With the passage of the Affordable Care Act in 2010 and most provisions due to take effect in 2014, it’s reasonable to ask what MD Anderson is doing to prepare.
Geriatricians Holly Holmes, M.D., (left), and Beatrice Edwards, M.D., both conduct comprehensive assessments with their patients. Each physician also has a sub-specialty that enhances the clinic's services. Photo: Wyatt McSpadden
“Quality of life” might be hard to define, but for MD Anderson’s two practicing geriatricians, guarding and protecting it informs everything they do.
Geriatricians are physicians trained in family practice or internal medicine, who are then trained and board-certified in geriatrics to care for adults 65 and older. Holly Holmes, M.D., and Beatrice Edwards, M.D., both associate professors in the department, specialize in the care of cancer patients in active treatment.
They believe patients and their loved ones shouldn’t plan for survival without considering how treatment might affect their quality of life. This is especially true for frail elders, who may be significantly affected by certain side effects of surgery, chemotherapy, radiation and other cancer treatments. They may be on many medications or dealing with bone loss, cognitive loss, dementia or depression.
Both Edwards and Holmes conduct the Comprehensive Geriatric Assessment with their patients. This is a cognitive, psychological, nutritional, social and functional evaluation that helps in two ways: It allows physicians to determine which patients can have better outcomes with cancer therapy; and it allows geriatricians to tailor an individualized care plan for those beginning cancer treatment.
Although both want to help their patients remain as functional and independent as possible, each has expertise in a field of research crucial to an elder’s quality of life.
Holmes is a former pharmacist whose research focuses on polypharmacy (the interaction of medications) and overmedication.
“Older people take a lot of medications, and we need to find ways to prevent the harms of overmedication during cancer care,” she says.
Understanding bone health essential
Edwards’ research concerns bone health in cancer survivors. She knows that the health of a person’s bones affects balance, strength and the ability to remain independent.
She says targeted cancer therapies like tamoxifen, aromatase inhibitors and androgen deprivation increase patients’ risk of developing osteoporosis. This condition makes people more susceptible to serious fractures of the hip, spine and axial areas, such as wrists and ankles.
Edwards is also part of the Rolanette and Berdon Lawrence Bone Disease Program of Texas, a collaboration of Baylor College of Medicine and MD Anderson that focuses on treating complex bone disorders. The program brings together internists, endocrinologists, rheumatologists and others to do translational research on safeguarding patients from fractures.
“Cancer ages you before your time,” Edwards says. “We want to stop the disability cascade.”
In our rapidly aging society, it’s clear that cancer among elders — and the difficult treatment decisions that follow — is a growing problem. But Edwards and Holmes try not to get overwhelmed by the demographic trends that show an explosion in the need for geriatricians.
They’re busy caring for patients, doing research and educating oncologists and fellow primary care doctors on the need to tread carefully when making treatment decisions for an aging population.
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