February 5, 2016 | by Robin Heffler
While the population of the United States continues to age, fueled in large part by medical advances and baby boomers, the number of physicians who specialize in treating older patients is on the decline. At the same time, the risk and incidence of cancer increases with age, with approximately 60 percent of all cancers occurring in people over 65.
Arti Hurria, M.D., a geriatrician and oncologist, is a national leader in addressing the needs of older patients with cancer. On staff at City of Hope since 2006, she serves as director of the Cancer and Aging Research Program, co-leader of the Cancer Control Population Sciences Program, and professor in the Department of Medical Oncology & Therapeutics Research.
For her contributions, she recently became the first geriatric oncologist to be appointed to the board of the American Society of Clinical Oncology.
Here, she talks about her passion for medicine and working with older adults. She also explains the tools she has created, and continues to develop, for evaluating the overall health of seniors diagnosed with cancer, and determining the best mode of treatment in each case.
1. What drew you to medicine in general and to the fields of gerontology and oncology in particular?
Both of my parents were doctors ─ my father was an orthopedic surgeon, and my mother was a radiation oncologist and later a family practice physician ─ so it was kind of assumed that I would be one, too. My parents emigrated from India, where older adults are very revered. I became a geriatrician first, and have always loved caring for older people. They bring their whole life experiences, stories and wisdom. And they’re always wanting to support me, often asking if I’ve eaten!
Also, my mom’s passion for radiation oncology clearly played a role in my pursuing oncology. Later, I realized how little data there was about caring for older adults with cancer, and decided to try to bridge these two fields with the support of mentors during my residency.
2. A key innovation you developed is a set of questions that assesses an older patient’s functional age so that cancer-treatment recommendations can be tailored to each individual. What are the factors that are included in that assessment and how do they help determine treatment?
Patients fill out a questionnaire that asks about how active they are, their ability to care for themselves, medical conditions, cognitive and psychological status, nutritional status and social support. They are very practical things that help us determine a patient’s functional age.
From that, we can calculate the risk of serious side effects from chemotherapy, probably my most significant research discovery to date. Before, we didn’t have a way to predict which patients who receive chemotherapy are most at-risk for being hospitalized, placed in an intensive care unit or likely to die. Now we can determine that risk, share it with patients and their families and make a decision together about treatment that fits the patient’s wishes. For some, chemotherapy will be worth the risk, while for others it won’t.
3. Is that assessment tool being used outside City of Hope?
Yes, at medical centers nationwide.
4. What cutting-edge research are you working on now?
We are working with many other medical sites to evaluate older patients with breast cancer, trying to identify both clinical and biological factors the might predict the risk of chemotherapy side effects in those with Stages 1 to 3 of breast cancer.
Another study is looking at patients who are about to start chemotherapy, calculating the risk of side effects and trying to intervene to prevent them. For example, if a patient has problems with daily functioning, we might recommend physical therapy. If there’s limited social support, we might get a social worker involved. Or, if he or she has lost weight, we might get a nutritionist to help.
We also have a study underway to understand the impact of chemotherapy on the memory of both patients with breast cancer who are newly diagnosed and receiving therapy, and those who are survivors and no longer receiving treatment. And, we need healthy women over the age of 65 to serve as control subjects for that study.
5. What do you find most distinctive and valuable about working at City of Hope?
The multidisciplinary care that is provided. In collaboration with nurses, social workers and pharmacists, we bring a team together that provides outstanding care. As a physician it is both meaningful and helpful to work side by side with members of this team. In addition, we just hired a second geriatric oncologist, Dr. Daneng Li, who will lead the way in our care of gastrointestinal malignancies in older adults.
Learn more about City of Hope's Cancer and Aging Research Program. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.
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