Age Alone Isn’t a Reason to Forgo Aggressive Cancer Treatment
Harriet Geary inspires a lot of adjectives: "fit," "vital," "sharp," and "social." But certainly not "old."
At 90, the South Side resident has the kind of life many people decades younger would envy. She lives on her own, goes to the gym at the YMCA three times a week, and makes regular lunch dates with friends she’s had for a lifetime. But all of that was threatened in late 2009, when she felt bloated and started to have more frequent bowel movements.
When tests revealed she had a small bowel obstruction from metastatic ovarian cancer, she was shocked. A retired Board of Education secretary who worked until her 70s, Geary had been remarkably healthy most of her life, up until that point.
"When they told me I had ovarian cancer, I thought it was a death sentence at my age," says Geary, who was married for 50 years before her husband, a psychiatrist, passed away 10 years ago. "I can’t even describe how upset I was by the diagnosis."
Experts Who Understand Older Adults
For older adults like Geary facing cancer, the University of Chicago Medicine offers an innovative program called the Specialized Oncology Care and Research in the Elderly (SOCARE) clinic. The clinic provides specialized care planning for older cancer patients, helping them identify and proactively manage possible problems that could affect their outcomes so they can better manage their treatment.
Doctors and nurses at the clinic help patients like Geary understand their cancer care options and act as advocates for older adults and their families during cancer treatment.
William Dale, MD, PhD"We help put a cancer diagnosis in context for older patients," says William Dale, MD, PhD, who founded and co-directs the SOCARE clinic at the University of Chicago Medicine. "Just because people are in their 80s or 90s doesn’t mean that they shouldn’t receive effective cancer care that could lengthen their lives. Age alone isn’t the primary factor when it comes to decision-making. It’s more important to look at the overall health of a patient, especially the presence of other diseases, their physical function, their medications, their memory, and their social support."
Other than her cancer, Geary was in near-perfect health through her mid-80s, says Dale, who is also chief of the Section of Geriatrics and Palliative Medicine at the medical campus. Factors that worked in her favor: She had stayed a healthy weight her entire life, she exercised several days a week, and she was very independent. In addition, she only took medication for high blood pressure. According to Dale, "She was as healthy as many of my 60-year-old patients, with a similar life expectancy."
Learning Her Options
The SOCARE clinic—the only one of its kind in Chicago and one of a few such programs in the United States—is staffed by Dale, a geriatrician, James Wallace, MD, a geriatrician-oncologist, and an experienced advanced practice nurse. Together, they see up to 30 patients on clinic days each Friday morning. The SOCARE team works side by side with medical center oncologists and other specialists, and consults regularly with patients’ personal physicians.
At the clinic, Dale provided Geary with a comprehensive geriatric assessment to determine if she was a candidate for standard treatment for metastatic ovarian cancer, namely surgery and chemotherapy. Dale assembled Geary’s cancer team, which included a medical oncologist, Gini Fleming, MD, and a gynecologic cancer surgeon, S. Diane Yamada, MD. Together, they crafted an individualized treatment plan that took into account Geary’s overall health, functional status, and care needs.
The First Path: Chemotherapy
Gini Fleming, MDGeary and her treatment team decided the best approach was to start with chemotherapy. They were careful to identify any potential side effects that could arise during treatment. Because of Geary’s age, Fleming chose a slightly lower than usual dose of combination chemotherapy with the anti-cancer medicines carboplatin and paclitaxel. Fleming also began Geary on a growth factor medicine with each cycle of chemotherapy to prevent low white blood cell counts. This would reduce the risk of infection, which could be deadly in an older cancer patient.
"Mrs. Geary was living independently and in stunning health," says Fleming, who also chairs a Gynecologic Oncology Group (GOG) research working group on the treatment of elderly patients. "She also had the right attitude, being both calm and upbeat. While she was able to handle near full doses of chemotherapy, those doses might have been fatal to another older patient. For patients like Mrs. Geary, having the availability of the geriatricians at the SOCARE clinic to help coordinate treatment and supportive care is certainly a benefit."
Joan Bigane, APN/FNP-BC, a geriatric nurse practitioner at the SOCARE clinic who previously worked in medical oncology, saw Geary every month to monitor side effects from her chemotherapy. "She did have mild fatigue but had very little nausea and vomiting," Bigane says. "She tolerated the treatment very well."
Bigane also spoke to Geary on the phone several times to help coordinate appointments with her cancer specialists and make sure she knew what to expect during treatment. During their interactions, Bigane was struck by her patient’s optimistic outlook. "How Mrs. Geary faced chemotherapy was really remarkable," she says. "She didn’t look back."
The Next Step: Surgery
Typically, patients with metastatic ovarian cancer who have chemotherapy undergo a follow-up surgery to remove the ovaries and any remaining cancer tissues. But because of Geary’s age, the team was concerned that surgery might be too difficult on her body. Yet when her geriatrician, medical oncologist, and surgeon weighed the options, they decided together that Geary was healthy enough to handle the operation. And Geary agreed.
S. Diane Yamada, MD"We had extensive conversations with Mrs. Geary about the direction we thought was best for her," says Yamada, chief of the Section of Gynecologic Oncology, and Geary’s surgeon. "We knew from her tests that she had a very good response to the chemotherapy. But we didn’t want the cancer to return to her ovaries. When Dr. Dale, Dr. Fleming, and I put our heads together, we decided that the benefits to surgery outweighed the risks."
During an operation in March 2010, Yamada removed both of Geary’s ovaries, fallopian tubes, and the omentum, a fatty layer of tissue over the intestines. After the surgery and a short hospital stay at the medical campus, Geary recuperated at a rehabilitation facility for six weeks until she was strong enough to live on her own again. She did have one complication from her surgery, a large blood clot that needed to be removed during a second procedure.
"We have to be on our toes with older patients like Mrs. Geary," Yamada says. "They do that at the SOCARE clinic, which has an umbrella view of cancer care. The geriatricians provide expertise in medication management, functional assessments, and psychosocial issues that aid in decision-making about therapy. They don’t have a one-size-fits-all approach—but at the same time, they don’t compromise on treatment."
Back to the Gym
Geary walks the track at her local YMCA.Today, Geary has returned to her local YMCA, where she swims in the pool or walks the track three days a week. Her tumor markers are in the normal range, which means her cancer is in remission. She’s back to cooking, doing the laundry, and taking care of her condo. She sees her son, grandson, and three great-grandchildren when she can and meets with a few social clubs for lunch dates. Every three months, she returns to the hospital for regular blood tests and computed tomography (CT) scans to make sure her cancer has not returned.
"I feel very well," says Geary. "I’m still here, and I think I did very well for my age." She credits Dale and the team at the SOCARE clinic for her quick return to form. "Dr. Dale is very knowledgeable in his field, so I felt comfortable having him as my doctor. He gave me great advice: Don’t sit around. Keep seeing people and don’t think of yourself as a sick person. And that’s what I did. I kept a positive attitude and told myself I’m not quite ready to give up yet."
Request an Appointment
To request an appointment with a SOCARE physician, please call (773) 834-7424. Or send an e-mail message to the SOCARE clinic director, William Dale, MD, PhD, at wdale@medicine.bsd.uchicago.edu.
October 2010
