Advancing care for older people across health specialties, the AGS and AGS Health in Aging Foundation announced that two expert researchers—Kavita Dharmarajan, MD, MSc, an assistant professor in the Department of Radiation Oncology and the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in N.Y.; and Nazema Siddiqui, MD, MHSc, an associate professor of obstetrics and gynecology at Duke University Medical Center in Durham, N.C.—will receive the 2020 Jeffrey H. Silverstein Memorial Award for Emerging Investigators in the Surgical and Related Medical Specialties. Originally slated for presentation at the AGS 2020 Annual Scientific Meeting—now canceled due to the COVID-19 pandemic—the awards will be presented to Dr. Dharmarajan and Dr. Siddiqui at the AGS 2021 Annual Scientific Meeting (#AGS21) in Chicago, Ill. (May 12-15, 2021).
“Palliative Radiation Treatment in Older Adults with Brain Metastases: Benefit or Burden?” (Kavita Dharmarajan, MD, MSc)
For her work originally slated for presentation at #AGS20 and now profiled in a special supplement from the Journal of the American Geriatrics Society (JAGS), Dr. Dharmarajan and colleagues from across the Icahn School of Medicine at Mount Sinai looked at whether a certain form of palliative radiation therapy (a form of cancer treatment intended to reduce symptoms and improve quality of life) was associated with more benefits or burdens for older adults with certain types of cancer. For their work, the team looked at data from more than 28,000 patients with breast, lung, or gastrointestinal cancer and a diagnosis of brain metastases (which means that cancer has spread, or metastasized, to the brain from its original location). Of those patients, 20 percent were 75 years old or older, and more than 52 percent received a form of palliative radiation treatment known as “whole brain radiation therapy” (WBRT). More than 80 percent of patients receiving WBRT completed treatment.
Compared with younger patients, those 75-years-old and older were less likely to be offered palliative WBRT and more likely to stop WBRT prematurely. People over age 75 also experienced a higher rate of mortality within six months of completing radiation therapy. According to Dr. Dharmarajan and her colleagues, results suggest that WBRT as a palliative option frequently goes unfinished and can be associated with worse outcomes in older adults with cancer that has spread to the brain. More research is needed to identify patients likely to benefit from this type of a palliative option.
“Urinary Microbiome in Menopausal Women with Recurrent Urinary Tract Infections” (Nazema Siddiqui, MD, MHSc)
In her research also featured in the JAGS supplement, Dr. Siddiqui and colleagues from Duke, Oregon Health and Science University, and the University of Virginia turned a critical eye to one of healthcare’s most pervasive concerns for older women: Recurrent urinary tract infections (UTIs).
Specifically, Dr. Siddiqui and her team looked at the role different treatment options might play in the “urinary microbiome,” the medical term for the bacterial environment found in our urinary system (including normal/healthy levels of bacteria, as well as bacteria that can contribute to recurrent UTIs). These options include topical vaginal estrogen (a cream or ointment applied to the vagina to improve levels of estrogen, a hormone that declines during menopause and which many believe impacts levels of urinary-tract bacteria) and antibiotics (the standard treatment option for most bacterial infections, including UTIs).
Analyzing sterile urine samples from 65 women, the research team found that a specific type of bacteria known as Lactobacilli was found in the urinary microbiome of all women, but there were higher amounts in women without UTIs. For example:
- 35 percent of women with recurrent UTIs had moderate to large amounts of Lactobacillaceae when they were treated with topical vaginal estrogen and daily antibiotics.
- 44 percent of women with recurrent UTIs had moderate to large amounts of Lactobacillaceae when they were treated with topical vaginal estrogen but without daily antibiotics.
- By comparison, 56 percent of women without recurrent UTIs (also known as the “control group”) had moderate to large amounts of Lactobacillaceae.
There were also trends towards different species of Lactobacilli recovered in women taking daily antibiotics. Interestingly, the team was also able to use a new research technique known as Bayesian graphical compositional regression to identify smaller clusters of microbiome differences in women from the three groups above. These results point to subtle but important differences in bacteria, which may change our thinking about how and why UTIs recur, and our approaches to treatment by extension. Those differences are important, since UTIs remain among the most common bacterial infections for women, accounting for nearly 25 percent of all infections and ranking high among those infections most likely to reoccur.
The Silverstein Memorial Award is one of several honors conferred by the AGS at its Annual Scientific Meeting.
Past Recipients of the Jeffrey H. Silverstein Memorial Award
2019 Courtney Balentine, MD, MPH
2019 Candace Yvonne Parker-Autry, MD
2018 Tony Rosen, MD, MPH
2017 Anne M. Suskind, MD, MS