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In her first year of residency, Kah Poh (Melissa) Loh, MD, MS, was sometimes uncomfortable treating older adults because their problems were seldom straightforward. Often, the issue that brought them to the hospital was just one of several interconnected challenges.

“It’s not just one thing, and being a young doctor, I was troubled with that,” recalled Loh, who is now an associate professor of hematology-oncology and director of the Geriatric Hematology Research Program at University of Rochester in New York. 

But rather than shy away from the complexity, Loh decided to lean into it. She worked to overcome her own anxiety and focused more on listening. She did a clinical rotation in geriatrics, joined a geriatric interest group, and even made visits to an assisted living facility, where she played games with the residents. 

“I care a lot about being efficient, so I just wanted to focus on what they were saying and solve it right there. But that’s not really the right way,” Loh said. “You really have to sit down, listen to what they say and really probe the right questions to get to what is important.”

Loh said that extra work made her a better doctor overall and ended up fostering her interest in the care of older adults. Today, at 36, she is focused on improving the care of older adults with aggressive blood cancers both through her pioneering clinical work and through research. 

Loh, who has received grants from the National Cancer Institute and multiple organizations and has more than 200 peer-reviewed published articles, develops and evaluates behavioral and supportive care interventions, often using digital health technologies such as telehealth or mobile apps.

Treating older adults with cancer requires physicians to be excellent diagnosticians and honest, clear communicators while also recognizing the patient’s autonomy, said Supriya Mohile, MD, the Philip and Marilyn Wehrheim Professor of Medicine at the University of Rochester, who has worked with Loh since she came to the University of Rochester as a fellow 10 years ago. Loh excels in all those areas, she said. 

“What sets her apart is she really takes what she’s learning in the clinic and translates that to interventions that could help the broader community outside of Rochester,” Mohile said.

From Malaysia to Rochester, New York

Loh’s training has taken her across the world. Born and brought up in Malaysia, she attended medical school in Ireland, where her first experience with cancer research happened at the Royal College of Physicians and Surgeons. “I knew at that point that I was interested in research and wanted to incorporate it as part of my training,” she said. 

During those years, a student exchange program also took Loh to Bahrain. After medical school, she moved to the United States for residency training in internal medicine at Baystate Medical Center in Massachusetts before pursing fellowship in hematology-oncology and geriatrics at the University of Rochester. She joined the faculty there in 2019. 

Her global perspective has allowed Loh to see the pros and cons of the US healthcare system. “The US has the latest advances and research in clinical trials and drugs, but the problem is access,” she said. 

Another challenge in the US is coordination — especially important for older adults, who may be taking 20 medications that were prescribed by multiple physicians spread across different healthcare systems. “When I try to call a clinician, it’s 10 steps before I get there, and a lot of people don’t want to do that,” Loh said. “The way the system is set up, there are just a lot of barriers, and you need to be really persistent to get through that.” 

Harnessing Digital Technologies for Decision-Making

Along with clinical care, Loh is focused on research into nonpharmaceutical interventions that can improve the quality of life for older patients undergoing treatment for cancer. These can come in the form of different behavioral interventions, such as exercise or digital health apps.

“The overall goal is for them to feel better as they go through treatment for the cancer,” Loh said. “Drugs are important, don’t get me wrong, but drugs often come with side effects. I want to do it through lifestyle or supportive programs.”

In an ongoing pilot randomized controlled trial, Loh and her team are comparing the early effects of a mobile exercise intervention for cancer patients vs chemotherapy education among 100 older adults with myeloid neoplasms who are receiving outpatient cancer treatment. The study looks at patients’ physical functions as well as patient-reported fatigue, mood and quality of life. 

“We know physical activity helps with things like quality of life, fatigue, and memory. Exercise can help a lot without the side effects that come with drugs,” Loh said. 

Loh is also exploring ways to help older patients with cancer make complex care decisions more quickly. She is currently testing the use of a strategy that aims to distill what is most important to patients by asking about what they value most, from living longer vs quality of life to how important it is to be at home vs the hospital. The questionnaire also asks about how well they care for themselves at home and whether they have caregiver support.

“We want to see if that information, now given to the oncologist and patients themselves, will then make the decision more shared or more patient centered,” Loh said. “I want to make sure that the decision that we make for each older adult with cancer is what they want.” 

Loh is also testing the ability of telehealth to facilitate serious illness conversations for older adults with cancer. 

The goal of all these efforts is to create personalized care for all older adults with blood cancers, Loh said, whether that is a targeted drug therapy or a specific supportive care program that can be utilized alongside it. 

The challenge, she said, is that the interventions that prove successful in clinical trials don’t always make it to the patients who need them. “We create this great exercise program or this great drug, but in reality, many times they don’t get to the people we are trying to serve, for a variety of reasons,” Loh said. “The system needs to be easier for patients to get what they need. I think there is a lot of complexity built into the healthcare system that is serving as a barrier.” 

Loh reported no relevant financial relationships.