2010 American Society of Hematology Annual Meeting 3rd - 7th December
Interview with Dr Reinhard Stauder - Innsbruck Medical University, Innsbruck, Austria
Haematological cancers in the elderly
RS Reinhard Stauder
IV You’re on the steering committee for this big meeting in Rome in March, in 2011, on blood cancer and the elderly. You’re steering the meeting, what do you think are the really important issues that you want to focus on there?
RS Important focus is to overcome ageism in elderly blood cancer patients because ageism is something which happens in daily practice. It’s based on the lack of evidence, the lack of clinical studies so doctors often have... they are missing information about how to treat elderly cancer patients, how to integrate cardial impairment or renal impairment into their decisions. That’s why one of the main goals of this conference is to overcome ageism in elderly blood cancer patients.
IV Could you give me a typical example of how ageism manifests itself? What actually happens?
RS For example, when you consider a lady of 80 years old who is suffering from Diffuse Large B-cell Lymphoma; Diffuse Large B-cell Lymphoma without treatment results in death, in dying, within two or three months. So when this lady is sitting in front of you first of all you have to consider age adjusted life expectancy, which means life expectancy from birth in Austria is 82 years, but when someone manages to get to 80 years old, has good genes, has risk factors under control, which means a lady of 80 years has a life expectancy of eight years.
When she has low co-morbidities she even has a median life expectancy of more than ten years. Colleagues are often not aware of that fact, but when you tell them the time horizon, your decision is based on this ten years so you lose... or might gain these ten years, then your decision gets a more profound basis. First of all it’s age adjusted life expectancy, and secondly it’s the inclusion of co-morbidities.
IV How would that change your management?
RS I mean, age adjusted life expectancy has to be considered, which means I have to integrate that horizon of eight to ten years, which this lady would live for without having this lymphoma. In general, therapy in Diffuse Large B-cell Lymphoma is based on anthracyclines which means I have to make a careful evaluation of the cardiac situation, to figure out if anthracyclines are appropriate in this situation. Renal function is relevant and several other dimensions like cognition, which means I need an informed consent. Does the lady understand completely what’s going on? Can I obtain her consent?
IV So this is when the doctor takes over and not just the cancer doctor? You need to have the whole view of the patient, the care, in your mind?
RS Yes, and you have to integrate, of course, the patient’s perspective, the patient’s opinion, and the wishes of the patient.
IV Now the meeting in Rome – what are doctors and clinicians going to be doing there?
RS We will discuss issues of how to treat different haematological malignancies, we will discuss to come up with recommendations, and we will try to define biological age, which means how does the ageing process influence the situation, how has it to be integrated into my decision making?
IV And just how different can biological age be from chronological age? How big is the gap sometimes?
RS The gap is sometimes in the range of ten years because you might know those guys, 80 years old who are running up, or who are biking and even... yes, I also watch to see if they are faster than someone who is ten or 15 years younger than they are. And then there are other elderly who are frail, who are reduced in the quality of life, who are reduced in the functional capacities, who need everything they have to keep up their daily life – so the definition of vulnerable is certainly very important. So who can tolerate stress, who can tolerate the therapy which we plan? So individualised management, individualised therapy is one of the key issues of this conference.
IV Could you sum up just one or two points that you think anybody planning to attend this meeting will get out of it?
RS He or she will get out discussions by specialists from all of Europe on physiological age, on the issues of different haematological malignancies and how to make an individualised, tailored approach in an elderly cancer patient.
IV Well, I look forward to hearing much more about it and attending the meeting, of course. Reinhard, thank you very much for being on ecancerTV.
RS Thank you.