Age is the single greatest risk factor overall for cancer; our chances of developing the disease rise steeply after age 50.
Geriatric oncology is a branch of medicine that is concerned with the diagnosis and treatment of cancer in the elderly, usually defined as aged 65 and older.
An older patient with cancer will benefit from the expertise of a Geriatric Oncologist.
Older patients have unique needs because of their often complex medical histories.
Daneng Li, MD, is here to discuss how City of Hope elevates awareness about the needs of the senior population and possible cancer risks.
Selected Podcast
Geriatric Oncology: Meeting the Needs of Seniors
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Learn more about Daneng Li, MD
Daneng Li, MD
Daneng Li, MD., is an assistant clinical professor in the department of medical oncology and therapeutics research at City of Hope, specializing in geriatric oncology and treating gastrointestinal cancers. Dr. Li earned his undergraduate degree from Ohio State University in Columbus, OH, graduating summa cum laude. He then went on to receive his medical doctorate from Weill Cornell Medical College in New York, before pursuing an internship and residency in internal medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center. He recently completed a hematology/oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York City.Learn more about Daneng Li, MD
Transcription:
Geriatric Oncology: Meeting the Needs of Seniors
Melanie Cole (Host): According to the U.S. Census Bureau, about 8,000 Americans turn 60 every day last year. That’s 330 people each hour and as our population ages the number of cancer cases inevitably will rise, too. My guest today is Dr. Dan Li. He’s an Assistant Clinical Professor in the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Li. Let’s talk about our aging population and what cancers are you seeing the most as our population gets to be over the age of 60 or 65?
Dr. Dan Li (Guest): Sure, Melanie. As many individuals know, the older that we get age alone has been identified as a major risk factor for numerous different cancers. Even the most common types of cancers, such as colon cancer as well as breast cancer, are definitely associated with age. Many of the cancers that I frequently take care of, particularly gastrointestinal cancers whether it’s gastric cancer or pancreas cancer, in particular, are heavily associated with age. We’re seeing more and more older adults come into our clinical practice on a daily basis who are older adults.
Melanie: Does the management of the cancer that you’re seeing, Dr. Li, based on an estimate of life expectancy or tolerance of treatment, patient preferences? How do you decide what treatment to do with a person based on their age and type of cancer?
Dr. Li: Sure. What we’re quickly learning is that chronologic age alone is not a reliable factor in itself in predicting overall life expectancy for our older adults with cancer. Rather, we need to take a particular focus on other entities such as one’s overall physical function and their overall ability to tolerate treatment when making specific decisions on what is the best approach to treating our older adults. In addition, we have to focus on their co-morbid medical conditions, their overall psychologic state, mental cognition, as well as their social support at home. Who are the individuals that are going to be taking care of them while they’re going through this battle with cancer itself?
Melanie: I think that’s a very important point--their support situation and even maybe socioeconomic barriers. Are you seeing that some elderly just assume or sort of write it off as “cancer is a given” as they get older?
Dr. Li: Yes. I do see a lot of patients that come to my clinic. As a geriatric oncologist, over 90% of my clinic is focusing on older adults who are 65 years or older with various different cancers. A lot of the individuals that walk into my clinic are older adults. They just think that it’s time for them and what I tell them is that treatments that we are able to provide them might be able to control the disease and really improve their quality of life. It’s not necessarily to be a burden for them but it’s really to try to improve their care. That really changes their outlook on the rest of their life because often when they go to other oncologists and they just basically rule them off and say, “You’re too old to be treated”. We definitely don’t do that in our geriatric oncology clinic here at City of Hope.
Melanie: One of the things that older people also have is the co-morbidites. They have arthritis or they have a little dementia or they have any number of other things, diabetes, blood pressure--there could be so much going on. What do you tell them about cancer treatment along with their arthritis in their knees?
Dr. Li: Sure. A lot of their co-morbidities are important in terms of doing calculations of their overall life expectancy and using it as a prognostic indicator to balance that decision in terms of whether they should receive treatment or not. If we are going to go down the line of being treated for these patients, what we often do is we use something that’s known as the geriatric assessment chemotherapy toxicity calculator which was originally developed here at City of Hope. What that allows us to do is really take into account their overall co-morbidities along with all of the other factors, such as their physical function as well as social support and, based on that, we can potentially predict what their risk is for chemotherapy toxicity. That ultimately allows patients to get a better sense of whether or not they can tolerate treatment.
Melanie: While they’re deciding and you’re figuring out if they can tolerate treatment, do you find out what their situation is? If they’re independent, if they’re living alone, how they can stay safe during treatment? Some of these treatments can really make it difficult to go about your daily activities.
Dr. Li: Exactly. Traditionally, in the outpatient oncology setting, most busy oncologists are often limited in terms of using certain small, quick scales such as the Karnofsky performance status scale or the Eastern Cooperative Oncology Group scale for performance status. However, what we find is that they’re not able to pick up certain vulnerabilities in our older adults that are undergoing key treatment. As a result, for all of our older adults, I typically incorporate some form of geriatric assessment into my daily oncology practice and, as a result of that, I’m able to pick up all these additional vulnerabilities and really try to address these vulnerabilities. In fact, we already have an additional study where using the geriatric assessment to pick up these vulnerabilities and we have a dedicated, multi-disciplinary team that will intervene earlier on to see whether or not these early interventions can make it better for our older adults as they go through the cancer treatment process.
Melanie: What a wonderful service you provide at City of Hope Dr. Li. I just applaud all the great work you’re doing. What about --because older people are on Medicare and they’re afraid that treatments aren’t going to be covered or clinical trials are not going to be, so what about insurance and the elderly and how does that work with cancer treatment?
Dr. Li: That’s certainly a challenge that we’re often meeting. Certain individuals come to us and their insurance might not cover their care here at City of Hope and we recognize that. What we’re really trying to do with some of our research programs is to see whether or not we can take what we do here at City of Hope on a daily basis and really apply it to our community setting. Like I said, we have that study where we’re doing early interventions with our multi-disciplinary team but, ultimately, the goal of that study is so that we can learn and provide other venues where local oncologists or community oncologists can be able to do what we do on a daily basis. Even if they don’t have a specific person, such as a dedicated research nurse that follows these patients or a social worker that follows these patients, we can provide them educational materials so that all community oncology clinics or all clinics across the nation could potentially do what we’re trying to do here.
Melanie: That’s really amazing and what do you want the caregivers and spouses to know if somebody over 70, 75, 80 gets cancer? What things do you want them to do and for them to ask about? Wuestions and things you want them to know?
Dr. Li: I think what they should know is that cancer is always going to be a challenging diagnosis and a challenging time in their lives but it can be managed in a very smooth manner. While it’s going to be stressful, we often take into account the caregivers stress levels as well and we’re really here to try to help. We know that it’s going to be a journey, in essence, and that it’s going to require multiple services and they should be very clear in terms of writing down whatever questions that they might have and just ask us any question that they have. There is no bad question to ask and there’s no too simple of a question to ask because they’re going through a challenging time and the more information that they’re able to get from us, because we’re the experts in this field, the more that they’re going to feel empowered as they go through the treatment process.
Melanie: Just tell us about your team at City of Hope and what are some of the very exciting advancements that you’re doing for the elderly population and geriatric oncology?
Dr. Li: I think City of Hope is continuing to be rapidly growing. When I joined, most recently this past year, I joined Dr. Arthur Huria who is the Director of the Cancer Aging Group here at City of Hope. Dr. Huria is a world-renowned leader in geriatric oncology. What we’re really trying to do is expand to different diseases for geriatric oncology. Dr. Huria currently specializes a lot in breast cancer. I have a focus in gastrointestinal cancers. We are actively recruiting physicians for genital/urinary cancers, as well as lung cancer--in essence, the major cancers that are affecting our older adults. That’s what we’re trying to build. We have a great multi-disciplinary team as, I mentioned before, ranging from a dedicated research nurse practitioner who follows all of our research patients, along with a multitude of individuals ranging from social workers to physical therapists to a psychiatrist to pain management specialist to a nutritionist as well as a pharmacist, which is obviously very important in our older adults who are often on numerous medications. We really have every single discipline that is covered to focus on the needs of our older adults as they go through this difficult time with their cancer diagnosis.
Melanie: That is such great information and so beautifully spoken. Thank you so much for being with us today, Dr. Li. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Geriatric Oncology: Meeting the Needs of Seniors
Melanie Cole (Host): According to the U.S. Census Bureau, about 8,000 Americans turn 60 every day last year. That’s 330 people each hour and as our population ages the number of cancer cases inevitably will rise, too. My guest today is Dr. Dan Li. He’s an Assistant Clinical Professor in the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Li. Let’s talk about our aging population and what cancers are you seeing the most as our population gets to be over the age of 60 or 65?
Dr. Dan Li (Guest): Sure, Melanie. As many individuals know, the older that we get age alone has been identified as a major risk factor for numerous different cancers. Even the most common types of cancers, such as colon cancer as well as breast cancer, are definitely associated with age. Many of the cancers that I frequently take care of, particularly gastrointestinal cancers whether it’s gastric cancer or pancreas cancer, in particular, are heavily associated with age. We’re seeing more and more older adults come into our clinical practice on a daily basis who are older adults.
Melanie: Does the management of the cancer that you’re seeing, Dr. Li, based on an estimate of life expectancy or tolerance of treatment, patient preferences? How do you decide what treatment to do with a person based on their age and type of cancer?
Dr. Li: Sure. What we’re quickly learning is that chronologic age alone is not a reliable factor in itself in predicting overall life expectancy for our older adults with cancer. Rather, we need to take a particular focus on other entities such as one’s overall physical function and their overall ability to tolerate treatment when making specific decisions on what is the best approach to treating our older adults. In addition, we have to focus on their co-morbid medical conditions, their overall psychologic state, mental cognition, as well as their social support at home. Who are the individuals that are going to be taking care of them while they’re going through this battle with cancer itself?
Melanie: I think that’s a very important point--their support situation and even maybe socioeconomic barriers. Are you seeing that some elderly just assume or sort of write it off as “cancer is a given” as they get older?
Dr. Li: Yes. I do see a lot of patients that come to my clinic. As a geriatric oncologist, over 90% of my clinic is focusing on older adults who are 65 years or older with various different cancers. A lot of the individuals that walk into my clinic are older adults. They just think that it’s time for them and what I tell them is that treatments that we are able to provide them might be able to control the disease and really improve their quality of life. It’s not necessarily to be a burden for them but it’s really to try to improve their care. That really changes their outlook on the rest of their life because often when they go to other oncologists and they just basically rule them off and say, “You’re too old to be treated”. We definitely don’t do that in our geriatric oncology clinic here at City of Hope.
Melanie: One of the things that older people also have is the co-morbidites. They have arthritis or they have a little dementia or they have any number of other things, diabetes, blood pressure--there could be so much going on. What do you tell them about cancer treatment along with their arthritis in their knees?
Dr. Li: Sure. A lot of their co-morbidities are important in terms of doing calculations of their overall life expectancy and using it as a prognostic indicator to balance that decision in terms of whether they should receive treatment or not. If we are going to go down the line of being treated for these patients, what we often do is we use something that’s known as the geriatric assessment chemotherapy toxicity calculator which was originally developed here at City of Hope. What that allows us to do is really take into account their overall co-morbidities along with all of the other factors, such as their physical function as well as social support and, based on that, we can potentially predict what their risk is for chemotherapy toxicity. That ultimately allows patients to get a better sense of whether or not they can tolerate treatment.
Melanie: While they’re deciding and you’re figuring out if they can tolerate treatment, do you find out what their situation is? If they’re independent, if they’re living alone, how they can stay safe during treatment? Some of these treatments can really make it difficult to go about your daily activities.
Dr. Li: Exactly. Traditionally, in the outpatient oncology setting, most busy oncologists are often limited in terms of using certain small, quick scales such as the Karnofsky performance status scale or the Eastern Cooperative Oncology Group scale for performance status. However, what we find is that they’re not able to pick up certain vulnerabilities in our older adults that are undergoing key treatment. As a result, for all of our older adults, I typically incorporate some form of geriatric assessment into my daily oncology practice and, as a result of that, I’m able to pick up all these additional vulnerabilities and really try to address these vulnerabilities. In fact, we already have an additional study where using the geriatric assessment to pick up these vulnerabilities and we have a dedicated, multi-disciplinary team that will intervene earlier on to see whether or not these early interventions can make it better for our older adults as they go through the cancer treatment process.
Melanie: What a wonderful service you provide at City of Hope Dr. Li. I just applaud all the great work you’re doing. What about --because older people are on Medicare and they’re afraid that treatments aren’t going to be covered or clinical trials are not going to be, so what about insurance and the elderly and how does that work with cancer treatment?
Dr. Li: That’s certainly a challenge that we’re often meeting. Certain individuals come to us and their insurance might not cover their care here at City of Hope and we recognize that. What we’re really trying to do with some of our research programs is to see whether or not we can take what we do here at City of Hope on a daily basis and really apply it to our community setting. Like I said, we have that study where we’re doing early interventions with our multi-disciplinary team but, ultimately, the goal of that study is so that we can learn and provide other venues where local oncologists or community oncologists can be able to do what we do on a daily basis. Even if they don’t have a specific person, such as a dedicated research nurse that follows these patients or a social worker that follows these patients, we can provide them educational materials so that all community oncology clinics or all clinics across the nation could potentially do what we’re trying to do here.
Melanie: That’s really amazing and what do you want the caregivers and spouses to know if somebody over 70, 75, 80 gets cancer? What things do you want them to do and for them to ask about? Wuestions and things you want them to know?
Dr. Li: I think what they should know is that cancer is always going to be a challenging diagnosis and a challenging time in their lives but it can be managed in a very smooth manner. While it’s going to be stressful, we often take into account the caregivers stress levels as well and we’re really here to try to help. We know that it’s going to be a journey, in essence, and that it’s going to require multiple services and they should be very clear in terms of writing down whatever questions that they might have and just ask us any question that they have. There is no bad question to ask and there’s no too simple of a question to ask because they’re going through a challenging time and the more information that they’re able to get from us, because we’re the experts in this field, the more that they’re going to feel empowered as they go through the treatment process.
Melanie: Just tell us about your team at City of Hope and what are some of the very exciting advancements that you’re doing for the elderly population and geriatric oncology?
Dr. Li: I think City of Hope is continuing to be rapidly growing. When I joined, most recently this past year, I joined Dr. Arthur Huria who is the Director of the Cancer Aging Group here at City of Hope. Dr. Huria is a world-renowned leader in geriatric oncology. What we’re really trying to do is expand to different diseases for geriatric oncology. Dr. Huria currently specializes a lot in breast cancer. I have a focus in gastrointestinal cancers. We are actively recruiting physicians for genital/urinary cancers, as well as lung cancer--in essence, the major cancers that are affecting our older adults. That’s what we’re trying to build. We have a great multi-disciplinary team as, I mentioned before, ranging from a dedicated research nurse practitioner who follows all of our research patients, along with a multitude of individuals ranging from social workers to physical therapists to a psychiatrist to pain management specialist to a nutritionist as well as a pharmacist, which is obviously very important in our older adults who are often on numerous medications. We really have every single discipline that is covered to focus on the needs of our older adults as they go through this difficult time with their cancer diagnosis.
Melanie: That is such great information and so beautifully spoken. Thank you so much for being with us today, Dr. Li. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.