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Geriatric Oncology Opportunities And Challenges PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Geriatric Oncology: Opportunities and challenges” by Jean-Pierre Droz, MD, PhD.

This medical PowerPoint presentation is about geriatric oncology, a branch of medicine that focuses on the diagnosis and treatment of cancer in elderly patients. This field combines principles of oncology and geriatrics to provide comprehensive care for older adults with cancer.

As people age, they are more likely to develop cancer and have a higher risk of treatment-related complications. Geriatric oncologists are trained to manage the unique challenges that arise when treating cancer in older patients, such as age-related changes in physiology, polypharmacy, and comorbid conditions.

The goal of geriatric oncology is to provide personalized cancer care to elderly patients, taking into consideration their overall health, functional status, and quality of life. Treatment decisions are made based on a patients individual circumstances, including the stage and type of cancer, overall health, and preferences for care.

Geriatric oncology also involves supportive care, which focuses on managing symptoms and improving quality of life during cancer treatment. This may include palliative care, pain management, and psychological support.

In summary, geriatric oncology is a specialized field of medicine that aims to provide comprehensive cancer care to elderly patients, taking into account their unique medical and social circumstances.

Tags : geriatric oncology, diagnosis and treatment of cancer in elderly patients, Geriatrics, Geriatric Medicine, Geriatrics PowerPoint presentation

Published on : May 02, 2023 | Views : 1144 | Downloads : 0

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Slide 1-

Geriatric Oncology: Opportunities and challenges Jean-Pierre Droz, MD, PhD. Professor of Medical Oncology, Lyon-RTH Laënnec School of Medicine. Chairman department of Medical Oncology, Centre Léon-Bérard, Lyon.
Slide 2-

Cancer incidence increases with age. Example of men. Cardiovascular diseases.
Slide 3-

The hypothesis : There are two approaches of geriatric-oncology.
Slide 4-

The characteristics of geriatrics (A medical oncologist opinion !!!) Elderly patients have multiple problems. Pathology is always poly-pathology. There is time for observation, time for investigations, time for conclusion, time for intervention. Tools are numerous and sophisticated. The objective of patient management is to increase « health status ».
Slide 5-

The characteristics of oncology. Extensive work-up, refined staging. Multidisciplinary approach, global treatment strategy, standard treatments and decision trees. Interest for objective response and median survival. Technical interest for toxicity. Recent interest for quality of life.
Slide 6-

Possible opinions on Geriatric Oncology: « popular » opinion ! Too sick ! Too old ! I know how to treat this kind of cancer, even in an elderly patient. Never chemotherapy ! Too old for surgery ! Good indication for palliative treatment and quality of life issues (the recently converted medical oncologist).
Slide 7-

The way to find. To learn about elderly patients. To learn about cancer in elderly patients. To understand what is the specific geriatric approach of patients. To think on specific geriatric approaches of elderly patients cancer treatment.
Slide 8-

Practical approach to geriatric oncology. I. The «classic oncological approach ».
Slide 9-

The classical approach of medical oncology in elderly patients. Cancer treatment is multimodal : surgery, radiotherapy, medical treatments. The most important prognostic factor is performance status : Karnofsky Index. Multivariate analysis is a good methodological approach in oncology. Geriatric parameters are refined KI factors to be introduced in multivariate analysis.
Slide 10-

However chemotherapy has the same effect in elderly than younger cancer patients. Aggressive NHL : MACOP, VNCOP-B or CHOP induce 40-50% cure rate and 0-30% toxic death rate (1). Pooled series (3351 pts) of 5-FU adjuvant chemotherapy in colo-rectal cancer : same survival benefit (2). Zinzani & al. Blood 1999; 94 : 33-38. Sargent & al. N Engl J Med 2001; 345 : 1091-7.
Slide 11-

Practical approach to geriatric oncology. II. The «geriatric approach ».
Slide 12-

Practical approach to elderly cancer patients I. To screen cancer patients likely to receive chemotherapy : No major organ failure (# few comorbidities). Good performance status (# no dependency). Able to follow experimental treatment (# no dementia). Without drug interaction (# no polypharmacy). Neither « frail », nor « too sick » patients Consequence :
Slide 13-

Senior adult patients in the SWOG studies. (Hutchins, NEJM, 1999). 16,396 patients. 164 SWOG trials between 1993 and 1996. 65 years and older: 25% in the trial population vs 63% in the true life. Breast cancer : 9% vs 49% respectively. 70 years and older patients represent only 14% of patients who were included in clinical trials.
Slide 14-

Older breast cancer patients. Trimble, 1994
Slide 15-

Practical approach to elderly cancer patients II. To build the trials on standard format : Selection of patients. Selection of tumor. Introduction of selected « geriatric parameters » in the protocol. To aim the trial to study « oncologic parameters » as objective response, survival, toxicity, EORTC QLC-30, pharmacologic parameters.
Slide 16-

The problems of such an approach. It does not consider elderly patients group as a particular entity. It selects only a small proportion of patients in « good health ». Results of trials may not be generalized. Do we learn anything from such studies ? Which geriatric parameters to select ?
Slide 17-

Life expectancy and treatment. (Prostate cancer) 7,7 years Limit for curative Treatment. May be important for : High-risk disease. Metastatic disease.
Slide 18-

Differential life expectancy according to « percentiles » Good health Médian. # Frailty. Healthy Vulnerable = reversible problem. Frail = non reversible problems. Too sick. From IACR; Drugs & Aging 1998 ; 13 : 467-478.
Slide 19-

Geriatric oncology approach in a Geriatric-Oncology Program. Exemple of Geriatric-Oncology Pilot Unit of the French National Cancer Institute in Lyon.
Slide 20-

Two institutions with equal role. Geriatrics hospital (within Lyon Hospitals network) : 400 beds, « acute care unit », long term hospitalization, CGA Unit, day hospital. Comprehensive Cancer center with GOP (one full time Medical Oncologist, specific team) Contract between institutions : 5 years prospective planification. Pr Ph Courpron, Dr G Albrand, Dr S Gaujard. Dr C Terret, Mrs G Moncenix RN.
Slide 21-

Tools for Health status evaluation in senior adult patients. Gold standard : Comprehensive Geriatric Assessement (CGA). Derived products, screening tools : Senior Adult Oncology Program (Tampa). Multidisciplinary Assessment of Cancer in the Elderly (MACE) (Padova). Mini geriatric evaluation (Lyon). Simplified screening in oncology clinics : µ-evaluation ? PPT or Performance Status Index ?.
Slide 22-

Evaluation of Elderly Cancer Patients in the program. Clinics : µ-evaluation. GOP : mini-CGA. Antoine-Charial Hospital : CGA. « Tumor specific committe » Geriatric-Oncology Committee Decision & treatment. +
Slide 23-

Clinics : µ-evaluation of screening. Clinical examination. Co-morbidities & pharmacy. Screening of geriatric syndroms. Activity daily living. Social setting. Monopodal stay. Decision : - no further investigation. - mini-evaluation. -CGA in geriatric hospital. Need for a test : PPT.
Slide 24-

Mini-evaluation : result of the work of a team in the cancer center. Geriatrician. Medical oncologist. Social worker. Dietetrician. Physiotherapist. Pharmacist. Research nurse.
Slide 25-

Mini-evaluation (1). Clinical exam. Measure of geriatric scales : ADL & IADL, MNA, GDS, MMS, Tinetti test. Nutritionnal assessement. Pharmaceutical assessement. Specific questionnaire (including QoL). Biological screening : Hemogram, liver tests, creatinine clearance, Ca & Ph TSH & LT4, vitamine B 12, folic acid, vitamin D3 Albumin & pre-albumin.
Slide 26-

Mini-evaluation (2). Synthesis : clinical report, recommandation. Clinical intervention on geriatric problems if « vulnerable ». Decision on cancer treatment. Information to the patient & family. Information to the general practitioner. Follow-up procedures : home or institution. Time : 90 + 30 mn.
Slide 27-

Decision of CGA in geriatric hospital. Patients who are « frail » or at the frontier « frail / too sick ». Patients who require specific work-up : Geriatric syndrom (dementia+++). Carefull dependency evaluation. Evolutive co-morbidity. Complex social problems.
Slide 28-

Treatment must be adapted to Health status. Good health : same treatment as younger patients Vulnerable : intervention then standard treatment. Frail : intervention then adapted treatment. Palliation. Standard treatment trials. Geriatric intervention trials. Not included in trials but demography must be known.
Slide 29-

CGA (structure) Screening Diagnosis Intervention Mini-evaluation (team) Orientation Micro-evaluation (Individual) Orientation Cancer treatment Good health. Too sick. Vulnerable. Frail. Cancer treatment The importance to introduce both screening and CGA / Geriatric intervention planning. Palliative cares.
Slide 30-

Examples of research programs. Geriatrics : evaluation methodology PPT : screening of dependence. Nutritional aspects. Impact of interventions. Oncology : cancer research Biology of aging and cancer. Research on drug metabolism. Decision trees applied to elderly patients. Clinical trials on treatment strategies.
Slide 31-

Teaching. Professional education of health care workers. Medical education : International University graduate in « Geriatric Oncology ». Organisation of a Geriatric Oncology network and fellowship.
Slide 32-

Conclusion. Importance of an « cross-talk » between geriatricians and oncologists. To direct research to: develop specific tools of evaluation. develop specific decision trees in oncology. Increase the knowledge in cancer treatment tools. Increase the knowledge on aging and cancer. Requires specific teaching programs. A long term program !