GENEROUS BENEFACTOR

The John A. Hartford Foundaton

In 1929, John A. Hartford, whose father had founded the Great Atlantic and Pacific Tea Company, decided to organize his charitable giving. With his brother George, he created a foundation and gave it only one guideline: to "strive always to do the greatest good for the greatest number." Early grants went mainly to nearby relief programs and health organizations, such as the New York City Cancer Institute, Westchester County Tuberculosis Association, and New York Infirmary. By 1959, the John A. Hartford Foundation was the nation's largest not-for-profit provider of clinical research.

Several years ago, the staff and board of the Foundation realized that, while 60% of cancer patients are over 65, seniors are under- represented in clinical trials. Despite America's aging population, few postgraduate medical education programs cover geriatrics adequately. "For the better part of 20 years, we've focused increasingly on health care for older adults. It's now our only program," explains Donna Regenstreif, PhD, Senior Program Officer. The Hartford Foundation funds training programs for doctors, nurses, and social workers who treat older patients and geriatric education for academic physicians. In 2000, the Foundation gave more than $24 million for geriatric training programs nationwide.

Apart from its unusual focus, the Hartford Foundation is unique for "recognizing that programs don't spring full-blown but take some evolution. [It] is very willing to work with grant applicants to develop an idea," says Harvey Jay Cohen, MD, Director of Duke University's Oncology-Geriatrics Training Program. A John A. Hartford Center of Excellence in Geriatrics, Duke has received significant funding over the past decade for geriatrics-related programs.

Dr. Cohen took part in several Geriatric Educational Retreats, designed by the Foundation with input from experts in the field. An Oncology Retreat in February 1997, he recalls, "spawned ways to implement the ideas we talked about [at the Geriatric Educational Retreats]. Some participants then gathered and planned the next phase, as related to oncology." The General Oncology Fellowship program was one result.

This program is funded through a two-year grant of $753,905, given by the Hartford Foundation to the University of Rochester School of Medicine and Dentistry, to create a nationally relevant subspecialty training model using geriatric oncology. John Bennett, MD, Professor Emeritus of Medicine at the University of Rochester, describes the model as "a formal training program in geriatric oncology that involves sections of medical oncology and geriatric divisions in universities, working closely together, in a common track of a three-year program." Dr. Bennett and William J. Hall, MD, Director of Geriatrics at the University of Rochester, were named as co-directors of the project, and 12 academic health centers took part.

"Without Foundation support," says Dr. Bennett, "this never would have happened."

Aware of the Hartford Foundation's work, ASCO hoped to hold a symposium on geriatric oncology at its 2000 Clinical Practice Forum. The first contact between the two organizations, in late 1999, was set up to explore possible Foundation help to defray expenses for the proposed symposium. With a $77,000 grant from the Foundation, ASCO presented the successful "Cancer Care in the Elderly: An Integrated Approach" in conjunction with last November's Forum.

In December, ASCO was selected to receive a direct four-year grant of $2,485,070 for Enhancing Geriatric Oncology Training (with the University of Rochester as a subcontractee). "Up to seven universities that want to develop a serious program linking geriatrics and oncology can receive funds under this program to support scholars at either the advanced or the junior fellow level," notes Dr. Regenstreif. Programs must include medical education, research, and clinical exposure to older patients with cancer. Grants, which begin in 2002, are under the aegis of a task force on aging and cancer, which will report to ASCO's Oncology Training Programs Committee. (ASCO will release Requests for Applications early in 2001.) More details on this exciting new program will be available in the April issue of ASCO News.

Dr. Bennett's goals are "improving skills of practicing oncologists by using new talent in a variety of ways and spreading the word through academic programs, lectures, and education." The three-year fellowships include rotations among different specialties in geriatrics and medicine, as well as research time. Fellows become Board-eligible in Medical Oncology and eligible for a Certificate of Added Qualification in Geriatrics. "We'll encourage them to stay in academic institutions, teach, do research, and provide limited patient care," says Dr. Bennett, who finds that a Hartford Foundation grant goes beyond financial support: "it's an ongoing dialogue, a very different approach."

Dr. Regenstreif concurs. "We're generally fully involved in developing a project. Once a grant is made, we don't turn our back and say goodbye for five years," she says. "We view this program as part of our strategies, to develop and test models for training medical subspecialists--in this case, oncologists--in geriatric aspects of their discipline, and to stimulate academic interest in issues related to care of their older patients."

Executive Director of the Foundation, Corinne Rieder, is "delighted the Foundation's long-standing commitment to improving the care of older adults now encompasses the education of fellows in oncology." She adds, "We hope our support will stimulate and hasten progress in this field, and we are grateful to ASCO for its willingness to administer and provide internal resources to support the effort," she says.

Dr. Regenstreif calls ASCO "the perfect organization, once these advances are made, to help translate them into everyday practice through its membership, and we also hope other subspecialties will adopt some variant of the model for their educational programs. The task gets more urgent with each passing year, as the population ages."

Dr. Cohen is optimistic. "Hartford's board [members] want to improve health and health care for older people. They know it takes time, with lots of intermediate steps, such as training practitioners who will improve the care along the way. I'd love to see ASCO, the John A. Hartford Foundation, and the American Geriatrics Society develop a long-standing partnership to pursue geriatric oncology."

ASCO appreciates the Foundation's commitment to furthering the training of oncologists to provide better care for older patients with cancer. With today's increasing elderly population, John and George Hartford could not possibly doubt that the Foundation is striving to do the greatest good for the greatest number.

Many of these articles appear on the publication's website, which are often password-protected or members-only. For your convenience, I've gathered them on my own website.