Advancements in the field of geriatric oncology

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Published: 22 Nov 2016
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Dr Stuart Lichtman - Memorial Sloan Kettering Cancer Center, New York, USA

Dr Lichtman speaks with ecancertv at SIOG 2016 about the presentation on the advancements in the field of geriatric oncology.

Dr Lichtman discusses the issues surrounding immunotherapy and targeted treatments, as well as issues regarding surgical oncology for elderly cancer patients.

This service has been kindly supported by an unrestricted grant from Merck/MSD.

 

We’re having our annual meeting now in Milan which is going to cover a number of topics which are very important to clinicians in trying to understand and best treat older patients with cancer. We had a session just now on advances in medical oncology which covered issues about immunotherapy and targeted treatment as well as other issues regarding radiation oncology, surgical oncology and how to best assess patients and issues about patient selection and evaluation. What’s happening in the field of geriatric oncology in this session, and the sessions we’re going to have in the next two days really reflects this, is that geriatric oncology is now really mainstream oncology. You can’t think of it as a separate field, this is not a niche field of a few dedicated investigators, this really is a field of all of medical oncology. I would like to say that all adult oncologists are geriatric oncologists, they just don’t recognise that yet but when they see their patients day in and day out and realise that the majority of patients that they’re going to be seeing are over the age of 65 or 70 and the majority of cancer mortality and drug consumption is in these older patients they have to understand that there’s a realisation that they’re going to have to understand basic principles about taking care of older patients and evaluating older patients. They don’t have to become geriatricians per se but they have to understand some very simple geriatric principles which will help them to take care of their patients in an optimal fashion.

Through the work of many investigators there are now a number of predictive models that we could use to help clinicians to make data-driven decisions. We don’t have to rely solely on clinical judgement which is helpful but one of the interesting things that these predictive models have shown is that clinical judgement only takes you so far. You really do need these models and algorithms to help you treat patients. They’re not onerous, they’re not overly time-consuming. There’s a fear that, ‘Oh my God, how am I going to do this. It’s going to take so much time and I don’t have that time,’ and I agree, actually, we don’t have that time, I don’t have that time. But just like everything else in medicine you could learn a skill, it’s a new skill to learn which I think we’re all capable of doing and translate that into routine practice. It does not add a lot of time, as a matter of fact in most of these studies it’s been shown that it only takes a few minutes and very often the patients actually assess themselves and it’s really up to you just to interpret the information that they give to you. Very simple issues like can they take care of themselves, how do they function in society, do they live alone, have they fallen - very rudimentary, simple things that have been shown to be highly predictive of outcomes, not just survival but drug toxicity. There’s very little data on drug evaluation in older patients, this has been a big problem, and because of that we really have to be very cautious about extrapolating data that’s derived from large clinical trials of younger patients to older patients. Fortunately through these researchers we have the tools to at least start to do that in a meaningful data-driven fashion.

We owe it to the older patients to do these kinds of things to avoid under-treatment, to avoid over-treatment, to avoid toxicity, to maintain quality of life and maintain independence. One of the great things about the SIOG organisation is we bring together people from all over the world who have various experiences about investigating older patients, taking care of them, this cross-cultural fertilisation that we have because in our current meeting there are people from 42 countries, I believe. This is an extraordinarily valuable experience to help clinicians take care of their patients. This has been very fruitful and I’m hopeful will continue to expand because the older patient population is expanding.

What are you looking forward to in 2017 for SIOG?

In terms of geriatric oncology what’s happening is the new drug development, there’s been a lot of focus recently on immunotherapy, precision medicine, genomic analysis and this is something that can be extrapolated to older patients. Better supportive care issues are always important, the use of radiation therapy in a limited but precise and effective fashion, for instance fewer fractions, patients will not have to come to the clinic as often, this is an area of investigation. So these are exciting times in certain diseases and there’s a shift away, not totally but there’s a subtle shift away, from conventional chemotherapy and we really have to learn how to use these new drugs in older patients, how to design clinical trials which are applicable to older patients because we have to get out of the mould where we’ve been doing it really for decades with standard chemotherapy and how to use these new drugs and evaluate them in an appropriate manner for older patients. In the next year or so there’s going to be a tremendous focus on not just the new drugs themselves but how to evaluate older patients in that context.