The prostate taskforce was started, now, more than a decade ago. Initially the aim of the taskforce was to come up with guidelines in order to help us treat older adults with prostate cancer in a more systematic and probably structured manner. Now, what has happened is that since it was first formed there have been four iterations of the guidelines and throughout this process the whole group of experts, the multidisciplinary team consisting of medical oncologists, urologists, geriatricians, nursing and also oncologists who have an interest in geriatric assessment, were all involved in a group which came to a consensus on what should be the appropriate assessment methods for prostate cancer patients. This cuts across early stage prostate cancer, right through advanced metastatic prostate cancer.
I’m currently the co-Chair of this committee with Dr Helen Boyle and we are now in the process of preparing for the next update which we hope should come out next year. There has been a lot of advancement, especially in the advanced metastatic setting. Specifically now prostate cancer has become personalised there is a lot of development in the field of homologous repair recombination genes that are implicated in the development of the cancer and also some targeted therapies that can help actually treat patients with these genes. So, in a sense, we are really looking very hard for data that involves older prostate cancer patients and using it to tailor treatment in an appropriate manner in order to not just prolong life but to improve the quality of life of these cancer patients.
How has geriatric oncology been affected during COVID-19 and what are the solutions?
Unfortunately, the geriatric oncology community of older adults who suffer from cancer have been affected tremendously. Prior to this, being an older adult with cancer, they already had a lot of issues. They had competing risks like comorbidities; cancer, of course, complicated things. Many of them had issues with social support and now comes COVID-19, truly a spanner in the works. So, basically, older adults with cancer became very low priority in terms of who they want to treat for many reasons. One, of course, when you talk about goals of care it defers from younger adults with cancer. The other issue is, of course, with multiple comorbidities it puts them at higher risk of contracting COVID-19 and dying from it. Because with cancer their immunity, especially with cancer treatment, may be impacted so this puts them at really high risk. So there was also a fear for these patients to seek help in healthcare institutions because of this high risk. In many ways these patients were isolated, they were not able to get care at the right time. Diagnosis was delayed and this obviously led to worse outcomes for them.
In order to address some of the issues that older adults with cancer were suffering from during COVID-19, SIOG actually formed a COVID-19 working group and they published this a couple of months ago online about adapting care for older cancer patients during the COVID-19 pandemic. They came up with some recommendations from this working group. This working group was led by my colleagues, Dr Nicolò Battisti and Dr Anna Mislang, and it consisted of experts from the field of surgical oncology, radiation oncology, geriatrics, of course medical oncologists as well.
This group reviewed whatever data was available with regards to older adults with cancer during this COVID period which, unfortunately, was not really very much at that point in time. However, they came up with very practical solutions on how to help this group of patients, looking at their treatment goals, looking at treatment plans, whether it is going to be systemic therapy, radiotherapy, surgery, etc., looking at patient profile, looking at their preferences, whether they had issues with geriatric assessment. These are tools that we used to use routinely, however, during the pandemic accessing healthcare institutions to get these assessments done was a big issue. So because of that, telehealth came into the picture. So there were some centres in the US, and now I gather even other countries like Australia and many parts of the world, have used telemedicine in order to do some of these assessments before the patients arrive. So geriatric assessment is probably one of those things. Then there was also tumour profile and at the end what resources were available to help these patients.
So, putting all these things together, the taskforce actually came up with some very simple, practical recommendations.