August 6, 2021:
by Vijaya Bhatt, MBBS, MS

With the aging US population, we face the challenge of rising incidence of cancer in older adults. Older adults are at a higher risk of developing and dying from cancers. Several factors contribute to poor outcomes including cancer biology, multimorbidity, frailty, and social isolation, which has become worse during the COVID-19 pandemic. Older adults are also frequently not well represented in clinical trials; this poses additional challenges by creating a knowledge gap in understanding how to optimally treat older adults with comorbidities. Improving outcomes in older adults with cancer requires multidisciplinary care, research collaboration and innovative trial designs.

As the only NCI-designated cancer center in the state of Nebraska, the Fred & Pamela Cancer Center, University of Nebraska Medical Center has collaborated with multidisciplinary teams of teams to provide outstanding care to all our patients with cancer. This has contributed to the success of our hematology-oncology, and blood and marrow transplant program. In recent years, we have extended collaboration with our colleagues from the Division of Geriatrics, Gerontology and Palliative Medicine. Our geriatric oncology collaboration focuses on improving the care of older adults with leukemia undergoing initial treatment as well as those who require a blood or marrow transplant. Such collaboration has enhanced quality of patient care and research.

My research is targeted towards improving quality of life and survival of older adults with acute myeloid leukemia, who face a high risk of early mortality and treatment failure. We know that geriatric assessment can predict the risk of toxicities of chemotherapy, and genetic risk categories correlate with survival following intensive chemotherapy. In an innovative precision oncology trial, therefore, we used the results of geriatric assessment and genetic profiling of leukemia cells to tailor selection of chemotherapy intensity. The trial had broad eligibility criteria and allowed patients with other active cancer and organ dysfunction to enroll on the trial. We also allowed patients to receive their treatment at community oncology centers. Our initial results of this pragmatic trial show promising improvement in early mortality and survival, highlighting the value of geriatric assessment in improving outcomes of older adults with leukemia. Biobanking done as a part of this trial has allowed us to foster a translational collaboration with our laboratory scientists to take a bedside-to-bench approach to solve clinical problems.

Designing clinical trials specifically for older adults with cancer, broad eligibility criteria to limit exclusion, and incorporation of comprehensive geriatric assessment are a few ways to improve outcomes of older adults with cancer. As we collaborate in the Big Ten Cancer Research Consortium working groups, we can promote geriatric oncology research to address the problems faced by our older adults because of cancer and cancer treatment.

 

About the Big Ten Cancer Research Consortium: The Big Ten Cancer Research Consortium was created in 2013 to transform the conduct of cancer research through collaborative, hypothesis-driven, highly translational oncology trials that leverage the scientific and clinical expertise of Big Ten universities. The goal of the Big Ten Cancer Research Consortium is to create a unique team-research culture to drive science rapidly from ideas to new approaches to cancer treatment. Within this innovative environment, today’s research leaders collaborate with and mentor the research leaders of tomorrow with the unified goal of improving the lives of all patients with cancer.

About the Big Ten Conference: The Big Ten Conference is an association of world-class universities whose member institutions share a common mission of research, graduate, professional and undergraduate teaching and public service. Founded in 1896, the Big Ten has sustained a comprehensive set of shared practices and policies that enforce the priority of academics in the lives of students competing in intercollegiate athletics and emphasize the values of integrity, fairness and competitiveness. The broad-based programs of the 14 Big Ten institutions will provide over $200 million in direct financial support to more than 9,800 students for more than 11,000 participation opportunities on 350 teams in 42 different sports. The Big Ten sponsors 28 official conference sports, 14 for men and 14 for women, including the addition of men’s ice hockey and men’s and women’s lacrosse since 2013. For more information, visit www.bigten.org.