Here is a riddle for our times: What do a blacksmith, a conservation analyst, a gerontology/oncology nurse specialist, and a sculptor have in common? The answer: $100,000, which is the cash grant each will receive for the next five years as one of this year's MacArthur Fellows, the so-called “genius grant” program underwritten by the John D. and Catherine T. MacArthur Foundation.
“I've watched the Fellowship announcements year after year, and I've always regarded [the MacArthur Fellowships] as an incredible societal service awarding originality and creativity and acknowledging contributions,” Sarah H. Kagan, PhD, RN, Associate Professor of Gerontological Nursing and the Doris R. Schwartz Term Professor in Gerontological Nursing at the University of Pennsylvania School of Nursing and Abramson Cancer Center recalled in a telephone interview.
Coincidentally, Dr. Kagan knows Jonathan F. Fanton, the MacArthur Foundation's President. “When I heard his voice on the phone, I couldn't figure out why he was calling me….I still don't believe it,” she said.
In fact, Dr. Kagan was so surprised by the announcement that she said she welcomed the three-month waiting period before she actually received the check. “I think that's why they have the three-month delay—so that the recipients can have time to fully comprehend the award.”
But while she is comprehending her good fortune, Dr. Kagan told OT that she is really not too worried about the check triggering a spending spree or causing her to lose touch with reality: “I've always considered myself pretty frugal….I haven't sought media attention, but I'm happy to have the opportunity to have people listen to me talk about nursing in a positive way or to discuss patient safety and the nursing shortage. I think this may be an opportunity to make people understand the incredible intellectual discipline that is nursing.”
Indeed, Dr. Kagan is a living example of her number one lesson: “that people can work with older adults who have cancer and not walk around depressed.”
She said that her days are actually filled with smiles because she has the opportunity to observe what nurses in oncology and gerontology are “doing in partnership with patients every day.”
This can-do attitude is a lifelong trait for Dr. Kagan, who grew up in Hartford, Michigan, a small farming community located about 40 minutes away from Kalamazoo on the I-94 corridor. “I grew up on a farm where we had corn and fruit trees—in fact my first leadership position was as president of the 4-H,” she recalled.
2 Undergraduate Degrees, Then MS & PhD
But the farm was also just 90 minutes from Chicago, and it was Chicago that initially attracted Dr. Kagan. She received an AB from the University of Chicago in 1986 and a BS two years later from Rush University. She explains the back-to-back degrees this way: “When I was at the University of Chicago, I read an article one summer about nursing, which was proposed as a solution to the then health care crisis. So I went back to school to get a degree in nursing.”
Although it was a scholarly article that prompted her to enroll in the nursing program at Rush, Dr. Kagan also has a family link to health care. “My grandmother was a nurse, and my grandfather was an orthopedic surgeon,” she said.
Armed with two undergraduate degrees she headed west to San Francisco, where she rounded out her education with an MS and a PhD from the University of California, San Francisco—and she found her true calling as an oncology nurse specialist.
“When I moved to San Francisco I took a position in acute oncology. I didn't realize how rewarding this would be,” she said. Interestingly, “most of our patients were older. These patients like to talk to the nurses.”
She said it seemed intuitive to her that oncology and gerontology are two fields that “are not two separate areas of health care, but actually absolutely need to be integrated.”
This need for integration of the two disciplines is increasing as oncologists begin to use more aggressive treatments on older patients, she said. The need for well-training dual nursing specialists is greatest among the “old, old patients over 85, who have more functional needs and fewer resources socially, financially, and personally, so we need to consider what it is we can do to adapt ‘usual’ oncology care to meet the needs of this unusual population.”
To that end, Dr. Kagan wrote Older Adults Coping with Cancer: Integrating Cancer into a Life Mostly Lived (1997, NY, Garland Publishing). That book was the outgrowth of her dissertation, and she was just preparing to go on sabbatical from her post at the University of Pennsylvania to write another book when she received the call from the MacArthur Foundation.
While most of that writing will be done in her home that she shares with three cats, Dr. Kagan said she will also spend some time traveling and lecturing. This spring she will be carrying her message about caring for elderly cancer patients to international nursing meetings in Stockholm, Dublin, and Sydney.
Research & Teaching
Dr. Kagan's program of clinical research is centered on symptom management in older adults, particularly those who have cancer. Head and neck cancer is a model of cancer in older adults, she notes. It affects primarily people who are in late middle age or older and is associated with many changes in function and quality of life that are amenable to nursing and collaborative intervention.
Dr. Kagan is now summarizing the results of a study that examined the use of e-mail for communication between patients and their doctors and nurses for symptom management after head and neck cancer surgery, a study that will be used to further explore this communication medium for patients who may be voiceless.
Dr. Kagan also teaches students in the undergraduate nursing program, where she directs the required course “Nursing Care of the Older Adult,” a hallmark of which is a student-directed seminar of ethical decision-making, which is facilitated by some of Dr. Kagan's physician colleagues with whom she collaborates in her clinical practice.
Dr. Kagan also lectures in the Gerontology and Oncology Master's degree programs and precepts graduate students and Geriatric Medicine fellows in acute care gerontology and symptom management.