1. Nalley, Catlin

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The B.J. Kennedy Award and Lecture for Scientific Excellence in Geriatric Oncology recognizes those who have not only made significant contributions to geriatric oncology, but have also helped fellows and junior faculty understand the importance of the specialty.

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This year's recipient is Andrew E. Chapman, DO, FACP, Professor of Medical Oncology in the Department of Medical Oncology of the Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, and a Clinical Professor in Jefferson's College of Nursing.


In September 2010, Chapman and colleagues launched the Jefferson Senior Adult Oncology Center. A unique concept at the time, this program specializes in the multidisciplinary evaluation and treatment of older adults with cancer, bringing together a number of disciplines.


"Geriatric oncology really is a team sport," noted Chapman, who is also the Chief of Cancer Services for the Sidney Kimmel Cancer Center, the Enterprise Senior Vice President of the Jefferson Health System for Medical Oncology, and Vice Chair for Clinical Operations for the Department of Medical Oncology. "And, [that] is the power of the multidisciplinary group where each of the health care providers is able to add their area of expertise."


When accepting the award during the ASCO 2020 meeting, Chapman noted, "I'm humbled to receive this award. It's an incredible honor, but it's really an honor for the team at Jefferson because we are only as good as each of us together."


Health Care Delivery

During his award lecture, titled "Health Care Delivery for the Older Adult With Cancer: Where Do We Go From Here?," Chapman discussed the current model in the U.S., as well as ongoing challenges associated with geriatric care.


He began by calling attention to issues in the health care delivery system, including fragmentation, unaffordability, unsustainability, the potential for consumer bankruptcy, significant provider frustration, and patient's falling through the cracks.

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"Fragmentation is really the risk that we can't afford when we try to build highly reliable, safe, high-quality health care delivery models and health care systems," he noted, going on to discuss how he has witnessed health care transformation and geriatric oncology intersect.


Looking at the landscape worldwide, Chapman noted that there is a tremendous opportunity to build geriatric oncology clinics and develop training centers globally (Crit Rev Oncol Hematol 2007;62:62-73, J Geriatr Oncol 2017;8:374-386).


The Jefferson Health Experience

When developing a care model for geriatric patients, Chapman emphasized that "there is no one-size-fits-all. There is no right way to specifically do this and what's really important is to look locally at what resources exist and to get started and really just do it."


The Senior Adult Oncology Center at Jefferson was the first multidisciplinary geriatric oncology evaluation center in the tri-state area, according to Chapman. "It's a multidisciplinary, interprofessional team that's comprised of navigation, geriatrics, nutrition, social work, pharmacy, and medical oncology," he explained. "And, I'm happy to report that within the past 2 weeks we have a commitment now to have full-time physical therapy in the center."


Chapman shared a number of patient outcomes highlighting the impact of the various disciplines on decision-making, including:


* Geriatrics: 80 percent of evaluations lead to changes in medications regimens, treatment plans, or referrals


* Nutrition: 60 percent of patients are identified as "at risk" for malnutrition and counseled


* Medical Oncology: 70 percent of treatment plans are altered by the multidisciplinary conference



In terms of next steps, Chapman noted that the center now has a G8 nursing pilot that is IRB-approved. The goal of this program, he said, is to train all nurses in the health system who work in the outpatient oncology offices to administer the G8 and score patients. Those with an abnormal score will then be referred to the Senior Adult Oncology Center.


A "Caregiver Education Program for Older Adults with Cancer" is in development as well as a "Enterprise Survivorship Program," which Chapman noted will include an emphasis on the needs of older adults. An electronic health record-based ePRO platform for symptom tracking and management is also underway.


Five Challenges in Geriatric Oncology

Chapman also highlighted five challenges associated with geriatric oncology that must be addressed. The first being the development of geriatric oncology programs.


"This is a call to action to all academic medical centers, NCI-designated cancer centers, and health system leaders," urged Chapman.


"If you have a geriatric oncology program, thank you. But, if you don't have a geriatric oncology program, can we please turn on the lights?


"There's been tremendous work done in terms of trying to understand how to help the health care workforce," he noted. "Most of the education in this setting has taken the form of needs assessments and curriculum delivery. There's been discussions about embedding geriatric oncology core curriculum and what role does licensure play."


Chapman acknowledged that there are not enough medical oncologists or geriatricians to care for the number of patients in the U.S. One way to close this gap, he noted, is to empower the caregiver with the knowledge they need.


This leads into the next challenge: workforce expansion. "Is it not time to require geriatric and geriatric oncology core competency education and training for all health care professionals to receive and maintain their licensure if they care for older adults with cancer?" Chapman asked.


"And, is it not time to alleviate caregiver burden and stress by providing the necessary education and skills to care for all older adults with cancer?" he continued. "I want to believe that all of you would agree that the answer to these is a resounding yes."


The third challenge, Chapman noted, is tailoring cancer delivery for older adults. He believes this can be done by respecting the unique vulnerabilities, needs, and goals of these patients, as well as taking a closer look at value-based and survivorship care programs.


The next challenge-geriatric assessment-goes hand in hand with this need for individualized care. The geriatric assessment for all older adults with cancer prior to starting active treatment for their disease must be standard of care, according to Chapman, who added that a gap assessment tool and how-to guide would soon be available through the Association of Community Cancer Centers.


"[This] brings me now to the fifth, and final, challenge that I call climbing the mountain," Chapman said, who recalled the experience shared by a mountain climber.


"He said that when everyone comes to base camp, there's a buzz. Everyone is excited. The passion is everywhere. They can't wait to get started.


"And then the climb begins, and the hours and the days go by," he continued. "and the wind picks up, the cold sets in, and the air gets thinner."


At that point, Chapman said, only those who are obsessed with reaching the summit and who will not take no for an answer will reach their destination. For those interested in geriatric oncology, he urged them to "look deep inside yourself and find the obsession.


"The obsession is to make the lives of older adults with cancer better," Chapman concluded.


"And once you find this, you will then learn that there is a whole family out there who will welcome you with open arms and support all of your efforts. I want to thank you so much for your time and attention in helping us to climb the mountain."


Catlin Nalley is a contributing writer.


ASCO B.J. Kennedy Award & Lecture for Scientific Excellence in Geriatric Oncology