Clin-STAR Journey Story

Age-Adaptive Oncology: Rethinking Cancer Treatment for Older Adults

Tanyanika Phillips, MD, MPH, is an oncologist and geriatrician at City of Hope, where she focuses on improving cancer care for older adults. Working with her mentor William Dale, MD, PhD, she was first author of a recent review article in the Journal of the American Geriatrics Society: Clin-STAR Corner: Practice Changing Advances at the Interface of Oncology and Geriatrics. This article focuses on the intersection of geriatrics and oncology and urges a shift from traditional age-based guidelines to an age-adaptive approach.

To move away from chronologic age as the main factor in treatment decisions, the article emphasizes the role of geriatric assessment. “This is why I use the term age-adaptive. We can’t sufficiently define an aging population by chronologic age anymore,” Dr. Phillips said. “A political construct defined the age of Medicare beneficiaries at 65. As the US population has aged, these concepts have shifted.”

She stresses that assessing functional status—whether a person can still engage in activities like working or exercising—should guide treatment decisions. “If someone comes in, and they’re still going to aerobics class three times a week, driving, and maybe even working at 82, we should talk about what treatments they are a good candidate for,” Dr. Phillips said. “But if they’re coming in using a wheelchair and can’t get through a day without help, the conversation changes. We need to be thinking about their functional reserve.”

This focus on functional reserve and functional status has important implications for older adults undergoing cancer treatment. Assessing functional status through tools like the Practical Geriatric Assessment has been shown not only to reduce the risk of treatment-related toxicity but also to improve chemotherapy completion rates, and the Practical Geriatric Assessment Tool has been endorsed by the NCCN and ASCO guidelines policy. “We’re seeing how geriatric assessment guides treatment decisions, helping us manage side effects while ensuring that patients actually complete the treatment as planned,” she said. “These tools make a real difference.”

In her clinical practice, Dr. Phillips works with a wide range of patients. Despite her specialization in lung cancer, her age-adaptive approach to oncology means that she treats a variety of cancers across different age groups, particularly those affecting older adults. “I don’t get to choose who walks through the door,” she said. “I may see an 80-year-old patient with lung cancer one day and a 60-year-old patient with prostate cancer the next. It’s about managing the complexity that comes with treating older patients.”

As a proponent of interdisciplinary approaches, Dr. Phillips readily acknowledges barriers to their widespread practice. “It’s not easy,” she said. “We have to be ambassadors for this change. We’re all overwhelmed in our practices and with emerging technology. We need better communication and collaboration across specialties. But we also need trust. It’s essential to get primary care physicians and geriatricians involved with the oncologists and other specialists because, ultimately, they are the ones who are going to manage these patients’ long-term care.”

Dr. Phillips’s perspective also incorporates a broader view of cancer and aging, beyond the clinical aspects. “We must now consider the dynamics of sociogenomic aging and cancer, which considers such concepts as the impact of chronic stressors, neighborhood disadvantage, and so on, and how those affect cancer genomics. We’re aging in a world that’s changing rapidly,” she said.

Through her work, Dr. Phillips envisions a future where oncology is less defined by the patient’s age and more by their ability to function. “In ten years, I don’t think we’ll focus on chronologic age,” she said. “We’ll be thinking about the whole person aging on a continuum—what they can do, how they live, and how they can keep their autonomy. I see that as the future of age-adaptive oncology.”