The differences between supportive care and geriatric oncology care

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Published: 23 Nov 2018
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Dr Gilbert Zulian - Hôpitaux Universitaires Genève, Geneva, Switzerland

Dr Gilbert Zulian speaks to ecancer at the International Society of Geriatric Oncology 2018 conference in Amsterdam about the differences between supportive care and geriatric oncology care.

He describes how these terms are used in the literature, and how palliative care meshes with this.

Dr Zulian also emphasises how geriatric care is specific to disease and treatment, whereas supportive care is about improving quality of life.

This service has been kindly supported by an unrestricted grant from Janssen Oncology.

I’ve been trained first as an internist then a medical oncologist, eventually a geriatrician and quite recently as a palliative care specialist. I suppose this is the reason why they asked me to speak about differences, if any, between supportive care and geriatric oncology care. Quite a funny task, actually, to be done, a challenge in a way. I try not to end up in dividing things and rather trying to make them together.

Looking at the literature it’s interesting to find out that when the word supportive care is used it is mainly used in a way to promote an approach against the toxicity, the side effects, of the treatments given by the physicians, be it chemotherapy, radiotherapy, immune therapy. There is another word coming quite close to supportive care that is precisely palliative care. One can even have sometimes the idea that they’re exactly similar – supportive care or palliative care, palliative care or supportive care. The definition of the NCI, ASCO, ESMO look alike, there is some kind of common objective, that is to improve the quality of life of the patient. So in this respect supportive care has a very large field of activity, it’s not only linked to cancer chemotherapy or radiotherapy but could address any type of treatment in our life path just until the end.
On the other side, geriatric oncology is more directed to a specific part of the part of the population, that is the so-called elderly, which are for most of them supposed to be vulnerable or even fragile and who obviously deserve a different attitude. So there is then some kind of difference because supportive care is for everyone through his lifetime whereas geriatric care, obviously, is limited to the elderly people.

Not only that, the other difference I found was to point out the fact that geriatric oncology has to do with diseases, disorders, specific – lung, brain, breast, digestive tract, urinary tract etc. – so it is definitely a medical specialty by itself and it is recognised as such in the US, for instance, but also in other countries of the world, in France for instance. Whereas supportive care is not a medical specialty, it’s a duty to support someone going through the adventure of a disease or a disorder.

So there are common aspects but at the end of my, let’s call that, research which was more done in the literature, what is truly specific for geriatric oncology care is a very small part that is the few cases in which the energy is to be put on curing a disease in an elderly person. Whereas most of the geriatric activity, because people are already old, is to make their life better or as good as it is possible to do, putting the emphasis on quality of life. That’s why I think the challenge I was given is quite hard to be met. There are small differences but at the end, let’s put it that way, we are all in palliative care, are we not? Even if life is not a disease.