Clin-STAR Journey Story

Centering the Patient in Cancer Care: A Journey Toward Personalized Survivorship Care

Dana E. Giza, MD, is a geriatrician who completed a family medicine residency before pursuing a geriatrics fellowship. She is an Assistant Professor in the Joan and Stanford Alexander Division of Geriatrics and Palliative Medicine at the University of Texas Health Science Center at Houston (UTHealth). Located in the heart of the Texas Medical Center, Dr. Giza has been fortunate to work closely with experts across multiple disciplines to advance patient-centered care and aging research. Early on in her medical training, Dr. Giza saw a pattern in her patients seeking primary care who had been or were currently undergoing cancer treatments. She realized that there was a missing piece in survivorship care—that of how to best assist older adult cancer survivors return to their baseline, and/or thrive in the recovery phase. Older adult cancer survivors often face unique challenges during survivorship care: managing multiple chronic conditions, complicated medication regimens, lingering complications from adjuvant therapies, and functional decline. Importantly, their health priorities may change, such as valuing the quality of life more than the quantity of life. What “good health” means after cancer can be very different for everyone. Dr. Giza believes that finding out what matters to the patient is imperative to ensuring a healthier and meaningful survivorship period.

At UTHealth, Dr. Giza works within a collaborative model that was established between the Oncology and Geriatrics Divisions. The teams work together to identify patient priorities during survivorship care, so that the best survivorship care plans can be crafted. This patient-centered approach is based upon the Patient Priorities-aligned Care (PPC) Framework. The framework was originally tested with a group of older adults with multiple chronic conditions (including cancer). Dr. Giza has adapted the framework to meet the specific needs of older adults during survivorship. Traditional cancer studies often use overall survival or progression-free survival as primary outcomes. However, older patients’ survivorship goals are not limited to a longer, disease-free status. Their goals include functional ability and socially oriented activities. Staying connected to their family and community is often a high priority and highly dependent on functional independence. Dr. Giza’s GEMSSTAR project used the adapted PPC framework for older women who had survived breast cancer. “The GEMSSTAR funding was essential for this project. It supported the research study and strengthened the multidisciplinary collaboration at UTHealth while improving the quality of care for older adult cancer survivors.” Patients enrolled in the study expressed appreciation for the opportunity to discuss what matters most to them during survivorship care. Since the initiation of Dr. Giza’s project, the Oncology and Primary Care collaborators found the information on what matters most to their patients during survivorship care useful to incorporate into survivorship recommendations, and the data and feedback inspired additional projects and ideas.

Dr. Giza also credits her success to the mentorship of Drs. Holly Holmes and Aanand Naik, who helped her create structured mentorship goals for her career and personal development. Her mentors introduced Dr. Giza to the Clin-STAR community. She is appreciative that the Clin-STAR community brings together clinical investigators from across the country. “There are a lot of experts working in aging research, and Clin-STAR is the resource that brings them together, facilitates networking, and provides opportunities to learn and collaborate.” Dr. Giza underscored the value of Clin-STAR as it initiates and supports collaborations outside of your institution and your geographical area. By attending conferences and connecting with others at different sites and levels of resources, you “identify universal challenges and local challenges.” When attempting to create solutions, it is very important to know if you are solving a local problem or if you are creating a process and collecting data in a way that can be applied to other regions or situations.

Dr. Giza is working on expanding the use of the adapted PPC framework tool and testing its feasibility in different cancer survivor populations. She believes that “if you prioritize the patient’s goals in the survivorship care, you can actually reduce treatment plan complexity by eliminating unwanted medications, procedures and visits that are in the way of achieving patients’ most important goal.” She hopes her work will encourage a shift in larger clinical trials focused on survivorship care to include outcomes that are important to patients themselves, like quality of life and functional independence. She is also committed to identifying value-based care strategies that support cost-effective survivorship care. “In the long term, we want to be able to modify and tailor survivorship guidelines for patient care that reflect their individual priorities so that they achieve the outcomes that matter the most for them.”