Clin-STAR Journey Story

Educating for Impact: Dr. Tullika Garg Leads the Charge in Geriatric Oncology Training for Urologists

Tullika Garg, MD, MPH, FACS, is a urologic oncologist with a dual appointment in the departments of Urology and Population Health Sciences at the Geisinger Medical Center in Danville, Pennsylvania. Dr. Garg (2019 GEMSSTAR) is an expert on caring for older adults with urinary bladder cancer, and she has focused her efforts on expanding the education and awareness of evidence-based geriatric care in the urology field.

Since medical school, Dr. Garg has enjoyed treating older adults. “Their stories inspire me,” she said. “As a first generation American, I didn’t get to know my grandparents, so I have always wanted to know more about the older adults I meet and learn from them.” When her father was diagnosed with prostate cancer in medical school, Dr. Garg developed her interest in urology. “Urologists take care of a lot of diseases associated with aging like cancer and urinary incontinence. I have always enjoyed working with my hands, so urology allows me to both care for older adults and operate.”

The biggest challenges Dr. Garg has seen in urology are decision making and risk assessment. Bladder cancer has one of the highest median ages at diagnosis, which means that in addition to cancer-specific risks, many older adults with bladder cancer also have co-existing chronic conditions and aging-related conditions. “Today there are so many therapeutic options. As surgeons, we also must think critically when weighing the risks for major cancer surgery in a medically complex, older adult, and we also need to understand their goals and values.”

Dr. Garg emphasized the need for clinicians to have meaningful conversations so that the decision-making process remains patient-centered. “Aging research gives us the tools to tailor urologic cancer care not just to the disease, but to the whole person—enabling older adults with cancer to live not only longer, but better.” Thus, Dr. Garg has dedicated her time and research to building awareness around the tools and evidence that are available to assist urologists in shared decision-making. “One of the biggest challenges for clinicians is time. There are great tools and risk scores, but they are not widely used.” Dr. Garg believes that education is the way we can increase the awareness and use of the tools, like frailty screening and surgical risk calculators. “When urologists can understand the tool AND its value in clinical care, my hope is that the use will increase.”

To aid in this journey, Dr. Garg led a multidisciplinary team that created the Geriatric Oncology Core Curriculum for the American Urologic Association (AUA). This resource was the first of its kind in urology to integrate epidemiology of aging populations, geriatric oncology, and palliative care competencies into urology education. The curriculum is embedded in international AUA programming and equips urologists at all stages of their career to better care for aging patients with complex needs.

Dr. Garg did not stop here. Along with colleagues from multiple specialties, Dr. Garg is focused on disseminating research and education via many modalities. In addition to the Geriatric Oncology Curriculum, she teaches an in-person course at the annual AUA conference (with another urologist oncologist and GEMSSTAR awardee, Dr. Sarah Psutka), where enrollment has consistently increased. “There is a general awareness that the population is getting older, and urologists are seeing this firsthand in their everyday practice,” she relays. “The interest by urologists continues to increase, and this is seen by the emergence of multiple forms of education dissemination.” Within the last few years, Dr. Garg has authored articles for continuing medical education, industry newsletters, and peer-reviewed journals. By putting risk and decision-making information into various forms of media, she hopes that more urologists will engage with existing tools and improve their ability to make thoughtful surgical decisions with older adults and ideally increase their quality of life.

When looking towards the future, Dr. Garg has been working on the validation and creation of improved shared decision-making tools for older adults with urologic diseases like bladder cancer. She continues to advocate for integration of age-friendly care in urologic practice. “Through training, urologists can have better conversations and true shared decision-making with older adults with bladder cancer,” she said. “The GEMSSTAR and Clin-STAR networks have wonderful resources to spark the interest of subspecialty junior faculty in aging research, and I would love to see more urologists engage in those opportunities.”