Dr Sindhuja Kadambi: It's Time to Address the Needs of the Aging Oncology Population

At the Advancing Value-Based Oncology Care second annual meeting held on June 20, 2024, in Phoenix, Arizona, Sindhuja Kadambi, MD, MS, assistant professor, Department of Medicine, Hematology/Oncology at the University of Rochester Medical Center, and senior instructor at the Wilmot Cancer Institute, presented on the importance of value-based oncology models for aging patient populations. Advancing Value-Based Oncology Care was an Institute for Value-Based Medicine® event cohosted by The American Journal of Managed Care^® (AJMC^®) and Banner MD Anderson Cancer Center.

In an interview with AJMC, Kadambi highlighted the misconceptions about aging patients that impact their type and quality of care, the particular obstacles this population faces when receiving oncology care, and the value of geriatric assessments.

This transcript has been lightly edited.

Transcript

Can you speak to any common misconceptions about the aging population that may influence the oncological care they receive or their health care experiences?

I think as a society, we have an image of what being older means, you know, sometimes we picture that person with a lot of health issues and physical impairments, cognitive changes, and that can affect the type of care that they receive. Sometimes, because of their age, they're not offered certain treatments that we know can be effective. On the other side, we as oncologists, we can also be overly optimistic about how well someone's doing when they're older and give them treatment that may be toxic, and overtreat those people and that also can have negative effects on their on their cancer care and overall outcomes.

Can you speak to the unique challenges the aging population faces when undergoing cancer treatment? What efforts can be made to mitigate these challenges?

I think one of the biggest barriers is that we don't have clinical trials that are really geared towards older adults and older adult–specific outcomes. A lot of our FDA treatment trials are on younger people who are healthy, and even the older people who are included are generally healthy people without health issues. And so that's a major barrier.

We do know that cancer is a disease of aging, and that older adults with cancer have more other health issues. They have what we call geriatric syndromes, or aging-related conditions. Those can be physical and cognitive impairments. It can be polypharmacy, or using multiple medications, for for their various health issues. Poor social support. There's really a slew of other aging-related issues that need to be considered, that can affect their cancer-related treatment and outcomes. And so those are really challenges that we need to think about when we're thinking about how to best treat our older adults.

Can you provide some context for the role of geriatric assessment in guiding the treatment for older patients?

Geriatric assessment is a structured way of assessing older adults in very specific domains based on those like issues that I talked about earlier about aging-related syndromes. If we can assess them in these multiple domains, we can have a better idea of their overall health. And then we can guide not only treatment but also supportive care ensuring that they do well with whatever treatment choices are made.