Blood Cancer in the Elderly: European Expert Forum, Rome, 19—20 March 2011
Professor Matti Aapro (University of Geneva)
Professor Matti Aapro is Dean of the multi-disciplinary Oncology Institute in Genolier, Switzerland and Executive Director of the International Society for Geriatric Oncology. He has spent much of his career building geriatric oncology as a specialism in its own right. We asked him to give us a brief history of how far the specialism has come over the past thirty years.
Basically, the area of geriatric oncology started, we believe, in 1983 when Rosemary Yancik from the National Institute of Health in the United States called for a meeting specifically about geriatric oncology. Then it moved forward and one of the persons really moving it forward was the past president of ASCO, many years ago, BJ Kennedy who took it as one of his primary goals as he was president of ASCO.
In Europe we followed suit, in 1990 we had a meeting with the help of the European School of Oncology and Ian Fentiman and colleagues wrote a very provocative paper in The Lancet called ‘Cancer in the elderly: Why so badly treated?’ Until the late ‘80s, early ‘90s there were no studies in older patients; basically patients above the age of 65 were excluded from any clinical studies and then it was realised that that was completely wrong because our population is aging, there are more and more older persons, even older than 75 or 80 and we have no data on how to best approach them. So we had to do something.
The next step was that Lodovico Balducci, one of the founders of the area, put together a book in 1998 - the first edition of Comprehensive Geriatric Oncology. Lodovico Balducci and other colleagues from Argentina, Professor Estevez, and from Europe like Professor Santi, had been putting together meetings called the International Conference of Geriatric Oncology. These meetings were the basis of the formation of the International Society of Geriatric Oncology, SIOG, in the year 2000. The society comprises of, I would say, most experts in geriatric oncology throughout the world and internationally we try to devise guidelines.
So in 2002 the first guidelines on really how to treat patients were devised by colleagues in Germany: Carsten Bokemeyer published them in 2002 in the journal called Oncologie and then there was the foundation in the United States of a specific consortium that wanted to do trials in elderly patients. Very well recognised entities like the EORTC, ECOG, NSABP and others embraced the importance of doing specific studies in the elderly. In 2005 we had a landmark meeting, the WHO met and decided that two areas had to have priority: one was aging and healthy aging and the other one was cancer prevention and control which, surprisingly, until then was not a main focus of the agenda of WHO. So since then we are on the political agenda worldwide.
SIOG has continued to develop, is very happy to be a member now of the UICC and also has launched, in 2010, The Journal of Geriatric Oncology with Arti Hurria from City of Hope in the United States as Editor in Chief. The journal has been very successful, it was launched in 2010, two issues then, now four issues, it probably might even go to six issues very quickly with excellent levels of papers and we hope to be high in the citation index very soon.
The progress in the area of geriatric oncology is remarkable. In the past few years we have gone from a situation in which no-one really wanted to do specific studies in elderly patients to specific studies in elderly patients. The only way to go forward is to have randomised clinical trials that do not exclude the real elderly, that take into account the elderly who have comorbidities who represent, after the age of 75, the majority of them.
The age of the patient should never been defined by the passport age; it all depends on who the patient is. Some of us are relatively fit when we hit 75-80. I have a patient who is 92 years old and I can assure you he is going to beat almost everyone, except Roger Federer, in tennis.