Advancing age is the leading risk factor for most cancers. 2016 data from NCI's Surveillance, Epidemiology, and End Results program show the median age at cancer diagnosis is now 66, and 25 percent of new cancer cases are diagnosed in patients between the ages of 65 and 74. Given the size of the Baby Boomer population in the U.S., this country faces a pressing need for physicians with dual expertise in oncology and geriatrics-and with particular interest in cancer research.
Arti Hurria, MD, is one of the few physicians meeting this need for dual specialty knowledge. And she is working diligently to change that. Hurria is Director of the City of Hope Cancer and Aging Research Program at City of Hope Hospital in Duarte, Calif., and a founder of the Cancer and Aging Research Group (CARG; http://www.mycarg.org). CARG's mission is to foster collaboration among geriatric oncology researchers across the nation so they can design and implement clinical trials that will result in improved care for older adults with cancer.
"This group provides a national mechanism for mentoring," Hurria told Oncology Times. "It brings together senior and junior investigators who might otherwise not have been able to work together. It has become a real community."
Professional Development
CARG's focus on professional developed was enhanced in part from Hurria's experience as chairperson of the Professional Development Committee for ASCO from 2015 to 2016. She began a 4-year term on the ASCO Board of Directors in June 2016.
"When I was chair of ASCO's Professional Development Committee my major focus was not just mentoring during an oncologist's early career, but mentoring that continues across the career trajectory," she said. "In medicine, we are pretty good at mentoring early in a physician's career. But few programs focus on sustaining that mentoring across the career."
She and colleagues at ASCO were influenced by an article published in The New Yorker in 2011. Written by surgeon and public health researcher Atul Gawande, "Personal Best," as it was headlined, explored the idea that much like elite athletes and performers, surgeons might benefit from coaching.
"No matter how well-trained people are, few can sustain their best performance on their own," Gawande wrote. He related his experience seeking help with his tennis serve, when an eye-opening parallel struck him. "Professional athletes use coaches to make sure they are as good as they can be. ... But doctors don't. I'd paid to have a kid just out of college look at my serve. So why did I find it inconceivable to pay someone to come into my operating room and coach me on my surgical technique?"
ASCO has developed several versions of this coaching concept. One is the luminaries program, in which ASCO invites experienced oncologists to foster knowledge and development in physicians who are newer to the specialty. "There are so many people who have been truly outstanding leaders in the field of oncology," Hurria said. "Sometimes when they get to that pinnacle, their wisdom might not be harnessed to the degree it could be for the next generation. We want to make sure they have the opportunity to engage with junior faculty and pass down lessons learned."
For information on other development opportunities within ASCO, visit https://www.asco.org/training-education/professional-development.
Enter CARG
CARG began to take shape in 2006, when a handful of oncologists started talking via conference call about their research ideas. "It began as a true grassroots effort, with no red tape," Hurria said. "My vision was that it be as open and collaborative as possible. The only requirement is the desire to help an older adult who has cancer."
Eleven years later, an average of 30-40 oncologists call in for each 1-hour meeting-and the group list has grown to encompass more than 190 people, Hurria explained. The calls are scheduled at the same time every other week, allowing participants to block out their office schedules consistently.
Oncologists typically learn about CARG via colleagues or articles such as this one. "Most commonly, people contact us and say they have heard about the work of this group and want to become involved. That's all they need to say," Hurria said.
She explained that CARG grows expertise and confidence by relying on a buddy system in which junior investigators and more senior investigators are connected to facilitate the fine-tuning of research ideas, answer career development questions, and more. The agenda for the calls can be adjusted for deadlines or other pressing concerns, when warranted. For example, CARG recently reworked its agenda plans for a call when some researchers faced a deadline for an NIH grant application that required some geriatric input. The researchers were allowed to present their questions during the phone call to gain valuable insight for the application.
CARG itself has been successful in obtaining grant funding to identify research priorities in cancer and aging. They received support for a 5-year U13 grant in collaboration with the NIA and NCI that supported three conferences focused on fostering high quality research for older adults with cancer. The white papers from these conferences and the slide sets are available on http://www.mycarg.org.
Some of the ongoing studies which CARG investigators participate in include evaluating the utility of an assessment tool for older adults with cancer; clinical and biological predictors of chemotherapy toxicity in older adults; the tolerability of the combination of lapatinib and trastuzumab in adults 60 and older with HER2-positive metastatic breast cancer; and the longitudinal impact of adjuvant chemotherapy on functional status, comorbidity, and quality of life.
Outside the Box
Oncology is certainly not the only medical specialty that needs more experts dually interested in the aging population. Hurria hopes CARG serves as a model for other physicians and health care providers to collaborate and foster advanced specialty knowledge. In their 2008 article on mentoring, she and colleagues from the group encouraged application of the model in other clinical areas (J Clin Oncol 2008;26(19):3125-3127).
"We had to think outside the box," she recalled. "We realized that the field could potentially die if we didn't get more people involved. It was that realization that prompted us to figure out a way to form a nationwide opportunity to fill that void.
"... We want to help people realize that you don't need to obtain dual training to help this patient population," Hurria continued. "You just need the desire to learn and help."
To inquire about joining the next CARG conference call, use the contact tool at this link: http://www.mycarg.org/contact_us2.
Michelle Perron is a contributing writer.