Oncogeriatry

The prevalence of haematological malignancies increases in elderly patients. The complexity of therapeutic management makes it necessary to evaluate them using a global approach, namely bio-psycho-environmental. Identifying and assessing their weaknesses are part of the roles of advanced practice nurse (APN). Various tools are used to do this, including the G8 questionnaire, which directs patients towards a comprehensive geriatric assessment, or the Geriatric core dataset, designed to be used during clinical trials and which is more detailed and faster...

Immune checkpoint inhibitors (ICI) are the standard of care for many solid tumors with specific physiopathology mechanisms and adverse events. While the percentage of elderly patients increase from years to years, these patients are underrepresented in clinical trials. Immunosenescence and inflammaging, two main components of the aging of our immune system, and their consequences on the safety and the efficacy are today major focus of clinical research. However, there are still no risk assessment score specific to ICI in elderly patients...

An oncogeriatric interdisciplinary activity exists only in a minority of high-income countries, and it is almost absent in those with lower incomes. Considering topics, sessions, and tracks in the main meetings and conferences of the major Oncological Societies in Europe and worldwide, the USA excluded, little attention has thus far been paid to the problem of cancer in the elderly. Again, with the exception of the USA, the major cooperative groups, for example, the EORTC in Europe, have only dedicated marginal attention to the research of cancer in the elderly...

Supportive care, in the context of breast cancer in the elderly, is part of standard oncogeriatric care. Nevertheless, the multidisciplinary reinforcement of the different transversal teams can support the global approach, that is essential to the quality of care and the life course. Evaluation is the basis of this management. As a result of this evaluation, the approach to sexual health is a novelty that is often insufficiently considered with elderly patients suffering from breast malignancy.

The growing incidence of cancer associated with an aging population implies important health challenges that require questioning on the care management of older adults with cancer. There is a need to rethink the care management of older cancer patients with patient-centered decisions and an adjustment of the care pathway for this population. The Priorities Age Cancer (PAC) French group, made up of physicians, pharmacists and researchers in geriatric oncology, set up proposals to answer this need. First, the heterogeneity and the specificities of older adults as well as their preferences regarding cancer treatment goals, care management decisions must be patient-centered...

OBJECTIVE: The aim of our study was to assess prevalence of geriatric assessment (GA) in patients over 75years with nonmetastatic invasive bladder cancer (MIBC). MATERIAL AND METHODS: We performed a retrospective study between 2000 and 2015. We assessed comobidity by Charlson score and ASA score, geriatric assessement (GA) and treatments. RESULTS: One hundred and twenty one patients were inclued. Median age was 81 (73-95) at diagnosis. Thirty nine patients (32%) were evaluated by GA, G8 screening tool was performed in 16% of patients...

Faced with an ageing population, carers are real allies and partners who are essential to the smooth running of the care of elderly patients. The objective of this study was to analyse their needs in oncogeriatrics, in order to verify the relevance of developing a serious game to support them. Although the need for better support for carers in oncogeriatrics was recognized, they especially value the need for human exchanges.

BACKGROUND: Active surveillance (AS) is a validated option for the treatment of small renal masses (SMRs), especially in older patients. This study investigates the oncologic outcomes and competitive mortality of older patients prospectively assigned to AS. METHODS: We conducted a monocentric study on patients ≥75 years treated between 2011 and 2016 for a SMR. Treatment modalities, biopsy data, survivals (overall, specific, cancer progression) and delayed interventions were analyzed...

INTRODUCTION: Among the themes to be addressed by a Massive Open Online Course (MOOC) on geriatric oncology, one of the priorities was delirium, due to its frequency, complications and difficulties encountered by healthcare professionals in diagnosing and managing delirium. Our study aims to evaluate professional practices in the area of education, regarding the evaluation of the content of a MOOC module about delirium syndrome in geriatric oncology. METHODS: We created a multidisciplinary group to define the scientific content, the pedagogical objectives, the scriptwriting and the development of a training module...

The older population accounts for almost 60% of new cancers. Their management is a public health problem and is complex. It raises different questions: Is the patient's prognosis linked to cancer or another pathology? The heterogeneity of this population emphasises the importance of the overall condition assessment, in particular to avoid over-treatment (or under-treatment), and to be able to identify frail or vulnerable elderly patients who are at risk of having more treatment toxicities. Through this article, we will recall the importance of geriatric in-depth evaluation (EGA) by detailing the different factors that impact the therapeutic decision, tolerance to treatments… This EGA is however time-consuming and not all patients can be evaluated...

The first challenge, after graduating as an advanced practice nurse is to establish a new model of care in one's place of practice. The feedback from the creation of an advanced practice nurse position in oncology in Amiens-Picardie university hospital, using a population-based approach, illustrates the roles and skills required in this new health profession.

Cancer management is changing rapidly. Changes in practices are not all transferable to the elderly population, which is heterogeneous. The description of the intrinsic toxicity of anti-cancer treatments is insufficient in the elderly. Recent studies dedicated to the elderly incorporate composite evaluation criteria combining efficacy and toxicity with a broad definition including, among other things, loss of functional autonomy. These new data acquired, as well as new organisations integrating the new profession of advanced practice nurse in oncogeriatrics will enable us to better respond to the challenge of caring for elderly patients in the future...

Aortic stenosis (AS) may soon become a significant public health issue. Referring elderly suffering from aortic stenosis for a transcatheter aortic valve implantation (TAVI) versus surgical valve replacement might be difficult and requires a multidisciplinary staff. G8 is a geriatric screening scale for frailty, validated in oncogeriatry. We study sensibility and specificity of G8 used by cardiologists in comparison to a comprehensive geriatric assessment (CGA) performed by geriatrician. Prospective study, from February to July 2015, in Bordeaux university Hospital, France...

Cancer is a major health problem that is widespread in elderly people. Paradoxically, older people suffering from cancer are often excluded from clinical trials and are undertreated when compared to younger patients. One explanation for these observations is age stigma (ie, stereotypes linked to age, and thus ageism). These stigmas can result in deleterious consequences for elderly people's mental and physical health in "normal" aging. What, then, is the impact in a pathological context, such as oncology? Moreover, health care professionals' attitudes can be tainted with ageism, thus leading to undesirable consequences for patients...

Aging is a risk factor in oncology. Indeed, it is estimated that, in 2030, 70% of diagnosed cancers in the United States will concern subjects older than 65 years. Paradoxically, elderly are often excluded from clinical trials and are undertreated compared to younger patients. An important explanatory factor (and yet still not considered!) for these observations is the age stigma (in other words our stereotypes linked to age, and so ageism), age being actually the main motive for discrimination. In this perspective, our aim is to present ageism manifestations in oncogeriatry and their direct consequences for patients, interlocutors (that is to say health professionals) and interactions between them...

Cancer is a major health problem for which age is a proved risk factor. Paradoxically, elderly suffering from cancer are often excluded from clinical trials and undertreated compared to younger patients. Also, their psychosocial needs remain unknown. An explanatory factor for these observations is the age stigma (that is to say our stereotypes about age and so, ageism), age being currently cited as the main reason for discrimination. Besides these age-related stigmas, cancerous patients face pathology-related stigmas because nowadays cancer (especially some types of cancer such as lung cancer) still conveys a lot of negative representations...

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In oncogeriatric patients, severe malnutrition is associated with increased morbidity and mortality, nosocomial infections, radiotherapy or chemotherapy toxicities, and decreased of quality of life. Therefore, systematic screening and care of malnutrition is mandatory, in accordance with the French guidelines in 2007. Now, dietary counselling should be purposed systematically in malnourish patients and when radiotherapy or radiochemotherapy are considered. Oral supplementation by specific diet (immune-enhancing diets) should be used with cautions, and actually, reserved only in digestive neoplasms and surgery...

Medicine, as well as the whole society, should cope with a society getting older and older. Yet, to what extend are the peculiarities of elderly assessed and taken into account? And what about relationship and communication? Are elderly offered similar therapeutic projects and are they equally informed about them? Do they have, themselves, the same needs? Oncologists and the nursing staff encounter several peculiar difficulties while coping with elderly. These difficulties are not only due to a complicated medical situation of a multi-treated patient with along history of many other diseases, but also to strongly anchored received ideas that "it's easier to die when one is old" and that "it's better to preserve the patient by hiding his disease to him, and by lying to him about it, because it is worthless to tell him the truth"...

Incidence of cancer increases with the recent increase of the life expectancy. Aging is characterized by health status heterogeneity. It is therefore difficult to exactly predict tolerance to treatment and to make decision. One of the major question is to classify the problems on the base of their impact on health status and outcome. It is only possible if oncologists and geriatricians work together. The objectives at the national and international levels are the same: to develop formation (teaching programs), information (for professionals and the public), clinical research...