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John D. and Catherine T. MacArthur Foundation	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Sarah Kagan, Ph.D., RN, is only the second nurse to win the “genius” grant from the MacArthur Foundation.

‘That’s so sad.” People meeting Sarah Kagan, Ph.D., RN, often get the wrong idea when she tells them she works with elderly patients with cancer. They react with sorrow as they imagine Kagan struggling through the daily despair of ailing seniors losing time and hope.

“My work isn’t at all sad,” Kagan counters. As both a practicing nurse and a researcher, she has found that the bleak outlook stems from ageist attitudes and a dearth of scientific knowledge about older people and cancer. Instead of believing that the elderly are “supposed to get sick,” Kagan has devoted her career to learning the paths to recovery for patients with cancer who are 65 and older, she said.

“It’s really about living, and living as well as you can,” said Kagan, an associate professor of gerontological nursing at the University of Pennsylvania. “As a result, I’m commonly in the situation of explaining to people what’s really rewarding and what’s really hopeful about working with older adults who have cancer.”

Thanks to the 41-year-old Kagan, there may be much more optimism to share in the years to come. Kagan was honored in the fall as one of 24 recipients of a 2003 MacArthur Foundation Fellowship, the “no strings attached” $500,000 annual award that goes to trailblazers in the fields of science, medicine and the arts.

Kagan is only the second nurse to win the prestigious “genius” grant, whose recipients in past years have included writer Thomas Pynchon, paleontologist Stephen Jay Gould, filmmaker Errol Morris, pioneering geneticist Barbara McClintock, magician and pseudoscience debunker James Randi and children’s activist Marian Wright Edelman.

The John D. and Catherine T. MacArthur Foundation cited Kagan’s efforts to meld research and clinical care to substantiate how elderly cancer patients respond differently than younger patients to treatment, in both physiological and psychological factors.

The foundation applauded Kagan’s 1997 book, Older Adults Coping With Cancer, for challenging “ingrained preconceptions about the treatment of older patients, [and] providing a framework for understanding their heterogeneity of responses to cancer.”

Like all MacArthur fellows, Kagan received the honor through an anonymous nomination process. She was notified by phone by the foundation, giving her “a bit of a shock,” she said, laughing.

Leading expert

The foundation noted Kagan is fast becoming one of the nation’s leading experts on older people with cancer—particularly head and neck cancers—while bridging the surprisingly nontethered sciences of oncology and gerontology. She is scheduled to publish her second book, Cancer in the Context of Lives Mostly Lived, next year.

“We are surrounded by a culture that views aging in a particular way,” Kagan said. “I think that older adults may even often self-stereotype themselves and believe that they might not benefit from cancer therapy. Or because they are old, they are supposed to be ill.”
Kagan’s interest in geriatric oncology began early in her career in the mid-1980s, when she arrived in San Francisco with dual bachelors degrees in behavioral sciences and nursing, and was offered a position at Children’s Hospital (now California Pacific Medical Center) under the wing of the medical/surgical oncology nurse manager. She accepted the job when she realized the effect nursing has in cancer treatment.

“That was when it really came together,” Kagan said. “Much of what older adults require to successfully complete cancer treatment is, in fact, delivered by nurses. Nurses really are the ones who make or break cancer treatment and the central experience of what we consider to be the medical model of cancer experience.”

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