendations into the overall treatment plan,” she says.
Data-Driven Care for Older Patients
Geriatric Oncology Clinic patients who do receive curative chemotherapy at UVA will be followed closely through a project called GERITrack (Geriatric Evaluation and Relative Intensity of Treatment). This registry allows Ramsdale to keep track of how older patients respond to various treatments. It’s data that she believes will be invaluable to oncologists as they see an ever-increasing number of aging patients.
“With this data, I hope to be able to guide clinical decision-making in the future,” she says. “We hope to collect information prior to and throughout treatment to see how patients do, if they agree to be part of the database. Then, based the data we collect, we can help determine if a treatment is going to benefit an older patient, or if it may cause more problems than the disease itself. This is data that we do not yet have for older patients in many cases.” Eventually, Ramsdale hopes to expand this registry to include all geriatric patients treated at UVA Cancer Center.