This story is reprinted with permission from the March/April 2018 issue of Chester County Life magazine.
Carrie Bova always knew the odds were high that she would be diagnosed with breast cancer one day. Bova's mother had both lung and breast cancer, passing away from the latter. So when Bova received the diagnosis of breast cancer last year, it didn't come as a complete shock. It had been years of getting mammograms every six months to monitor her health before Bova, of Exton, felt the lump on her right breast in the summer of 2017. "I had never had a scare before," says Bova. "I considered myself very healthy."
After an MRI and breast biopsy, Bova's diagnosis came back as stage 2 breast cancer. She sought treatment at The Cancer Center of Paoli Hospital, one of Main Line Health's five cancer centers. Due to her age—73 years old at the time of diagnosis—Bova was evaluated in Paoli's senior oncology program. The senior oncology program provides specialized attention to those patients over the age of 70 who have been diagnosed with cancer.
Older patients have different needs than younger patients diagnosed with cancer. This includes their ability to withstand aggressive treatment. "We do a more complete evaluation than the average oncologist would to evaluate those patients so we can identify any needs that someone over the age of 70 would have to help get them through chemotherapy well," says Michael Dabrow, DO, MS, oncologist and medical director of The Cancer Center of Paoli Hospital. "The goal is to find those patients who we don't think will tolerate treatment before putting them through something that would be somewhat detrimental to them. And we do not want to deny beneficial treatment to anyone simply due to their age if we feel physiologically they could tolerate treatment."
It's extremely common for patients over the age of 70 to be diagnosed with cancer. According to the National Institutes of Health, the total number of cancers is projected to increase by 45 percent from 2010 to 2030, driven largely by a growing number of older adults diagnosed with cancer. By 2030, an estimated 70 percent of all cancers will occur among adults over the age of 65. Dr. Dabrow explains that Paoli's senior oncology program uses the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) evaluation on each patient over the age of 70 to help predict the risk of chemotherapy toxicity in those patients. "The evaluation looks at things like what can the patient do on a daily basis, what's their mental status, what's their nutritional status, what chemotherapy are they getting," Dr. Dabrow explains. "They get a physical therapy and nutritional therapy analysis, and we put that all together to look for a total score that gives us an idea of what the risks are."
Through this evaluation oncologists can identify patients who wouldn't be able to withstand chemotherapy so they're not unnecessarily put through the toxic effect of treatment that would not provide a beneficial treatment outcome. According to Dr. Dabrow, there are newer treatments available today, such as immunotherapies, that could be used on these aging patients without the same side effects as traditional chemotherapy.
Some things that show up through the evaluation include low scores on nutrition and physical therapy, which can be addressed through the cancer center. "We can work with the patient to improve those scores and may be able to get them back into shape where they could withstand the treatment," says Dr. Dabrow. For those patients whose scores can't be improved, the oncologists are presented with the challenge of coming up with the most effective form of treatment for them.
Overall, geriatric cancer patients are benefiting from the advancements that are being made in cancer research. "Every day you look in the journals and someone is looking at something new and different when it comes to cancer research," says Dr. Dabrow. "As we identify more of the biology of the tumors and how gene changes effect growth of cells, we can target therapies that have a different or easier set of toxicities for patients. I think that's always encouraging."
Like all patients of The Cancer Center of Paoli Hospital, senior patients receive a complete pharmacy evaluation to look for polypharmacy and to make sure there are no detrimental drug interactions. Senior patients can also benefit from making use of the Cancer Center's extensive integrated therapies that include pet therapy, reiki, aromatherapy, massage, art therapy, music therapy, a nutritional support program, and more. The Cancer Center also has a collaboration with the Lankenau Institute of Medical Research, the biomedical research center for Main Line Health.
Carrie Bova went through the complete evaluation given to senior oncology patients at the center and was given her options once she was diagnosed. She met with Dr. Dabrow who explained that a bi-lateral mastectomy would be the best course for her to take in terms of local therapy. "Dr. Dabrow was excellent," says Bova. "He thoroughly explained what he thought would be the best treatment and the different chemotherapy drugs they would be using and the possible side effects I might have. He explained every single thing. It made me feel really comfortable knowing what might happen." Choosing to have the bi-lateral mastectomy ensured that Bova wouldn't have to go through another operation if something eventually showed up in her left breast.
Although Bova always knew she had the possibility of getting breast cancer due to her family history, receiving the actual diagnosis was humbling. "I approached the diagnosis the way I do everything in life, with a positive mindset," she says. "I knew what I had to do to get through it, and I just remained hopeful that everything would come out ok. It's so important to remain positive."
After the mastectomy, Bova went through three months of chemotherapy. "I had some good days and some bad days," she says. Chemotherapy side effects for Bova included extreme tiredness, queasiness and a metallic taste in her mouth.
Bova, a mother of two and grandmother of eight, recently completed her last round of chemotherapy. "My husband, children, family and friends were extremely supportive throughout my entire treatment," says Bova who is most looking forward to getting back to her normal routine post treatment. "I can't say enough about the high standard of care I received at Paoli," says Bova. "I felt so comfortable with the doctors, and the nurses were wonderful."
Caring for cancer patients age 70 and beyond
The average age of cancer patients in the United States is 70 years old yet many seniors are not offered certain cancer therapies because of concerns they will experience more severe side effects than a younger person. At Paoli Hospital we believe that older adults can and do benefit from cancer treatments, and that other medical conditions must be considered when developing a treatment plan. Our senior oncology program is specifically designed for patients age 70 and older who've been diagnosed with cancer and want to explore the variety of appropriate treatment options available to them—regardless of age.