Aging-Cancer Demographics
 As the population ages, many diseases that predominantly
affect older individuals will become more prevalent. Many conditions
that affect the elderly will occur in combination, thereby complicating
care for any specific condition. Advancing age is a high risk factor
for cancer, with persons over 65 accounting for 60% of newly diagnosed
malignancies and 70% of all cancer deaths. Moreover, the incidence
of cancer in those over 65 is 10 times greater than in those younger
than 65 and the cancer death rate is 16 times greater in patients over
65 compared to younger patients. More than 70% of the mortality
associated with many cancers including prostate, bladder, colon, uterus,
pancreas, stomach, rectum and lung occur in patients 65 and older
The
graying demographics of the United States population
and the fact that cancer incidence in humans rises exponentially in the
final decades of life, suggests that cancer may soon replace heart disease
as the leading cause of death in this country. These demographics raise critical
challenges to be met by American medicine. In addition to indicating
the importance of preparing to deal with the increased burden of cancer,
these data give rise to a number of questions regarding the relation
of aging to cancer. Why is cancer more prominent in older patients? Is
cancer different in older patients? Should cancer be treated differently
in younger and older patients? What can be learned about the biology
of cancer in the elderly that can be applied to cancer research and treatment
in general?
Aging-Cancer Research Development Grant
Anticipating
the surge in cancer patients among older Americans,
the National Institute of Aging and the National Cancer Institute convened
a workshop in 2001 to identify priorities and stimulate research efforts
to improve the outlook for this group of patients (Yancik & Holmes, NIA/NCI Workshop
Report). Based on the outcomes of the conference, the NIA & NCI
established programs to integrate Aging and Cancer Research at NCI Designated
Cancer Centers. Case Western Reserve University, under the leadership
of Dr. Nathan A. Berger, PI, and Dr. Jerome Kowal, co-PI, was designated
one of eight institutions to receive an NIA-NCI funded P20 grant for
Aging Cancer Research Program Development. The grant was awarded based
on Case Western Reserve’s long standing commitment to aging research
and geriatric education, the highly successful Case Comprehensive Cancer
Center, a strong institutional commitment to interdisciplinary research,
established collaborative relations between the aging and cancer research
communities, strong support from the medical school and the Cancer Center,
and strong leadership in both aging and cancer research. Aging-Cancer
P20 Grants were awarded also to Cancer centers at Memorial Sloan Kettering,
University of Pittsburgh, University of Iowa, University of South Florida,
University of Wisconsin, University of Colorado and University of Washington.
To
address the intersection of aging and cancer, the eight-P20
institutions are pursuing research in eight high priority
thematic areas identified by the NIA and the NCI. Investigations
at the Case Comprehensive Cancer Center take place
in four of these research priority areas:
- Treatment Efficacy and Tolerance
- Effects of Comorbidities
- Psychosocial Aspects of Cancer in the Elderly
- Biology of Aging and Cancer
As a result of pilot projects, other
research activities stimulated during the past three
years and interdisciplinary aging-cancer conferences,
we have developed six robust aging-cancer focus areas.
Each of the six programs has interdisciplinary overlap
and interacts with each other. They serve as the basis
for important translational research activities and
have already developed inter-programmatic activities
with other cancer center programs. By strategically
awarding new aging-cancer pilot projects in these areas,
the six focus areas serve as major platforms for continued
enhancement of aging-cancer research at the Case Comprehensive
Cancer Center. These focus areas are:
- Chromosomal
Breakage and DNA Repair in Aging and Cancer
- Age
Dependent Changes in Brain Tumor Biology
- Obesity
Signaling Mechanisms in Age Related Cancers
- Impact
of Comorbidities on Cancer in the Elderly
- Treatment
Efficacy and Tolerance in Older Patients with Cancer
and Age Bias
- Psychosocial
and Health Services Research in Aging & Cancer
Program
development has been accomplished and continues to
be developed by leveraging the considerable resources
and expertise of cancer researchers and aging researchers
at CASE, involving new investigators from across the
CASE campus including the Schools of Medicine, Nursing,
Arts & Sciences and Social Sciences and recruiting
new investigators from outside the University. The
mechanisms that have been used to successfully stimulate
integration of aging and cancer research include strategic
use of developmental funds from the P20 supplemented
by support from the School of Medicine and the Cancer
Center. Financial resources for the Aging-Cancer
Initiative have been provided also by the Schools of
Arts & Science, Nursing and Applied Social Sciences. These
funds have been used to support pilot project development,
meetings, seminars, symposia, guest speakers and faculty
recruitment. One of our important approaches,
to stimulate interdisciplinary research, is to require
that all pilot project applications have at least two
co-investigators, one a cancer researcher and the other
an aging researcher.
Since
the beginning of the P20 grant in October 2003, the
program has awarded 22 pilot grants to CASE faculty,
contributed to the expansion of two Cancer Center core
facilities (Clinical Trials and Clinical Pharmacology),
established a successful weekly Aging-Cancer Seminar
Series and conducted three very well attended Aging-Cancer
Symposia. The first symposium, in October 2004,
focused on Growth Factors in Aging and Cancer, the
second, in October 2005, focused on Psychosocial and
Health Services Research in Aging and Cancer and the
third annual Aging-Cancer Symposium, in November 2006,
focused on Chromosomal Breakage in Aging and Cancer
Research. The weekly seminar series, annual
symposia and associated guest lectures have been highly
effective at stimulating interest in Aging-Cancer research
and led to interdisciplinary and collaborative research
both within the University and with external collaborators
as well. Moreover, the symposia have been well attended,
attracted interest on a regional basis, and served
to recruit new trainees to aging-cancer research programs.
Aging Cancer Research Program in the Case Comprehensive
Cancer Center
In
2006, Dr. Jerome Kowal attained emeritus status and
was succeeded as Co-Principal Investigator of the P20
Aging Cancer Research Program development Grant by
Dr. Julia H. Rose, Ph.D., associate professor of Medicine. Currently,
Dr. Rose serves as Director of the Western Reserve
Geriatric Education Center at the school of medicine
and Co-Director of the Veterans Administration-Geriatric
Research Education and Clinical Center. Her
research focus is in health services and various aspects
of psychosocial interventions of geriatric medicine.
In 2007 the Aging Cancer Research Initiative, under
the co-leadership of Nathan A. Berger, M.D., and Julia
Rose, Ph.D. was included as a program in the competitive
renewal application of the Case Comprehensive Cancer
Center. The Aging Cancer Research Program was
recognized as an excellent addition to the Cancer Center
and was approved for five more years of funding by
the NCI through the Case Comprehensive Cancer Center
grant.
Geriatric Oncology Clinic at the Ireland Cancer
Center
In 2006, Dr. Cynthia Owusu, M.D., Ms.C., trained
in both Medical Oncology and Geriatrics was recruited
from Boston University Medical Center to organize and
supervise the Geriatric Oncology Clinic at the University
Hospitals Ireland Cancer Center. In the Geriatrics Oncology
Clinics, scheduled to open May 2007, Dr. Owusu will provide
consultative and management services for elder patients
with cancer; her specialty is elder patients with breast
cancer. Dr. Owusu is assisted in the Geriatric
Oncology Clinics by Dr. Panos Savvides who specializes
in Upper Aero-Digestive malignancies, especially in older
patients.
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