Geriatric oncology award recipient aims to ‘right-size’ cancer treatment for older adults
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William Dale, MD, PhD, FASCO, has experienced a range of emotions since learning he’d receive the B.J. Kennedy Geriatric Oncology Award at this year’s ASCO Annual Meeting.
The sense of honor he feels for recognition of his contributions to the field is accompanied by a deep gratitude for two past recipients — the late Arti Hurria, MD, FASCO, who received the award in 2013, and Supriya G. Mohile, MD, MS, the 2018 honoree.
“Supriya and Arti were my closest colleagues in everything I did. ... They both said, ‘Oh, we need to make sure you are recognized, too,’” Dale, vice chair for academic affairs in City of Hope’s department of supportive care medicine and director of the institution’s Center for Cancer and Aging, recalled during an interview with Healio.
Now that Dale has received the award, the achievement is bittersweet in that he and Mohile will not be able to celebrate with Hurria, a world-renowned leader in geriatric oncology who died in 2018 from injuries sustained in a car accident.
Dale — who holds the title of George Tsai Family Chair in Geriatric Oncology in Honor of Arti Hurria, MD — said he hopes to live up to the award in a way that would make his friends and other colleagues proud.
“I’m a little bit nervous, because there’s such a legacy to maintain,” Dale said. “I want to keep up the attention to the field, so I am honored, humbled and nervous all at the same time.”
‘A scholar at heart’
Dale — an internationally recognized leader in cancer and aging, supportive care, and cancer survivorship — has a doctorate in health policy.
He holds the distinction of being the first non-oncologist to win the B.J. Kennedy Award.
“I am a geriatrician and palliative medicine doctor, but I’m not an oncologist,” he said. “I’m very humbled by the idea that my contributions to the cancer world were important enough to be recognized by my oncology colleagues.”
The contributions that supported Dale’s selection as this year’s honoree are extensive.
He has more than 250 academic publications to his credit. He has received continuous funding from NIH and other foundations on medical decision-making, high-value medical care models, and building infrastructures that better represent the older adult population.
He is the first author who led the development of ASCO’s most recent guideline for the care of older adults with cancer. He also is co-leader, with Drs. Mohile and Heidi Klepin of the Cancer and Aging Research Group, a collaboration designed to connect diverse, multidisciplinary cancer and aging researchers around the country to design and launch trials and other scholarship to improve care for older adults with cancer.
“I’m a scholar at heart, and my contributions in research mean a lot to me — especially scholarship around ‘right-sizing’ cancer treatments for older adults,” Dale told Healio. “We don’t want to be overtreating people who are vulnerable and wouldn’t tolerate aggressive treatments but, on the other side, we don’t want to undertreat robust people just because they are a certain calendar age. We want to be making management decisions for people based not on their chronological age, but on their fitness or ability to tolerate treatments.”
When asked about career highlights, Dale cited two randomized studies — GAIN and GAP70+ — that assessed the value of geriatric assessment-guided management in cancer treatment.
“These studies came out and showed definitively that geriatric assessments, with the right supportive care interventions, can lead to important outcomes in a randomized setting that The Lancet and JAMA would publish,” he said. “They showed that we could significantly decrease toxicity from treatment with no negative impact to survival, meaning we didn’t decrease overall survival by lowering dosage, for example, or by giving more supportive care interventions.”
These studies influenced the need to update the recent ASCO guideline, Dale said.
“ASCO was inspired by the fact that we had this really strong randomized evidence that the GA-guided interventions we had developed were effective for patients,” he said. “It shifted the ground to where it really is a standard of care to do these multidisciplinary geriatric assessments for people over 65.”
Another career highlight for Dale is CARG, which he built while at City of Hope and grew with Mohile and Hurria.
Since its inception in 2006, CARG has expanded from 10 people to over 650 worldwide. Following Dr. Hurria’s passing, the group added Heidi Diana Klepin, MD, MS — professor of hematology/oncology at Wake Forest University School of Medicine — as a third partner and secured its second large NIH grant.
“Our community gets together on Zoom twice a month to have a conversation — not all 600+, but about 70 of us,” Dale said. “This has become the largest organization of its kind in North America, with reach across more than 20 countries. We’ve created a community, and I’m proud of having helped create that community.”
Dale is proud of the mentoring he has had the opportunity to do, and he acknowledged those who helped mentor him throughout his career.
“I love the mentoring we get to do,” he said. “I was lucky enough to have some great mentors, mostly women, and now I get to pay that forward.”
Intervention, integration and investment
Despite the considerable progress Dale and his colleagues have fostered in geriatric oncology, he continues to seek ways to advance the field.
“We have developed really nice geriatric assessments,” he said. “Now it’s time to fully develop real-world interventions — whether they are drug interventions or behavioral interventions — that are designed for older people with various levels of fitness. That’s crucial, and it motivates me a lot.”
Because cancer is a disease of aging, Dale emphasized the need to ensure better representation of older patients in cancer clinical trials.
“More than 50% of patients with cancer are over age 65. These are not atypical patients. They’re actually the standard [patients with cancer],” he said. “Yet, only about 20% or 25% of patients in cancer clinical trials are older than age 65. We develop a lot of therapies for young people, and then we apply those therapies and doses to older people.”
Improving clinical trial design to be more inclusive of the older adult population should be an ongoing goal in oncology, Dale said.
He also outlined his long-term goals, which he refers to as the “three Is” — interventions, integration, and investments.
“We need new interventions — especially complex, multispecialty interventions,” he said. “We need better integration of the medical delivery system for older people and everyone else currently excluded.”
With regard to investments, financial barriers must be overcome to make the first two “Is” a reality, Dale said.
“There are too many financial disincentives right now, at least in the short-term,” Dale said. “You can get reimbursed for geriatric assessments, but they’re minimal reimbursements, and they don’t really move the dial. If we’re going to do them, we need the time and resources to do them.”
Lastly, Dale emphasized the need for more general science research into the phenomenon of biological aging, which could provide important insight into the development of effective treatments for cancer.
“There’s clearly a link between our aging systems, our susceptibility to cancer, and our ability to tolerate cancer therapies,” he said. “We need to understand the aging process at a basic level to help with cancer care.”
Dale likened improving research and care for the older population to a wheelchair-accessibility ramp at a building’s entrance.
“We tend to think, ‘Oh, we’re helping people who are disabled get up the stairs,’ but if you go anywhere there’s a disability ramp versus regular stairs, 95% of people are on the ramp,” Dale said. “Our investments in taking care of our vulnerable people can have benefits for all of us.”
For more information:
William Dale, MD, PhD, FASCO, can be reached at wdale@coh.org.
Reference:
- Cancer and Aging Research Group. Available at https://www.mycarg.org/. Accessed May 21, 2024.
- Li D, et al. JAMA Oncol. 2021;doi:10.1001/jamaoncol.2021.4158.
- Mohile SG, et al. Lancet. 2021;doi:10.1016/S0140-6736(21)01789-X.
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