Cancer clinic is one- stop site to help older patients

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 bloodcancer patients 65 and older, and expanded this summer to serve patients with solidtumor 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 cancerrelated 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 Amy Compston, left, a physical therapist, and Dr. Ashley Rosko, co-director of the CARE Clinic at the Arthur G. James Cancer Hospital at Ohio State University, assess patient Marilyn Cooper of Powell, who has chronic lymphocytic leukemia, for strength and balance. The clinic is a one-stop shop for treatment of older patients with some cancers. 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 cancerspecific 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.

“A cancer diagnosis carries a lot of treatment burden,” Presley said. “For older adults, it’s just hard to deal with the work of having a new cancer diagnosis, so this clinic really addresses, ‘How can we support them and get them through this really life-altering event?’”

About 100 patients a year are seen at the oneday-a-week clinic, Rosko said. Services are billed to insurance.

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 biomarkers. 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.

Cancer survivor Arlene Hendrickson visited the CARE Clinic in July, where, she said, providers are “looking beyond the cancer.”

The 73-year-old Northwest Side resident was diagnosed with lung cancer in November and had surgery in February to remove part of her lung.

At the clinic, health-care professionals helped her begin addressing issues with dry mouth, gastrointestinal problems and arthritic knees. She’s also working to correct trouble sleeping.

“It can drive you crazy going around everywhere,” she said. “One week, in a seven-day period, I had nine different appointments and procedures.

“This makes it easier on you. … People come to you and assess you.”

Cassandro, the Marietta woman, was diagnosed in August 2014 with multiple myeloma, a cancer that forms in plasma cells in bone marrow. She has been treated with chemotherapy ever since.

She said she’s fallen a couple of times in the past 1

years and had a difficult time getting up. She had feared a fall could lead to a broken arm, leg or hip.

Along with her dancing stint, the therapy has meant that she’s able to walk better and do more things around the house.

“I really felt better than I thought I would, being able to get up on my feet,” she said.