The Unique Needs of Older Adults with Cancer
While growing up near Oshkosh, Wisconsin, nursing homes were as familiar as playgrounds to Emily Guerard, MD, assistant professor (CHS), Hematology and Medical Oncology.
"My dad was a dentist, and we would go to the local nursing home so he could take care of his patients. I have a lot of memories of talking and playing with the older adults living there," said Dr. Guerard.
The experiences contributed to her interest in geriatric medicine—a topic that Dr. Guerard explored while a student at the UW School of Medicine and Public Health.
"I did a rotation in geriatrics during my fourth year, learning from Dr. Steven Barczi and admiring the work of Dr. Sanjay Asthana, Dr. Cindy Carlsson, and Dr. Amy Kind. I felt like we were focusing on things that really matter to patients," she said.
When she also became intrigued with oncology, she struggled to decide between the two subspecialties.
"I really liked the strong relationship that you have with oncology patients," said Dr. Guerard.
During a combined medicine and geriatric residency program at the Medical College of Wisconsin, a mentor suggested that she didn't have to choose after all. The emerging field of geriatric oncology employs a dual focus on cancer in older adults, allowing Dr. Guerard a path to specialize in both areas.
"This made so much sense to me, because there's more variability in what optimal oncology treatment looks like among older adults. If you see three 30-year-old patients with the same cancer in your clinic, their treatment will be fairly similar. If you see three 75-year-old patients, their treatment will more than likely be different from each other given the heterogeneity of the aging process," she said.
For elders, success of treatment regimens can hinge on factors such as drug pharmacokinetics and chemosensitivity, the impact of patients' mobility and frailty status, and caregiver support. And given that geriatric patients are often excluded from or under-represented in clinical trials, evidence-based decision-making can be complicated.
Dr. Guerard wants to spread the message that older oncology patients are unique. And mere two months into her new faculty role, she's already created a resource for patients, families, and clinicians: the UW Health Cancer and Aging Clinic.
The clinic, which is located within the Geriatrics Clinic at the UW Health East Clinic, accepts referrals from primary care providers, geriatricians, hematologists, medical oncologists, radiation oncologists, surgical oncologists, and self-referrals from patients and family members. "Our goal is to use evidence-based medicine and multidisciplinary geriatric assessments to personalize treatment for older adults with cancer," said Dr. Guerard.
To do so, Dr. Guerard assesses the physiologic and functional age of patients to tailor their care plan to their needs.
"The basic geriatric assessment covers physical function, activities of daily life, falls, mental health, cognition, social activity and social support, polypharmacy, nutrition, and more," said Dr. Guerard.
She encourages other clinicians to adopt geriatric assessment tools to inform care plans, a strategy that she feels is instrumental to avoid both over-treatment and under-treatment.
"We do have objective tools that oncologists already can use to assess their patients," she said, noting examples such as the Cancer and Aging Research Group (CARG) Chemo Toxicity Calculator. She has also studied a nearly all patient-reported frailty assessment tool. "The tool generates a score that clinicians could use to aid in predicting outcomes," said Dr. Guerard. In the future, she hopes to use it as a measure of functional performance status.
In addition to her clinical duties in Madison, Dr. Guerard also performs clinical oncology outreach service at Southwest Health in Platteville, Wisconsin. She feels that serving patients in different regions of the state is an example of the Wisconsin Idea in action.
"The care [at the Platteville clinic] is very personal, because it's a small community. Everyone knows everyone. There are three infusion chairs, the same nurses are always there, the patient sees the same person every time they come in and out ," she said—a familiar dynamic reminiscent of patient rounds near Oshkosh years ago, conducted hand-in-hand with her father.
Date Published: 11/11/2016