A new program at The Ohio State University is adjusting cancer treatments based on a person’s biological age.
Laird “Smitty” Smith is in treatment for stage 3 lung cancer.
At 72 years old, he also walks every day, plays golf twice a week, and mows his own yard.
Smitty is being treated by Dr. Carolyn Presley, a thoracic medical oncologist at The Ohio State University Comprehensive Cancer Center (OSUCCC)–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
He’s also enrolled in the FITNESS study, a project designed to assess the physical and mental fitness of older cancer patients and the effect that may have on clinical outcomes.
“Biologic age does not equal chronological age,” Presley told Healthline. “A 70-year-old could be as healthy as a 50-year-old and a 50-year-old can be as frail as someone who is 80. Age is not necessarily telling the whole story.”
Jamie Fertal, DO, is medical director of the Outpatient Palliative Care Clinic,The Center for Cancer Prevention and Treatment at St. Joseph Hospital in California.
Among her specialties are palliative care and geriatrics.
Fertal told Healthline that people over 65 have unique problems and needs compared to those who are younger.
“They’re typically on far more medications than their younger counterparts, so there’s more possibility for drug interactions,” she said.
“Many older patients start to develop frailty, which is a syndrome that includes weakness and loss of skeletal muscle and susceptibility to disability. And you can certainly imagine how that would affect the ability to withstand chemotherapy,” she added.
Cognitive issues also need to be considered.
“Significant cognitive impairment would be a deterrent to treat with aggressive chemotherapies. The strict compliance required can be a challenge with cognitive impairment,” said Fertal.
She explained that older patients typically need more physical, psychological, and practical support, such as rides to treatment.
“Many of these factors are sort of taken for granted with younger patients,” said Fertal.
The Cancer and Aging Resiliency (CARE) Clinic at The Ohio State University is designed to meet the needs of older adults with cancer.
The clinic recommends treatment based on “biological age” rather than chronological age.
Presley said the FITNESS study is open to older adults with lung and blood cancers, noting there may be a stigma associated with “geriatric” assessment.
So far, the study has accrued 27 patients, with a goal of 50.
Presley explained that prior studies have involved in-depth geriatric assessment but only before treatment started.
In the FITNESS study, participants are followed closely for side effects and geriatric assessment throughout the course of treatment.
“We want to understand side effects better. We have a lot of newer treatments and we don’t know how older adults will tolerate and respond to them,” she said.
The geriatric assessment is a comprehensive visit.
“We’re really looking to see how the patient is functioning,” said Presley. “Can they still take care of themselves? How’s their mobility and nutrition? Are they vulnerable or fit? Can they tolerate treatment?”
It’s important to know if a patient is able to take medications as prescribed on their own or if they would need assistance.
“Treatment itself can involve taking a pill. And every treatment relies on taking other medications for things like nausea, diarrhea, constipation. Sometimes lifestyle changes are involved,” said Presley.
That’s why it’s important to understand how well a person functions and what type of support system they have around them.
“We also do blood and stool tests to check the microbiome bacteria that live in the gut. We think there’s a link between the types of bacteria in the gut and how you’ll respond to immunotherapy and what the side effects might be,” said Presley.
She noted that research has shown that when you ask about specific symptoms and treat them, people can actually live longer, even if you don’t change anything about their cancer care.
“I ask all my patients, regardless of age. Function is what we’re focusing on. And we have a symptom monitoring program for FITNESS age criteria 60 and older,” she said.
Presley said it’s something that could be done in routine practice, even if it’s not part of a study.
“Our clinical team learned a lot from this study and will probably apply basic geriatric principles as part of routine care for all patients. It’s about personalizing cancer care. It’s patient-centered care,” she continued.
Presley believes doctors need more time with their patients.
“I do think patients on this study get more time with the research coordinator. They ask detailed questions about how they’re feeling. We’re asking, so they tell us. We don’t know if they would otherwise,” she said.
The goal, said Presley, is to keep patients living the life they want to live during cancer treatment.
“Smitty is one of the healthiest patients. He’s done exceptionally well,” she said.
Smith learned he had cancer in September 2018 after seeking treatment for hip pain.
Cancer in the lung had reached surrounding lymph nodes and the esophagus.
A Vietnam veteran, Smith told Healthline he had been exposed to Agent Orange, a known carcinogen.
Initial treatment included five months of chemotherapy and radiation therapy, as well as surgery to remove part of this left lung.
“I’m breathing better now,” he said, still working at his desk.
Through it all, Smith continued in his career as a building manager.
He still goes to the OSUCCC–James once every two weeks for chemotherapy. It’s a regimen he will continue for two years.
“It’s a lighter type of chemo to make sure the cancer doesn’t come back. I’m wiped out for a couple of days, then I’m fine until next time. I don’t lift heavy things anymore. I don’t go as fast as I used to, but I still keep up a good pace,” he said.
His daily walk, once 9 to 11 miles, is now down to 6.
Smith calls the FITNESS program “amazing.”
He believes state of mind plays an important role, too.
“When I found out about the cancer, I knew nothing would ever be as hard as Vietnam. If you have something in life you went through, you mentally think in your mind, ‘OK, I got through that. I can get through this.’ You can still keep positive even if you can’t do some stuff you used to be able to do,” he said.
As of this week, Smith is retiring, at least for now. But that doesn’t mean he’ll be taking it easy.
He’ll start by painting the interior of his house. It’s the first item on the “honey do” list.
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