Dana-Farber expands program for older adult blood cancer patients

The OHM Program team includes, from left: program assistant Nolan Condron; geriatrician Tammy Hshieh, MD; program director Gregory Abel, MD, MPH; and geriatrician and program co-director Jane Ann Driver, MD, MPH.

Launched three years ago, a program unique to Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) has paired geriatricians with oncologists to address the needs of blood cancer patients 75 and older, whose ability to tolerate chemotherapy treatment may be complicated by frailty, non-cancer medical issues, and cognitive impairments.

Now, the successful pilot program has been expanded to include not only patients with leukemia and myelodysplastic syndrome – as in the original project – but lymphoma and multiple myeloma as well.

“I’m excited to see the program grow,” says Gregory Abel, MD, MPH, director of the Older Adult Hematologic Malignancy (OHM) program. “There will now be rigorous assessments of all patients 75 and over,” he adds. “They will be assessed by a specially-trained clinic assistant at their first visit, and if they need geriatric services, they will be referred to a geriatric physician.”

The geriatric specialists are Jane Ann Driver, MD, MPH, who is the co-director of the OHM program, and Tammy Hshieh, MD, who also serve in the Brigham and Women’s Hospital Division of Aging.

A key feature of the program is that the oncologist and geriatricians are located together in the clinic, where they can see the patients on the same day time rather than in separate appointments.

“I share the same room as the oncologists, making this a very patient-centered process,” says Driver. “This is especially helpful at the very beginning, when we are making decisions with the patient about what type of treatments would be appropriate.”

The geriatrician’s input is also important later, she adds, “when patients may become more frail from the effects of chemotherapy and we may need to lower the dose of other medications – such as for diabetes or high blood pressure – so they are able to continue treatment.”

While the leaders of the OHM program believe the incorporation of geriatric care can improve patients’ outcomes and quality of life, this has yet to be proven scientifically. So they have launched a new clinical trial to compare patients who receive the added geriatric services with those getting standard care.

Patients with blood cancers who are 75 and older can have a higher risk of side effects from treatment. They also often have chronic conditions, such as heart disease or diabetes, or problems with mobility or memory, that complicate therapy.

The initial assessment may find that despite their age, some patients are robust and living independently, while others could benefit from a range of support services. The geriatricians can refer them for help with diet and exercise, physical therapy, counseling for emotional well-being, transportation to and from medical appointments, and financial security.

Driver says she’s not aware of any other cancer center that embeds geriatricians with oncologists, or that is conducting research on how this partnership can improve outcomes.

“We believe what we’re doing is unique and important,” she says. “If we can show that it helps, our program has the potential to impact how older patients receive cancer care everywhere.”