Dr. John Bennett Lauded for His Work in Geriatric Oncology

Fran Lowry

June 07, 2011

June 7, 2011 — John M. Bennett, MD, is slated to receive the 2011 B.J. Kennedy Award and Lecture for Scientific Excellence in Geriatric Oncology from the American Society of Clinical Oncology (ASCO) for his contribution to the field of geriatric oncology.

Dr. John Bennett

He will receive his award at the ASCO annual meeting, held in Chicago, Illinois, June 3 to 7.

Dr. Bennett is professor emeritus of medicine, pathology, and laboratory medicine at the James P. Wilmot Cancer Center, University of Rochester Medical Center, in New York.

The B.J. Kennedy Award honors individuals who have demonstrated outstanding leadership or contributed outstanding scientific work to further the field of geriatric oncology. It is named for ASCO past president B.J. Kennedy, MD, who was a pioneer in the field of geriatric oncology and who fostered the recognition of medical oncology as a subspecialty of internal medicine.

"John Bennett was one of the first oncologists to become interested in geriatric oncology," Lodovico Balducci, MD, program leader in the senior adult oncology program at the H. Lee Moffitt Cancer Center and Research Institute, in Tampa, Florida, told Medscape Medical News. Dr. Balducci was awarded the inaugural B.J. Kennedy Award in Geriatric Oncology by ASCO in 2007.

"As early as 1999, Dr. Bennett sent 2 of his faculty members to the annual meeting of the American Geriatric Society to participate in the special interest group of geriatric oncology. He was responsible for getting the grant from the Hartford Foundation that supported the first group of fellowships in geriatric oncology. He has been a visionary leader in geriatric oncology; without him, there probably would not be the programs of geriatric oncology that are flourishing throughout the United States. In him, I like to salute the mentor, the colleague, and the inspiration," Dr. Balducci said.

Career as a Hematologist

Dr. Bennett, who graduated cum laude from Harvard College in 1955, and who received his MD degree, also cum laude, from Boston University in 1959, originally trained in hematology and internal medicine in Boston, Massachusetts, and hematopathology at the National Institutes of Health in Bethesda, Maryland.

In 1969, he moved to Rochester, where he joined the faculty as head of the division of hematology/medical oncology at Highland Hospital. Five years later, he became the clinical director of the university's cancer center, a position he held for 20 years.

"Early in my career as a hematologist, it became perfectly clear that one could separate winners from losers on the basis of age," he told Medscape Medical News. "The younger you were with a hematologic malignancy, the more likely you were to respond to treatment."

Older people are more likely to suffer more complications from the same treatment that would be offered to a younger person with curative intent, he said.

There has been reluctance, over the years, to treat older individuals.

"When such treatment is offered to a person 70 years and older, often the complications resulting from the treatment can be significant, can impede the ability to respond, and may actually lead, in some instances, to premature death. There has been reluctance, over the years, to treat older individuals."

There is also a "clear cut" bias in the literature against older individuals, he said. "When one looks at regimens that have been approved and are in widespread use, these have been tested in younger people. So you're going into blind territory," he noted.

For example, bone marrow transplantation, until very recently, was only offered to individuals younger than 50 years of age. Now, individuals as old as 75, and even older, may be offered both allo- and autotransplantation, depending on the indication.

"A lot of this has to do with better supportive care, but a lot has to do with a better understanding of quality-of-life issues and what we call a 'geriatric assessment,' where we look at things like undiagnosed early dementia, the availability of companions and healthcare providers, and economics. You can have a patient who superficially looks very good, smiles, is happy, and gives consent for a procedure, and then find out that the patient really didn't know what you were talking about, suffers complications, and ends up in a nursing home," he said.

These factors started to be recognized in the 1970s and 1980s. In the late 1990s, Dr. Bennett spearheaded the development of a program that would allow young oncology fellows to train and be certified in both geriatrics and medical oncology.

"As oncologists and hematologists, 60% of our practice involves treating men and women who are over the age of 65," he said. "Our idea was to develop a new cadre of specialists who would, by and large, remain in academic institutions and be able to instruct medical oncologists, house staff, and medical students in the intricacies of how to care for older patients with cancer."

He was instrumental in securing funding from the John A. Hartford Foundation, which provided seed money and grant support for the new training program, started at 12 cancer centers in the United States. Soon after, Dr. Bennett persuaded ASCO to became involved and expand the program.

Eventually, he was able to convince the American Board of Internal Medicine, the American Medical Association, and the American Hospital Association to approve a combined certification program, not just in geriatrics and medical oncology, but in geriatrics and all the other specialties.

More Optimistic Today

Dr. Bennett said he is more optimistic today about the treatment that geriatric oncology patients receive than he was back in the 1990s.

"A lot of that optimism has little to do with what we've developed in these specialized training programs, but more to do with the molecular biologic discoveries, gene mapping, the identification of molecular pathways that affect the way tumor cells grow, and the development of targeted treatment that is basically antienzyme and, therefore, prevents some of the serious bone marrow complications that we used to see," he said.

"One of the best examples is imatinib (Gleevec). No matter what your age, you have the same likelihood of getting a good remission from imatinib," he points out.

The days when people used to feel that cancer patients older than 75 years of age should just go off to palliative care are for the most part over, he said.

"I think there has been so much dissemination at major meetings and in publications about new and better approaches for older patients with cancer that my suspicion is that the vast majority of medical oncologists and hematologists are thinking much more positively about their encounters with older patients than they were 15 or 20 years ago. It's difficult to quantify that, but it is my impression," Dr. Bennett said.