Role of the surgeon in geriatric cancer management
Prof Kwok-Leung Cheung - Nottingham University, Nottingham, UK
I think the role of the surgeon is very important in the multidisciplinary team in terms of managing cancer. In particular, when managing older adults with cancer disease I would say it is probably even more important because surgery is the only treatment which potentially cures cancer at the moment, if we put aside haematological malignancies, just focussing on solid tumours. Say, for example, for someone like an older adult with cancer which we think that person is probably not suitable or not fit for chemotherapy or the other way round, not suitable for surgery, let’s say not fit for surgery. I doubt if that person would be suitable for chemotherapy, it would be quite tough for that. So therefore, surgical treatment or other forms of local therapies like using radiotherapy and so forth, which is being touched upon at this conference as well, is quite important in managing this group of patients.
As in most oncology conferences, we tend to have a huge population of medical oncologists to talk about chemotherapy or different kinds of targeted treatments, which I don’t disagree with and they’re important treatments. But we should not forget local therapies such as surgery, such as radiation therapies, which are very important, especially they tend to give the patient less in terms of systemic side effects.
What were the most important points on the updates to surgery?
I think the key points were I looked at the literature for the last year, I was unable to find any ground-breaking studies. However, there were emerging randomised controlled trials and some studies starting to focus on geriatric assessments, how to select patients. So the bottom line would be for a surgeon how best to select the patients. So the best surgeon is someone who knows when not to operate, so can we select the patients that we should not operate or should offer them less radical surgery? That’s point number one, I would say, most important. The second point would be then you would then have two groups of patients, one group you’ve selected them that you should operate or for them some sort of surgery; the other group would be for those that you don’t. For the first group the key point then for the role of the surgeon would be how to optimise their care before, during and after surgery.
What are your thoughts on personalising therapy for older patients?
That probably fits with my research themes in breast cancer. I look at two things: one is from the biological perspective. So you need to look at the biological reasons to treat certain cancers or not to treat. For example breast cancer – breast cancer could be treated in some patients with hormone sensitive breast cancer by an anti-hormone treatment, for example, which may not be available in some other solid tumours; there’s a biological element. Then the other element is the geriatric element, which fits in very well with the vision of SIOG, is to look at the individual from the geriatric perspective, the geriatric domains, not to say other things like quality of life and patient choice and all these.
What would be your take home message for doctors?
Try to decide how to select the best patients to have an operation or not. Think about alternatives. The second thing would be for those that you have selected to operate on them, optimise their state so that they can undergo surgery with minimal complications.