之间的医疗、老年肿瘤学模糊

Five years after chemotherapy and radiation treatment for breast cancer, she’s a feisty survivor who jokes good-naturedly about cooking for her Italian husband of 40 years.

Her visit to MD Anderson’s Internal Medicine Center in July put her in rare company, because her physician is a geriatrician.

Holly Holmes, M.D., is the only practicing geriatrician at the institution. An assistant professor in the Department of General Internal Medicine, she specializes in the care of elders who are long-term survivors, as well as those in active treatment.

Unique concerns of aging cancer patients

癌症是一种衰老疾病，我们的社会正在老化。这提出了关于最佳治疗选择的决定中的问题。

Elders are, on average, more likely to be on medications — in fact, a larger combination of them. They may also be dealing with bone loss and its effects on balance, strength and healing. Or they may be suffering from cognitive losses, dementia or depression.

完整的故事：
Support for Those Aging With Cancer
SEER Database 'Exceptional Resource'

A physician who is board certified in medicine and geriatrics, a geriatrician tries to help older adults remain as functional and independent as possible.

A geriatrician’s area of expertise, Holmes says, is taking care of frail elders.

Geriatric oncologists use well-established tools to assess the patient’s physical and mental state — called “staging the aging” — then recommend which therapies would most benefit them.

这些包括筛选工具，用于评估步态（行走）速度，完成日常生活活动的能力，例如沐浴，固定膳食，认知功能和抑郁症。

Patients are identified as being very healthy, average or frail. Frail patients are most at risk for adverse effects from cancer treatments, Holmes says.

Research explores medication

药剂师在她去医学院之前，福尔摩斯还进行了研究，该研究占她的70％的工作和对多酚职业的中心 - 药物的相互作用 - 以及过度地理解。188bet体育网址

She’s also helping to create a tool any physician can use as an aid to estimate the risks to elders of adverse effects from stem cell transplantation.

“We want to know who becomes medically frail as a result of certain treatments,” Holmes says. “My goal is to let patients know the likely consequences of choosing certain therapies, and do so thoroughly. I take into account not just what’s most effective to treat the cancer, but also how the patient will function afterward.”

Too much or too little

最难以罢工的平衡 - 以及治疗老年人的诱发者的关键是治疗和过度治疗之间。

Relatively few elders participate in clinical trials, though that is changing, and some treatments may be considered too harsh for those with co-morbid health conditions or physical or cognitive deficits.

霍尔姆斯说，对于虚弱长老来说，维持功能和舒适可能比尝试冗长或苛刻的治疗更重要。

“如果您有移动性问题，平衡问题，跌倒历史，或认知或记忆赤字，癌症治疗不会改善它们。”

Not enough geriatricians

Because there are only 7,000 geriatricians in the United States — three for every 10,000 adults older than 75 — Holmes says that family practice and internal medicine physicians must be aware that an older person diagnosed with cancer might need special attention and screenings before deciding on treatment.

她还考虑了老年人为教育肿瘤学家对老年患者的特殊需求是必不可少的。

幸运的是,研究生的鉴定委员会Medical Education, which accredits post-medical-degree training programs in the United States, recently mandated that oncology fellows receive training in geriatric oncology.

Data: U.S. Census Bureau's2008 national populationprojections

Van Morris，M.D.，血液学和肿瘤学研究所，阴影福尔摩斯，因为她在最近的周五看到患者。虽然莫里斯将专注于研究，但他理解旋转与福尔摩斯的重要性。188bet体育网址

“As the U.S. population gets older, we’ll see more people in the geriatric population. It’s important for us to understand the co-morbidities that affect treatment,” he says.

Coordinating care with patience, humor

在我们访问期间，Circelli报告称，她最近有尿路感染的症状和一些温和的背痛。她说，她去了她的初级保健医生进行治疗。

Soon Holmes is on the phone with this physician, finding out which tests he’s run and what he’s found. “This is what I spend a lot of time doing,” she explains to Morris. “Coordinating care.”

At the end of the call, she offers to send the primary care physician an email on the visit so he can keep Circelli’s chart up-to-date.

福尔摩斯有一种酷炫的床头方式，患者而不是直接的。很明显，她释放了她的练习并将患者视为独特的人。

And Circelli, whom Holmes calls “snazzy,” clearly adores the Internal Medicine Center — and Holmes. “I love her,” she says. “I feel I can tell her anything … like she’s my niece, maybe. They take good care of me here.”