Surgeon blends precise skill, compassion to treat head and neck cancers

As director of the Division of Head and Neck Oncologic Surgery in the Department of Otolaryngology – Head and Neck Surgery, Dr. Old specializes in removing tumors from some of the most sensitive areas of the body. These are places with complex nerve groupings and bone structures, and they’re also highly visible places like the face. Understandably, patients tend to be very self-aware about how a reconstruction in that area will appear after surgery.

As such, the margin for error in such sensitive places is minuscule — a mistake as small as a millimeter could have greatly affected what Kayne was able to do post-surgery.

Carcinoma can spread quickly, but because Kayne’s cancer was detected and treated early, he now lives a full, cancer-free life. The lifelong Columbus resident has since moved to Chicago to be near his three young grandchildren, but he comes back to see Dr. Old twice a year. His admiration for Dr. Old is boundless.

“Ever since early January of 2017, he was my doctor, oncologist, surgeon and my savior,” he says. “My outcome is a testament to his skill.”

A surgeon of the people

Talk to anyone in Dr. Old’s wide orbit — patients, nurses, fellow surgeons, medical professionals he has helped to educate — and you’ll hear the same chorus of adjectives.

Approachable.

Humble.

Patient.

Dedicated.

Caring.

“There are a lot of technical surgeons that do a great job, but don’t always have the soft skills or the emotional intelligence to navigate a really difficult situation,” says David Cohn, MD, MBA, FACHE, interim CEO and chief medical officer of the OSUCCC – James.

Specifically, Dr. Cohn points out how challenging it can be to deliver the kind of news that Dr. Old routinely has to tell patients. It’s not easy to explain to someone that they need a major lifesaving surgery that might reshape their appearance.

“He does an incredible job of still having the soft skills and knowing how to communicate appropriately,” Dr. Cohn says. 

Leslie Moore, RN, BSN, has worked with Dr. Old for all 15 years he’s been with the OSUCCC – James. She’s one of the core members of his team, serving as a sort of right hand to him on his weekly days in clinic. Those days are hectic — he’s usually scheduled to see 40 to 50 patients for post-surgery followups, each in increments of about 15 minutes.

Because the surgeries he performs are complex, there tends to be a long recovery period in the hospital before a patient is discharged. As such, Dr. Old has spent a good amount of time with his patients before they come back for these followups.

Leslie marvels at his ability to relate to the people he treats.

“He’ll always ask patients what they do for a living,” she explains. “We’ll have people who work in the trades, like plumbing and electrical. And he’ll say ‘Well I do the same thing as you, I just do it in the body and have different terms for it. I’m doing it with blood vessels and not pipes.’”

Gratitude for those who helped him

The youngest of four children of a career Texaco employee, he spent the first 13 years of his life in Houston before his father was transferred to New Orleans. After attending college at Stanford, where he was a standout swimmer on a team that won an NCAA national championship, he earned his medical degree at University of Texas-Houston Medical School.

“No one in my family was a physician, but for some reason I always knew that I wanted to be a doctor,” Dr. Old says.

“I am honored and humbled to do this for a living and be a part of people’s lives as I take care of them during a difficult time,” Dr. Old says.

His path to Ohio State began in about the last place you’d expect: the University of Michigan.

Dr. Old was there for a five-year residency where he met Theodoros Teknos, MD, who became his mentor. In 2008, Dr. Teknos was named director of the Head and Neck Oncologic Surgery program at the OSUCCC – James. One of his early recruits was Dr. Old, who arrived in 2009.

“Once I came and I met the people here, I saw the trajectory of the department and the trajectory of the cancer center,” he says. “I saw the amount of resources that are re-invested into furthering the mission. That, coupled with the people here, made this the place to be for my career.”

Here, he met David Schuller, MD, the first CEO of The James. Dr. Old now holds the David E. Schuller, MD, and Carole Schuller Chair in Otolaryngology, an honor he cherishes.

“He has just an unrelenting energy about him, a professionalism, a dedication and an unwavering ability to always do the right thing at the highest moral and ethical standards,” Dr. Old says of Dr. Schuller, who retired in 2015 after 44 years with Ohio State.

The two still stay in touch and discuss the many things they share in common, not the least of which is a passion for fly-fishing. (“He always catches something bigger than I do,” Dr. Old concedes.)

Growing the program

During Dr. Old’s time here, the Department of Otolaryngology – Head and Neck Surgery has grown into a national leader.

One of the major surgeries he performs is called a free flap surgery. This involves transferring a portion of tissue from one part of the body to help rebuild the part affected by cancer surgery. Nearly 350 of these procedures are performed annually at The James — more than double what most centers do nationally and triple what The James was doing a decade ago.

That volume is a big part of the reason that Ohio State’s fellowship program in head and neck surgery is highly sought after. James Rocco, MD, PhD, chair of the department, credits Dr. Old for overseeing its growth.

“It’s among the best head and neck fellowships,” Dr. Rocco says. “We usually rank our top two candidates every year and everyone fights to come here.”

One of those who flocked here for the Head and Neck Fellowship in 2023 is Lauren Miller, MD. She joined the Department of Otolaryngology here after completing it.

The culture and stability of the team at Ohio State spoke to Dr. Miller.

“One of the biggest reasons I was excited to stay in this department is the culture. I’m excited to come to work, and that sort of thing doesn’t happen by accident,” Dr. Miller says.

“Dr. Old definitely has a reputation for being a great leader and an excellent surgeon. As a Fellow, I got to see his technical skill and decision-making in the operating room. He’s constantly pushing the needle for how you can do the surgery better.”

Making strides against cancer

When reflecting on how research and treatment for head and neck cancers have evolved in his career, Dr. Old gives a lot of credit to the field of immunotherapy.

Skin cancers and head and neck cancers are very responsive to the treatment, which harnesses the body’s own immune system to attack cancer cells. Its use has grown significantly, and lives are changing because of it.

“Every week that I have clinic, I’ll see four or five people that normally I never would have seen before,” Dr. Old says. “They would have been dead without immunotherapy.”

Much of the research Dr. Old and others are doing into immunotherapy is funded by another passion of his — Pelotonia, an annual cycling and event series that has raised more than $309 million for cancer research at Ohio State.

Cycling was always a passion in the Old family. Dr. Old fondly remembers his weekly Sunday rides with his dad growing up.

Dr. Old arrived in 2009, just in time to ride in the inaugural Pelotonia. He hasn’t missed a single mile of any instance of it in the years since. His wife, Molly, is captain of the Team Head and Neck for Pelotonia, and he rode one year with both of his brothers and his dad.

But the most cherished memories he has from the more than 2,500 miles he’s ridden as part of the event?

“The moments that I remember are seeing my patients and spending countless hours with riders with unique stories and reasons for participating,” he says. “There are some very memorable patients spread out all around Ohio and farther, and some of them rode with us.

“It’s a great community. To wrap that into your job, it just brings more meaning to why we do what we do. It’s such a gift.”