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Once she began treating adults, she “branched out” to study the psychosocial effect that cancer—and cancer treatments—had on older patients. “I began to understand that older adults are influenced 85 by ageist attitudes on the part of others,” Kagan said. “We’re almost paternalistic in an effort to protect older people whom we think are vulnerable.”

The idea that cancer was inevitable or expected in older populations perhaps fed the notion that the elderly would not benefit—or could not tolerate—conventional cancer treatments.

The elderly were less frequently enrolled in clinical studies than younger patients, due to insufficient family support or commuting difficulties, and because Medicare did not cover the costs of clinical trial participants older than 65 until 2000.

Oncology professionals also lacked studies on how elderly cancer patients with comorbidities—heart disease, diabetes, etc.—would respond to common therapies.

Edward Trimble, MD, a leading cancer researcher at the National Institutes of Health in Bethesda, Md., said among studies comparing treatments in clinical trials, “older patients tend to fare about as well as younger patients” when no comorbidities exist.

“But there is a perception 85 that they are frail and less likely to tolerate aggressive treatment for cancer, for they tend to get treated less aggressively.”

Collaborative gap

Even with the Medicare change, a large collaborative gap between gerontology and oncology remains, Trimble said. “We are looking at a number of cancer centers 85 that are active in gerontology, but we just don’t have that now,” Trimble said. “We need to come up with an effective form or scale 85 to help the busy oncologist figure out how somebody who is older and has morbidities is going to tolerate his cancer treatment.”

Kagan, Trimble said, has “been one of the people fighting the good fight to bring the oncologist together with the gerontologist.”

The prejudice that results in fewer care options for the elderly has spurred much of Kagan’s research, which includes collaborative articles in nursing and medical journals such as the American Journal of Epidemiology, Critical Care Nurse, American Journal of Nursing and Head and Neck.

Kagan teaches at Penn’s nursing and medical schools, and conducts research through Penn’s Hartford Center of Geriatric Nursing Excellence (one of only five geriatric nursing centers in the United States funded by the New York-based John A. Hartford Foundation).

She also holds a clinical post as a gerontology clinical nurse specialist at the Hospital of the University of Pennsylvania. In addition, Kagan holds numerous visiting academic posts in Hong Kong, Sweden and at Harvard University.

“One of the privileges I have is being able to see the success that advances in biomedical technology have generated, and also the needs that advancing therapies have created,” Kagan said, “which give nurses who are interested in building science and evidence-based practice a lot of room to take leadership. And that’s one of the things I really enjoy doing, and helping people see where we should go next.”

Contact Glen Fest at glenf@nurseweek.com.