Organization of the clinical activity of Geriatric Oncology: Report of a SIOG (International Society of Geriatric Oncology) task force

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Abstract

Management for elderly cancer patients world wide is far from being optimal and few older patients are entering clinical trials. A SIOG Task Force was therefore activated to analyze how the clinical activity of Geriatric Oncology is organized. A structured questionnaire was circulated among the SIOG Members. Fifty eight answers were received. All respondents identified Geriatric Oncology, as an area of specialization, however the organization of the clinical activity was variable. Comprehensive Geriatric Assessment (CGA) was performed in 60% of cases. A Geriatric Oncology Program (GOP) was identified in 21 centers, 85% located in Oncology and 15% in Geriatric Departments.

In the majority of GOP scheduled case discussion conferences dedicated to elderly cancer patients took regular place, the composition of the multidisciplinary team involved in the GOP activity included Medical Oncologists, Geriatricians, Nurses, Pharmacists, Social Workers.

Fellowships in Geriatric Oncology were present in almost half of GOPs.

Over 60% of respondents were willing to recruit patients over 70 years in clinical trials, while the proportion of cases included was only 20%. Enrolment in clinical trials was perceived as more difficult by 52% and much more difficult in 12% of the respondents.

In conclusion, a better organization of the clinical activity in Geriatric Oncology allows a better clinical practice and an optimal clinical research. The GOP which can be set up in the oncological as well as in the geriatric environment thought a multidisciplinary coordinator effort. Future plans should also concentrate on divisions, units or departments of Geriatric Oncology.

Introduction

Since to organize the clinical care of older cancer patients and to address problems of aging may improve the overall treatment success and the quality of life of elderly cancer patients, a dedicated Geriatric Oncology Program (GOP) [1] should address the following goals:

  • 1.

    to provide comprehensive care through a multidisciplinary approach that considers age-associated conditions which influence cancer management;

  • 2.

    to conduct clinical trials in representative older patients;

  • 3.

    to reduce adverse outcomes such as nursing home placement and hospitalizations;

  • 4.

    to allow patients to continue to live in their primary area of life either at home, hospice, or in nursing home;

  • 5.

    to educate health professionals, the public, older patients and their families about cancer therapy and research.

There is presently no widely accepted clinical model for the delivery of cancer care to frail and vulnerable elderly. Due to the progressive aging of the population, cancer in the older person has become an increasingly common problem. More than 60% of all tumors occur over 65 years and 45% after 70 years with more than 2/3 of tumor deaths in people older than 65 years. While the number of older patients has progressively risen in our wards and clinics, an elderly oriented approach is practiced by a minority of Medical Oncologist and in general the therapeutic and clinical research approach is far from being optimal [2]. Not all patients are treated, only a minority enters clinical trials and informed consent is usually not fully understandable. Furthermore the majority of patients is not managed with an interdisciplinary approach integrating the geriatric aspects into the oncological one [3]. The increasing needs of management of cancer in the elderly should require a solution taking into account a new type of organization. [4].

Section snippets

Methods

A SIOG Task Force on the Organization of the Clinical Activity of Geriatric Oncology conducted an international survey of Geriatric Oncology clinical services among its members through a structured questionnaire (Appendix A). This was circulated to 216 SIOG affiliate members from July 2005 to January 2006.

The questionnaire requested institutional data to provide a context for the description of the clinical services and to determine the presence/absence of:

  • (1)

    GOP or a Clinic for elderly cancer

Results

Fifty eight answers were received (26.8%) up to mid January 2006. Twelve from USA and Canada, 42 from Europe (Italy 10, France 5, Belgium 2, Germany 3, others 1 each), and 1 from India, South America, Saudi Arabia and Japan, respectively.

All respondents identified Geriatric Oncology as an area of specialization. About 20% reported having access to Geriatricians, 37% reported routine interaction between the specialists and 34% reported that Geriatric Oncology was incorporated into general

Discussion

The low rate of members participation to the survey is probably related to the scarcity of a structured activity in the field of Geriatric Oncology. However, useful information came from 58 members around the world. These SIOG members were all involved in the management of older cancer patients in their clinical practice. Moreover, over one third of them were actively incorporated in the framework of a GOP. These data, although biased by a very low return rate, are encouraging and show that

Proposals

Expected benefits from a structured Geriatric Oncology activity are summarized [1], [3]:

  • to identify centers of excellence in order to enhance referrals;

  • to develop and disseminate expertise on the provision of specific cancer care;

  • to evaluate treatment models;

  • to motivate and support clinical and translational research;

  • to enhance social support and quality of life;

  • to provide expert management in continuous care for follow up care.

These objectives can be achieved through a GOP in both oncological

Conclusions

The situation of the organization of the clinical activity of Geriatric Oncology is highly variable in different places. There is though a common background across the various countries since the needs are present in both oncological and geriatric environment. Next to the position paper on CGA [5], this SIOG Task Force would like to encourage for a better organization of the clinical practice in managing cancer in the elderly through the availability of an efficient network allowing optimal

Reviewers

Dr. Cesare Gridelli, Head, Division of Medical Oncology, S.G. Moscati Hospital—Avellino, Via Circumvallazione, 1-83100 Avellino, Italy.

Prof. Claude Jasmin, Hopital Paul-Brousse, Federation des Services des Maladies Sanguines Immunitaires, et Tumorales, 14 Ave Paul Vaillant Couturier, BP 200, F-94804 Villejuif Cedex, France.

Dr. Ulrich Wedding, Chief, Anesthesiology, Klinik fur Innere Medizin II (Hamatologie—Onkplogie), Freidrich Schiller Universitat, Erlanger Allee 101, D-07747 Jena, Germany.

Acknowledgement

The authors thank Dr. Alberto Bortolami for the data management and help in the preparation of the manuscript.

Prof. Silvio Monfardini is the author of over 280 publications in indexed journals; his works concern the main fields of medical oncology with particular reference to non-Hodgkin's lymphomas, Hodgkin's lymphomas, chronic myeloid leukemia, solid tumors, phase I–II studies and tumors in the elderly. He has been President of the European Society for Medical Oncology, President of the Associazione Italiana di Oncologia Medica and of the International Society of Geriatric Oncology. At present he is

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Prof. Silvio Monfardini is the author of over 280 publications in indexed journals; his works concern the main fields of medical oncology with particular reference to non-Hodgkin's lymphomas, Hodgkin's lymphomas, chronic myeloid leukemia, solid tumors, phase I–II studies and tumors in the elderly. He has been President of the European Society for Medical Oncology, President of the Associazione Italiana di Oncologia Medica and of the International Society of Geriatric Oncology. At present he is Chief of the Division of Medical Oncology. Istituto Oncologico Veneto, Padova (Italy). Earlier he was scientific director of the National Cancer Institutes, Naples (Italy) and scientific director of the National Cancer Institutes, Aviano (Italy).

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