OSU cancer clinic uses fitness level to determine treatments
When Frances Cassandro started therapy to battle leg pain, she had one goal: to be able to dance at her grandson’s wedding.
After fighting a blood cancer for four years, the 80-year-old Marietta woman had an appointment earlier this year at the Cancer and Aging Resiliency Clinic — or CARE Clinic — in the Arthur G. James Cancer Hospital at Ohio State University.
Health-care professionals there tested such things as her hearing, memory and balance.
Though her hearing and memory tested OK, her balance was a struggle, and she was excited when she was referred to therapy to address the tingling in her legs caused by nerve damage.
And it worked. She danced at the wedding with her husband, her son and her grandson.
“That was one of the highlights of my time,” she said of the July wedding. “I have pictures to show I was up and doing it, a slow dance and a fast dance even.”
Maintaining good balance might not be the first thing to come to mind when an older person is coping with a cancer diagnosis, but the doctors behind the CARE Clinic say attending to a cancer patient’s total health can make a difference in quality of life from the time a diagnosis is made, through treatment and into survivorship.
The CARE Clinic opened in February 2017 for blood-cancer patients 65 and older, and expanded this summer to serve patients with solid-tumor cancers, such as breast and lung cancers.
The goal is to determine a patient’s fitness level, or “biological age,” as opposed to relying on chronological age, to craft treatment regimens and address other health issues that could affect or exacerbate cancer-related conditions.
People don’t all age the same and some older people might be better able to tolerate intensive therapies that might once have been rejected solely based on age, said Dr. Ashley Rosko, a researcher who treats blood cancers and co-directs the clinic.
Doctors aim to increase resiliency and allow patients to stay as independent as possible.
“Ohio is an aging state,” Rosko said. “The 65-plus community will continue to grow and expand, so we really want to be ahead of the game and provide centralized care for older adults with cancer.”
The one-stop-shopping model pairs patients with seven health-care providers who review not just cancer-specific treatment, but also balance, cognition, hearing, nutrition, other medications, and social issues such as caregiver support, financial constraints, psychological stressors and advance directives.
Rosko said the clinic’s multidisciplinary approach to care is an emerging phenomenon, and the James is one of a just a few hospitals in the nation that offers such care for any older patient at any point in the cancer process.
The clinic helps to reduce barriers that older adults might face in getting needed care and to streamline the care they’re already receiving, said Dr. Carolyn Presley, a researcher and oncologist who specializes in lung cancer and is the clinic’s other co-director.
Being proactive is key to preventing bad outcomes from, for example, a fall or being on multiple medications, she said.
Another component lacking in geriatric oncology is research, she said, and the clinic also seeks to remedy that. Many cancer-related clinical trials have upper age limits or disqualify people for other conditions that older people might have, such as poor kidney function, she said.
Christin Burd, a researcher in the James’ Molecular Biology and Cancer Genetics Program, specializes in aging bio-markers. She and her team are working with clinicians to develop a blood test that can gauge biological age and ability to endure cancer treatments. Among other projects, they also are working to determine whether exercise can improve resiliency in cancer patients.
Cancer therapy, Burd said, is “pretty rigorous treatment that we know can result in increased aging.”
“You’re accelerating the rate of biological aging, so understanding that process of biological aging and how that impacts survivors is really important,” she said.