The decision to focus on the care of elders with cancer came during my residency in internal medicine at the Johns Hopkins. Encouraged by leaders in oncology and geriatrics, I began to examine oncology as a disease of aging -- not just increasing chronological age but also declining physiologic age and consequent loss of function. My particular research focus is the assessment, prognosis and clinical decision-making involving elders with cancer. I am most interested in how the distinction between fit and frail elders is made, how that assessment can inform prognosis and enhance decision-making as well as clinical trial enrollment. Given the aging of the population in general and those with cancer specifically, focused research on the care of elders is imperative.
As a recipient of the American Society of Clinical Oncology Young Investigator Award grant for 2008-2009 supported by the Hartford Foundation, I am completing a project entitled “Impact of age and comorbidities on treatment effect, tolerance and toxicity in colorectal cancer”. This study utilizes three unique patient study cohorts (one community-based, two clinical trial-based) to determine the impact of the age and comorbidity on response rate, disease-free or progression-free survival, overall survival, treatment-related toxicity, and treatment intensity of older patients with stage II – IV colorectal cancer. The seminal finding of this three-part study was presented at the 2009 Annual meeting of the American Society of Clinical Oncology. That study, “Impact of older age on the efficacy of newer adjuvant therapies in >12,500 patients (pts) with stage II/III colon cancer: Findings from the ACCENT Database,” questioned the presence of survival benefit for older patients receiving newer combination chemotherapy regimens for colorectal cancer following surgical resection.
The above effort will define the potential risks of cancer treatment for older patients with colorectal cancer. Current research focuses on developing methods of treatment risk stratification for older patients with cancer. Unfit older patients are at increased risk for toxicity from cancer therapy. Geriatric assessment may provide a method of identifying those individuals at risk of functional decline prior to cancer treatment and an opportunity for clinicians to intervene. The primary objective of my current work is to evaluate the feasibility of a self-administered web-based computer cancer-specific geriatric assessment in a population of older individuals prior to and following treatment for solid tumors. This work is performed in collaboration with other experts in geriatrics, oncology and geriatric oncology. Additionally, I am chairing a prospective study for the Cancer and Leukemia Group B incorporating geriatric assessment in a treatment study in advanced colon cancer in collaboration with the North Central Cancer Treatment Group.
As a faculty member of Gastrointestinal Oncology at the Dana-Farber Cancer Institute, the majority of my time is devoted to clinical research with the balance of that time spent in clinical service and teaching. I continue to enrich my research endeavors as a Research Fellow in the Program for Cancer Outcomes Research Training program of Harvard University from July 2009 through July 2011.