Oncologist Ashley Rosko, MD, has a unique perspective on patient age: Biological age is more important than chronological age. Dr Rosko is founder and director of the Cancer and Aging Resiliency (CARE) Clinic, a multidisciplinary clinic designed to address the needs of older adults with cancer. The clinic is located in The James Cancer Hospital at The Ohio State University, where Dr Rosko is associate professor in the Department of Internal Medicine.1
Dr Rosko conducts research using the biological age of older patients, rather than their chronological age, to better understand their ability to tolerate aggressive cancer therapies. She recognizes that older adults with cancer may be undertreated or never treated. Her goal is to systematically improve cancer care for older adults in terms of complications, hospitalizations, and overall survival.
Age, Health, and Cancer Treatment
No two people age the same way. This is especially obvious in terms of how their health changes — if it even changes at all. Older people with cancer may otherwise be extremely fit and exercise on a regular basis, whereas others are quite frail and unable to tolerate chemotherapy for any number of reasons. Many factors can contribute to frailty, including comorbidities, difficulties at home, or caregiver issues.
Dr Rosko says her group has no age-related cutoff or limitations of any kind regarding bone marrow transplant for patients with multiple myeloma. Patients are asked to come into the clinic so they can be evaluated for any occult issues. If someone arrives in a wheelchair or directly from a nursing home, staff can easily determine that that patient is frail; ambulatory patients with good functionality are obviously fit.However, many patients are vulnerable because they fall in between frail and fit. Oncologists should be certain they are screening appropriately, so that if they recommend an intensive treatment, such as a bone marrow transplant, the treatment really makes sense for that patient, Dr Rosko explained to Oncology Nurse Advisor.
Assessments of older patients should consider that not all 70-year-old patients would be in the same physical condition. With the CARE Clinic, the Ohio group has evolved a way to figure out older patients’ biological age. They measured all the variables associated with bone marrow transplant and put together a plan to help facilitate bone marrow transplant decisions. If there is an alternative they can talk about it. If there is no alternative, they discuss ways to control the adverse events.
Ancillary Care in a Central Location
When Dr Rosko opened the Cancer and Aging Clinic in 2016, it was specifically for patients with blood cancers. A focus was on multiple myeloma, an uncommon blood cancer of older adults known for its chronicity in which patients can have many good years. The clinic combines innovative research into aging with appropriate care for older patients. It was expanded in 2018 to cover solid tumors, becoming the multidisciplinary Cancer and Aging Resiliency Clinic.
Its focus is on how cancer treatment affects patients’ quality of life in relation to geriatric syndromes. Some patients are affected by their cancer in many ways, whereas some experience more moderate effects. At the clinic, patients discuss insomnia, falls, neuropathy, and other issues related to how chemotherapy has affected them.
The 7-person clinic team evaluates each patient for treatment eligibility. Dr Rosko screens patients for anxiety and depression; a nurse specialist performs a cognitive assessment; and a physical therapist conducts a number of functional evaluations including Timed Up and Go, a gait assessment, and a multilevel balance evaluation. Patients see a nutritionist who can evaluate their appetites and discuss the need for an appetite stimulant.
A new hearing loss may go on the back burner when a patient finds out he or she has cancer. But because hearing deficits are common in the elderly, the clinic has a sound booth and patients can undergo an audiometry test. They can then take the results anywhere to get hearing aids.
A nurse case manager discusses the patient’s role at home: Is the patient a caregiver for someone else? How is the patient functioning? What are the financial limitations and costs of medications?
A clinic pharmacist reviews all the patient’s medications and calls the patient’s pharmacy if there are issues. The clinic pharmacist also creates a plan for identifying potential drug/drug interactions or medications that are contraindicated with the planned chemotherapy. Patients are often seeing multiple oncologists. They may be taking medications they no longer need, that are duplicates of another prescription, or that interact with other drugs the patient is taking.