Critical Reviews in Oncology/Hematology 68 (2008) S10−S21www.elsevier.com/locate/critrevonc

Faculty abstracts

Friday, October 17, 2008

08.20–09.35

Session II: Why should we care?

F1 08.20–09.35Understanding and meeting the needs of the older population: aglobal challenge

H. Bergman*. McGill University and Jewish General Hospital, Montreal,Quebec, Canada

Health care systems around the world are faced with the challenge ofimproving the health of their populations, meeting their health and socialservice needs (particularly those of vulnerable groups), assuring qualityof care and guaranteeing equity; all of this while striving to be cost-effective. This challenge is being faced within the context of significanttransitions. The demographic transition has already affected the developedworld and now has a significant impact upon developing countries as well.These changes result not only in an increase in the number of thoseover 65 years old, but also in the old-old, those over 80 years. Thesedemographic changes are linked to an epidemiologic transition, resultingin the increasing importance of chronic disease and its consequences inboth developed and developing countries, in different proportions and fordifferent reasons. The third transition for health care systems has been theadvances in therapeutics and technology and the increasing intensity ofmedical interventions for increasing older persons.There is evidence that improved living conditions, education, nutrition,physical activity and other lifestyle changes as well as progress in thera-peutics and technology have contributed to an increase in life expectancyand increased years without disability (“health expectancy”). Secondaryprevention including screening and treatment of hypertension, diabetes,heart disease and osteoporosis, also plays an important role. As a result,a significant proportion of older persons are in good health and leadactive and independent lives. However, as a result of cumulative effects offunctional limitations associated with age-related changes and of cumula-tive effects of acute medical problems and chronic diseases, 10% of theelderly population is independent but is considered frail and vulnerable toincreasing acute and chronic illness, hospitalizations and dependency inActivities of Daily Living (ADL). Another 10% of the older populationaccounts have complex needs: they are among the oldest with both acuteand chronic medical problems, need help in ADL while being dependanton depleted social support. They are high and costly utilizes who need acomplex combination of both acute and long term care with have frequenttransitions throughout the health care system.Cancer is increasingly recognized as a disease of older persons. Theapproach to older persons with cancer needs to be based upon theunderstanding of the heterogeneity of the health and functional status ofolder persons.

F2 08.20–09.35Geriatric bio-psychosocial dimensions through case presentations

I. Hings1, J. Blair2, A. Plante3. 1McGill University, Montreal, Quebec,Canada, 2Moffit Cancer Center, Tampa, Florida, USA, 3SCIO, CICM,Longueil, Quebec, Canada

This presentation will illustrate the potential complexity of the bio-psycho-social dimensions when treating a senior adult with cancer. Casepresentations will be used to demonstrate the utility of specific screeningtools when assessing patients in Geriatric Oncology. An interactive formatwill touch pads for multiple choice questions will encourage audienceparticipation. Case discussions will focus not only on options for medicalmanagement but also on the specific needs and expectation of patientsin Geriatric Oncology. The interdisciplinary approach to patient care inGeriatric Oncology has the potential to not only improve the experienceof patient and family but may also provide valuable support and teachingto the members of the team caring for this population of patients.

09.35–11.00

Session III: Assessment

F3 09.35–11.00Evaluation then and now

L. Balducci*. Moffit Cancer Center, Tampa, Florida, USA

The assessment of physiologic age has traditionally been preformed with acomprehehnsive geriatric assessment (CGA). The original aim of the CGAhas been to identify domains that may require rehabilitation, caregiverand special care. Eventually it was found that different protions of theCGA, namely function and comorbidity may help predict individual life-expectancy, while function, comobidity, polypharmacy and social supportmay predict tolerance of cytotoxic chemotherapy.In the last ten years three major events may have rendered the geriatricassessment simpler and more brief. These include:– The definition of frailty– The recognition of age as a progressive and chronic inflammation– The attempts to assess entropy based on electrocardiographic variations

F4 09.35–11.00Evaluation here and there

S. Monfardini*. Fondazione Don Gnocchi, Milano, Italy

Some form of Geriatric Evaluation is recommended in USA by theNational Comprehensive Cancer Network (NCCN), while in Europe somepublications have insisted on the need of a better organization of cancertreatment in the elderly including the Multidimensional Geriatric Evalua-tion (MGE). However, from an inquiry conducted by us in Italy only 12%of Italian Medical Oncologist is making routinely use of the MGA forolder cancer patients. The major obstacle reported has been the “lack oftime” since it is believed that the MGA is too time consuming.A worldwide enquiry among SIOG members in 58 Centers has shownthat MGE is not performed in all cases (only in 48%). Even among thoseinterested in Geriatric Oncology in Europe the type of geriatric assessmentis quite variable.This explains the variability of the length of time reportedfor the MGE in the SIOG enquiry (from 15 to 360 minutes).