Episode 44: Ageless Decisions - Navigating Geriatric Oncology, Clinical Trials, and Patient-Centric Care
This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features this study by Dr. Mohile.
About our guest
Dr. Supriya Gupta Mohile, a distinguished figure in the field of geriatric oncology, is a Professor of Medicine and Surgery at the James Wilmot Cancer Institute, University of Rochester. Her research focuses on assessing patterns of care, health outcomes, and quality of life in older patients undergoing systemic cancer treatment. With nearly 300 publications in geriatric oncology, she serves as the Editor-in-Chief of the Journal of Geriatric Oncology and chairs the ASCO Geriatric Oncology Clinical Guideline panel. Her significant contributions include receiving funding from organizations like the Patient-Centered Outcomes Research Institute and NCI R-level awards, for evaluating the impact of geriatric assessment on the outcomes of older cancer patients. You can find her research in the following journals: Lancet, Journal of Clinical Oncology, and JAMA Oncology. In addition to her research focus, Dr. Mohile works closely with such patients in the Cancer and Aging Research Group, providing administrative support to a community of older adults with cancer and their caregivers.
Watch the video of our episode on YouTube
On the challenge of treating older cancer patients using clinical trial data.
But the problem is, we're getting clinical trial data in very fit patients, either younger or even older patients who are very healthy. And then we don't know when we have the drugs come on market, what is the safety and efficacy for the patient that's sitting in front of me in the clinic who has a disability, has heart disease, has real insufficiency, lives alone, is having trouble taking their medicines, and may not be as fit as the people that are in the trials. And then we're just guessing. It's really crazy in medicine how much guessing we do.
On the way people often make decisions based on anecdotal evidence from their friends and not science.
Even my mother does this too, for example, about knee injections. She said ‘All my friends told me not to do this one. They told me to do that one instead.’ I'm like, ‘mom, I'm a physician. This doesn't matter. This is what the data shows. I appreciate that this bad thing happened to your friend, but it's not necessarily going to happen to you.’ But people will use anecdotal information to drive decisions more than evidence.
Despite preventative measures, people still get cancer.
Screening is really important and will detect things. But unfortunately, no matter what you do, there are patients who will get cancer because of genetics, or for reasons we just don't know. It's unfortunate, but there is an existential thing that I believe in: we can't control everything. The world functions in a way that, as human beings, we just can’t explain, and we cannot control. And we're not going to be able to explain it. So when patients come to me and say ‘why me’? They want to know why. I can say sometimes we just don't know why and it's not up to us. Something happens, the universe exists. So we have to move forward and help with what we can help.
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