Tumors, an ad hoc cure is needed for the elderly

“Cancer is above all a pathology of the elderly, but perhaps it is the elderly patients whose needs and requirements are taken least into account during treatment. A paradox. The situation would be different if in our country, as in others, there were more geriatric oncology units with ad hoc programs for the over 70s”. Talking about oncology of the elderly and paradoxes is Silvio Monfardini, Chairman of the History of Oncology project of the European School of Oncology (SEO, European School of Oncology).

Monfardini has just signed with Francesco Perrone, president-elect of Aiom, and Lodovico Balducci, oncologist at the Geriatric Oncology of the Moffitt Cancer Center in Tampa, Florida, a commentary published in Cancers, which clarifies very well what the obstacles are to the implementation of programs and ad hoc oncological treatment units for the over 70s.

“Programs and units that not all elderly people need – the expert immediately explains -. But some do, and they are those with other pathologies in addition to cancer, with depression, with difficulties in everyday functions: the frail, in a word. The chronological age does not always correspond to the physiological one”.

Recognize the fragile

Evaluating the elderly before subjecting them to cancer treatment would allow doctors to make more weighted choices: for example, evaluating the opportunity to intervene surgically or not, or to administer or not a certain drug that would certainly be given to a more elderly person. young. And for patients to be able to count on better outcomes against the disease and on a better quality of life.

onco-geriatric units

In Italy we have only a dozen onco-geriatric units, structures where the frail elderly patient is taken care of by a mixed team of professionals: oncologists and geriatricians but also nutritionists, dedicated nurses. “Things are much better in France and also in the USA – continues the expert -. However, we can say that in low-income countries these centers are absent, and in high-income ones they are almost absent”.

geriatric screening

To obtain an oncological path tailored to the elderly patient, the first step is to submit the over 70s diagnosed with cancer to a geriatric evaluation before treatment. “And little is done, or little is done – says Monfardini – Yet today we have rapid screening tests that in a few minutes provide us with information on comorbidities, weight loss, depression and more, and can direct us to the most suitable path for the individual case”.

The obstacles and the tsunami

But what then hinders the spread of geriatric assessment? And, more generally, what is holding back the emergence of geriatric oncology? After all, we’re talking about a branch of oncology that treats cancer medicine to patients who today make up a fifth of the population in Italy and who in 2050 will be a third. Who represent 64% of the approximately 365,000 new cases of cancer each year, and whose risk of getting cancer is forty times higher than between 20 and 44 years old and four times that between 45 and 64 years old. Which, after all, means that a real oncological tsunami will soon arrive, as in fact the next (predictable) surge in cancer cases has been christened. “The difficulty of collaboration between oncology and geriatrics is first of all due to a personnel problem – says the oncologist – There are few geriatricians everywhere, and above all in low-income countries. And then there is a scarcity of referrals to geriatrics in specialization courses. A bit like saying that the specialist doctor, in this case the oncologist but not only him, leaves the university calibrated only on the adult: a discreet myopia, given our demographic destiny. “In addition to this – continues Monfardini – there is a lack of time and staff in the health system, which are not the responsibility of doctors and which doctors suffer. Finally, there is a prejudice linked to age”.

Ageism in oncology

In society there is a tendency to consider the elderly incapable of changing, a somewhat encapsulated person, reluctant to evolve and on which it does not always make sense to bet, “ageism exists in society and is also present in medicine, where it exerts a negative influence on the general diffusion of the onco-geriatric approach.But evaluating an elderly patient from a geriatric point of view would mean, for example, substantially reducing the toxicity of oncological treatments, making more weighted, more sensible choices, and with positive also on health systems and the community, as well as on individuals”.

Exclusion from trials

But, as Monfardini writes in Cancers, despite the difficulties – practical and also cultural – professionals interested in geriatric oncology have undertaken a series of important initiatives, which include the organization of an international society, the Société international de onco-geriatric , or Siog. And the formation of clinical research groups dedicated to geriatric oncology.

Well, that of clinical research in geriatric oncology is a theme. “Elderly people are not included in clinical trials of new drugs in the same percentages as adults. The reasons are various and have to do with the interests of pharmaceutical companies, but also with the difficulties it objectively entails for medical researchers”, underlines the ‘expert.

Getting people with movement, mobility or communication problems, or with other major chronic diseases, in addition to cancer, into trials can be challenging. “However, the result is that when, at the end of the trial, the drug reaches clinical practice, its effects on the elderly are less known, less clear than those observed on the adult patient. The over 70s should be more represented in the research – concludes Monfardini – even if it requires more resources and greater effort”.