12th - 14th Nov 2015
Dr Brain talks to ecancertv at SIOG 2015 about the SIOG education initiative and the Treviso course.
This entails teaching and learning to teach oncologists and geriatricians and developing and disseminating specific high-standard guidelines that advocate fine-tuned strategies in elderly cancer patients.
The SIOG education initiative and the Treviso course
Dr Etienne Brain - Institut Curie, Paris, France
You have been giving the opening address here at the SIOG meeting about geriatric oncology. What do you see as the key things that you want to stress right now? I know you’re very interested in education, aren’t you?
Yes, because that’s the way to build the future. You need to breathe new life in the society and for that you need to get interest in young people, so to teach them, to organise education around geriatric oncology.
Can you tell me about the initiative that you’re doing?
One of the most important ones is the launch of a masterclass in geriatric oncology which is held is Treviso, in the vicinity of Venice, yearly, end of June, beginning of July. We hold the third edition next year, 2016, so that was developed in collaboration with the Università Cattolica of Roma and with the support of ESSO and ASCO as well.
What are the special things you’re able to do there?
It’s to bring together to geriatricians, young geriatricians and young medical oncologists or radiotherapist or oncologists in general, and to teach them, geriatricians what is oncology and oncologists what is geriatrics and to make them work together on clinical cases to understand and to better develop collaboration in their own institutions.
It’s quite difficult for doctors to get away from busy practices so how would you justify the value added from going to this sort of educational course?
It’s a masterclass which lasts 3-4 days. It’s once a year and the purpose is really to make them aware and able to disseminate this knowledge and this skill to interact between oncologists and geriatricians.
Initiatives seem to be very key to what SIOG is doing because you’ve got another initiative, this is the CNOW initiative, cervical neoplasms in older women. Could you tell me about this?
CNOW is not exactly a direct initiative from SIOG, it’s supported by SIOG but one of the important actions of SIOG is supporting research and supporting young investigators. So we have a young SIOG group and they designed this type of enquiry looking at what is current practice for the management of cervical cancer in Europe. That was a way to support them, to stress that the young, the involvement of young people or the young members is really a key point. It’s a way to spread.
What are the big issues, though, of cervical cancer in older women?
Usually we need to adjust the strategies and very often these adjustments are not evidence based or scientifically based in terms of omission of chemo or omission of radiotherapy. So the purpose of CNOW is to get a picture in order to design a clinical trial behind. So, you see, it’s an enquiry amongst oncologists all around Europe and the final goal is through the extraction of the data to understand what happens to be able to raise a clinical question in a clinical trial.
So do you believe that there can be some big gains from addressing this topic specifically?
Yes, yes, definitely yes. The way to the best care is provided by clinical research, always.
Another thing, I’d like to ask you about adjuvant treatment, optimising the adjuvant treatment in low risk breast cancer, what are you doing here?
That’s a programme, an adjuvant clinical trial of breast cancer in women over 70 where we investigate the role of the addition of chemotherapy to hormone therapy after surgery. That’s a programme which is quite interesting because it associates geriatric assessment but also the use of new innovative tools assessing the genomic profile of the tumour. So the setting is the most common case presentation of breast cancer in women, in elderly women, with endocrine sensitive cases, HER2 negative, and we raise the question is there a space for chemo in this population according to our genomic tool. That’s a programme which has been running for the past three years and which is almost complete, having enrolled roughly 2,000 women which is quite extraordinary in terms of dynamics, unprecedented work, I must say. It’s run by the French group, UNICANCER with [?? 5:51] and the Breast Group.
How is all of this looking because clearly these are challenging areas because the data are not in. What are the messages for doctors in trying to get some of these treatments optimised for older women where they are already optimised for slightly younger women?
The main message is that we can be [?? 6:14] to gene profiling any tumour with getting the molecular portrait of any disease. If we do not look at the person globally, in a more holistic way, we miss something and that’s the role of geriatric assessment. I’m not performing a geriatric assessment, I work with geriatricians who teach me how to use this information and who balance the benefit risk constantly in my decisions. That’s the main message.
There seems to be a lot changing and lots of scope for improving care for older patients with cancer. What sort of take home message would you leave doctors with following your very fascinating conference right here?
This collaboration, sharing information between two worlds, oncology and geriatrics, leads usually to modified treatment plans. That’s very important to be aware that most of the time when we modify in 25% of cases, more or less, it’s for a de-escalation of the aggressivity of our not very specific, not very targeted treatments. So that’s a way to improve the quality of life of our elderly population with cancer.