Enrique Soto Pérez de Celis, M.D.
Geriatric Oncologist, Departamento de Hemato-Oncología Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránFollow this author
As a geriatric oncologist in Mexico, I’m eager to develop our first geriatric oncology program. The need for such a program has never been greater, as life expectancy in Mexico has been increasing, especially over the last decade. Life expectancy for women has risen to 77 years, and for men to 74 years. And as with any aging population, this means a concurrent increase in the cases of cancer seen in the elderly.
As such, it’s been my privilege as a visiting doctor from Mexico to meet and work alongside Dr. Arti Hurria, City of Hope’s Director of Cancer and Aging Research Program.
One of the areas that I find most fascinating is the research that Dr. Hurria is doing on chemotherapy toxicity. Her findings – including a toxicity calculator to see if elderly patients are more at risk of developing toxicity to chemotherapy – will help me to improve the treatment of elderly cancer patients back in Mexico.
I’m also studying other facets of the doctor’s life in the U.S., for example how they approach their work and how they structure their day. It’s particularly interesting to watch how Dr. Hurria interacts with her patients, especially the elderly, and also how she and City of Hope doctors deal culturally with Mexicans and other Latinos living outside of their mother countries.
This is an area that has a lot of research potential: How family structures are different in the United States vs. Latin America, or even how they are different in Los Angeles vs. the rest of the United States because of the heavy influence of Latinos here; the way different cultures deal with doctors, and how doctors deal with different cultures and languages; how Latinos adapt to life in the United States – a very foreign environment with differing access to healthcare resources and a different mindset regarding involvement of family and friends in health decisions. All of these are important factors that can influence everything from treatment outcomes to the levels of satisfaction that patients and their families’ experience.
This is why speaking Spanish is such a huge asset for doctors here in the Los Angeles area, with its large Latino population – many of whom are first generation and don’t speak much if any English. There’s always been a prevailing notion that immigrants should adapt to their surroundings, not the other way around. But that doesn’t work with very large immigrant populations. You’ve got to respect the culture and make an effort to understand family dynamics and other cultural values, and I can see this in the way that Dr. Hurria interacts with her patients and builds relationships with them.
This intersection with culture and language is particularly poignant when you think about the elderly population – and how we treat them in our respective countries. As Latinos, we cherish our families and especially our elders. But that is not always reflected in public policy toward the elderly. Almost all public health policies and investments are made with regards to young or working adults and their children – those deemed current or future productive members of society. We have to try harder to make sure that our elders do not become “the forgotten population” – and that they have opportunities to enjoy full lives, not just longer ones.
This means learning how to take better care of our aging population. Elderly patients with cancer do not always get the treatment and support that they need. If we don’t take preventative measures now to address this problem, it will only get worse as the elderly population grows and life expectancy continues to get longer.
America has already addressed the issue of an aging population and we hope to learn from that experience and tailor it to our own needs. For example, U.S. citizens have better access to medical facilities and insurance. If you are 65 or older, you are eligible for Medicare. In Mexico, there are no insurance programs from the government if you don’t work and pay taxes. About one-third of the population has no insurance and must pay out of pocket for their medical expenses. There are efforts underway to solve this, but so far the public insurance that has been made available is very limited and covers only new cancers – not the many cases of cancer already afflicting the elderly.
Another motivating factor for taking better care of the elderly is this: age is not always the best indicator of someone’s health or ability to overcome illness. Genetics, lifestyle choices, cultural attitudes, family and social support systems, involvement in activities outside the home – all of these play a part in longevity. We look at these things in geriatric oncology as well, as they can determine a patient’s ability to tolerate treatment and predict which ones might have problems with it – something we can use in conjunction with Dr. Hurria’s research on toxicology. All told, such information helps us tailor treatment to the individual, or find alternatives when it becomes necessary.
The experience here has been a win-win all around as we can learn a great deal from each other. We say in Mexico that Los Angeles is the second largest Mexican city because of its large population of immigrants. So we can share the social and cultural and linguistic nuances that are important to understand, especially when interacting with people in a healthcare environment. A little cultural intelligence goes a long way in reaching patients, adapting to their needs and understanding how to best treat them.
At the same, I am looking at the clinical setting through a new lens and gaining exposure to cutting-edge research. As I do so, I realize that we share a similar challenge. Just as U.S. doctors must learn to adapt to a changing population made up of more and more Latinos, so too must we in Mexico adapt to and better serve our growing population of elderly patients.