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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:

  1. Treatment Efficacy and Tolerance
  2. Effects of Comorbidities
  3. Psychosocial Aspects of Cancer in the Elderly
  4. 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:

  1. Chromosomal Breakage and DNA Repair in Aging and Cancer
  2. Age Dependent Changes in Brain Tumor Biology
  3. Obesity Signaling Mechanisms in Age Related Cancers
  4. Impact of Comorbidities on Cancer in the Elderly
  5. Treatment Efficacy and Tolerance in Older Patients with Cancer and Age Bias
  6. 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.