Tailoring Care to Vulnerable Patients
Mohamed Sorror, Blood Cancer Physician and Outcomes Research Scientist
Dr. Mohamed Sorror’s patients come to him with a trove of stories accumulated over a lifetime of family, career, hobbies and travel. But Sorror’s focus is on their future, not their past. And he is determined to help them make the most of it.
“For older patients, the time remaining is extremely precious,” said the clinical researcher at Fred Hutchinson Cancer Research Center, whose work is dedicated to improving the care of older, frailer or medically complicated patients. “And their focus is on those fine details of enjoying life, on the time they spend with a partner, with loved ones.”
At the heart of what Sorror does lies an unfortunate reality: Most people with blood cancers like leukemias are seniors, and yet research studies aimed at improving care for these diseases routinely exclude them.
There can be good reasons for this — patient safety, for example, on trials of an experimental new drug. But that leaves a big gap in knowledge about how best to care for people in their 60s and up and those with health challenges.
That gap is what Sorror has dedicated his career to filling in.
“How are we going to change that? We cannot just say ‘you’re doomed,’” Sorror said. “There has to be science to say: ‘Can we change things around to make your life better, or longer?’”
Sorror, who is originally from Egypt, came to Fred Hutch in the early 2000s, when his new Seattle colleagues had just developed protocols that made it possible for older or sicker patients to receive bone marrow transplants. Bone marrow transplantation is an aggressive, highly toxic therapy that nevertheless offers people with advanced blood cancers a chance at cure.
This development, which used lower levels of noxious chemotherapy and radiation, presented many patients who could not tolerate standard transplant with a valuable new treatment option. But it also illuminated an important question: How can you know if a given patient will be best served by one transplant protocol or another — or by some other form of care entirely?
"We cannot just say ‘you’re doomed,’” Sorror said. “There has to be science to say: ‘Can we change things around to make your life better, or longer?’”
With his research, Sorror is erecting trail markers that help patients and their doctors choose the best way to go when they are presented with these diverging paths. He and colleagues developed the first scoring system, now used worldwide, for predicting the risks a transplant poses a particular patient. He is developing new, evidence-based decision-making tools for blood-cancer doctors. And his research studies turn the traditional paradigm on its head by enrolling only those he calls the “marginalized patients” who desperately need research to inform their care.
For such patients, “decision-making can be extremely confusing. Because on one side, they are hearing from [doctors] who may not be aware of all the data. They might hear: ‘Well you’re old, your chances are minimal.’” Sorror explained. “So they appreciate hearing that, no, we actually have models to give us a better idea about your health, to give us a better idea about how to move forward.”
Some patients are likely to wring the most enjoyment out of life by forgoing the most toxic cancer treatments, which cause side effects that would likely put them in and out of hospitals and nursing homes for the rest of their lives. Others, whose later years are graced with strength, could safely choose an aggressive treatment that could cure their cancers. His research has helped to draw clearer delineations between the two and define more-tailored treatment protocols to help them.
Sorror thinks back to one patient, a retired doctor who was nearly 80 years old when they met for the first time. The man had a type of cancer that could theoretically be cured with a bone marrow transplant. But only a few people in the world had ever received a transplant at that age.
Nevertheless, Sorror’s evidence-based tests found that the man was as strong as someone decades younger and would be a good candidate for a transplant. With Sorror’s guidance, the man went ahead with it.
Two years later, Sorror ran into his former patient and his wife, who had been newlyweds when Sorror first met them. The man began to cry when he saw his doctor again. “And his wife said, ‘You’ve given us two additional wonderful years of life,’” Sorror remembered.
Some may say that compared to a long lifetime already lived, two years means little. But Sorror — and the many patients he has helped — know better than that.
— By Susan Keown, Nov. 14, 2018
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