European Geriatric Medicine - Supplement 1 - Volume 6 - September 2015

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S158 Symposia / European Geriatric Medicine 6S1 (2015) S157 –S176
years post transplant. We are also investigating possible ways to
improve current selection criteria for KTx in the elderly.
S-03
Improving the care for older patients with cancer
S. Rostoft
Oslo University Hospital, Oslo, Norway
Presentation 1: Surgical oncology – what does the surgeon need
from the geriatrician? Speaker: Riccardo Audisio (UK)
Presentation 2: Geriatric intervention in frail older patients
operated for colorectal cancer – does it improve outcome? Speaker:
Nina Ommundsen (NOR)
Presentation 3: Geriatric assessment in older cancer patients – what
is the evidence? Speaker: M. Hamaker (NL)
Presentation 4: Common biology of cancer and ageing. Speaker:
Claire Falandry (F)
Introduction (Siri Rostoft, MD, PhD, Oslo University Hospital)
Increasing age is the most important risk factor for cancer
development, and a declining mortality from heart disease and
other non-cancer causes leaves an elderly population at high risk
of developing cancer. Many patients in the aged population will
have co-existing problems such as chronic diseases, dementia, and
frailty, while others are fit well into their 80s or 90s. Careful patient
assessment is necessary in order to avoid both over-treatment
and under-treatment. In the recent years, a geriatric assessment
has been advocated as a useful tool to assist clinicians in making
treatment decisions in older cancer patients. This symposium will
give an overview of the evidence that is available with a particular
focus on geriatric assessment and surgery. It will be discussed
how the geriatrician in collaboration with the surgical team may
improve care for older surgical cancer patients.
In addition, the final talk will investigate the link between cancer
and aging. Is there a common biology for cancer and aging? What
are the theories that explain the association between cancer and
aging?
1. Surgical oncology – what does the surgeon need from the
geriatrician? (Professor Riccardo A. Audisio, University of Liverpool,
Consultant Surgical Oncologist, St Helens Teaching Hospital; email:
): Cancer surgeons do not need geriatric
input; they firmly believe that they are entirely capable of deciding
how and when best to operate on their patients. After all, the
largest majority of cancer patients they deal with, on a daily basis,
is senior patients. They are used to it.
Surgeons check drains and catheters meticulously, they monitor
patients’ temperature; it must be admitted that most of them make
the right decision. But what happens when things go wrong? Could
a problem not be anticipated? And if not, are we entirely sure that
surgeons could not do any better?
Surgeons are proud to state that it is indeed the surgical procedure
that saves live, more than any other treatment plan; if this is the
case it is predominantly their responsibility if cancer outcomes of
older patients are far worse than for younger ones [1].
Surgery is the best treatment we have in hand; for the time being
the removal of the cancerous growth cures most patients [2]. On
the other hand, we shall never forget that surgery comes at a
price: it should be offered at the time where other, less intrusive,
alternatives are not viable. Overtreatment is not good surgery, even
if the procedure is performed to perfection.
Regrettably, the evidence for surgical procedures on older patients
is scanty and clear cut data should be retrieved in order to
substantiate the most appropriate management in this age group.
Prospective, phase IV “real world” trials will be very useful in
providing an answer to most unsolved issues (e.g. is axillary surgery
always needed for breast cancer patients?). This will assist in
minimizing undertreatment: tailoring the appropriate surgery is
still resting on a rule of thumb.
This is where surgeons have started absorbing the art of
frailty assessment from geriatricians; there is a whole world of
information to be captured and put in place. A careful, well
balanced, decision should be made [3].
Beside assisting in the decision making, geriatricians have also been
crucially helpful in advising on how to master rehabilitation and
prehabilitation: between the fit patient who is ready to receive
extensive surgical treatment, and the frail individual who should
be denied surgery, sits a large number of vulnerable ones. These
individuals should be considered for correction of anaemia and
malnourishment, rehydration, depression and so on. Physical and
mental weaknesses should be tackled and corrected. There is sub-
stantial evidence that quick screening tools can be used in clinical
practice; they are helpful in predicting surgical outcomes, thus as-
sisting the decision making process and treatment planning [4,5].
Finally, a rather obscure area of clinical practice is postoperative
delirium: its prevalence is very high when, different from everyday
clinical practice, it is accurately monitored and detected. Delirium
associates to increased number and severity of postoperative
complications and lethality, longer hospital stay and costs. It is
indeed a very important area where more lessons can be learned
on how best to care for elderly patients surgically treated.
2. Geriatric intervention in frail older patients operated for
colorectal cancer – does it improve outcome? (Nina Ommundsen,
MD, Dept. of Geriatric Medicine, Akershus University Hospital;
email: ): Colorectal cancer is a major
cause of morbidity and mortality in the older population. The
primary treatment is surgery. In general, older patients tolerate
elective surgery well, but in the frail group of older patients,
postoperative complications are prevalent.
Through a preoperative Comprehensive Geriatric Assessment (CGA),
the geriatric team can adress multiple aspects of each individual
patient’s health, such as comorbidities, use of medication, ADL
function, cognitive status and nutritional status. The result of the
CGA can be used to estimate the patient’s level of frailty, and
through this it can give valuable prognostic information. However,
the CGA also pinpoints targets for intervention and preoperative
optimisation of each patient. Typical targets for intervention are
malnourishment, comorbidities, functional decline and harmful
polypharmacy.
The presentation will give examples on how to perform a
preoperative CGA-based geriatric intervention in frail older patients
with colorectal cancer, and summarize the evidence for such a
method.
3. Geriatric assessment in older cancer patients – what is the
evidence? (M. Hamaker): Currently used measures for quantifying
a cancer patient’s vitality, such as performance status, do not appear
sufficient for differentiation within the heterogeneous elderly
population. In particular, geriatric syndromes can be present even
in those with a good performance status and can easily be missed if
not especially looked for. Therefore, a 2005 International Society of
Geriatric Oncology task force recommended that a comprehensive
geriatric assessment (CGA) should be implemented for older cancer
patients. At that time, the task force could not recommend any
specific approach above others due to lack of cancer-specific
evidence. Ten years have passed and despite numerous publications
on this subject, many questions still remain to be clarified.
This presentation will provide an overview of the currently
available evidence on the use of geriatric assessments for older
cancer patients, with regards to capturing the health status in
this patient population, predicting prognosis, treatment-related
complications and the impact on oncologic and non-oncologic
treatment decisions.
4. Common biology of cancer and ageing (Professor Claire
Falandry, University of Lyon, Geriatrics Unit, Centre Hospitalier
Lyon Sud; email: ): Aging induces the