S12 Critical Reviews in Oncology/Hematology 68 (2008) Abstracts

F8 11.15–13.50Testimony on interdisciplinarity. Behind the mirror

L. Roy*. CICM Hopital CharlesLemoyne, Quebec, Montreal, Canada

Ten minutes is hardly enough time to convey not only the richness and joysof a daily interdisciplinary practice but also the questions and challengesthat practicing in this way can give rise to.

14.20–15.35

Session VI: Screening and prevention

F9 14.20–15.35Screening for common cancers in the senior adult

L. Walter*. University of California, San Francisco and the SanFrancisco VA Medical Center, San Francisco, USA

Should a 70-year-old woman with moderate dementia be screened forbreast cancer? What about an 80-year-old woman who walks 3 milesa day? The answers to these questions are difficult for many reasons:(1) most trials of screening interventions have excluded persons over age75; (2) data from trials may not be applicable to an individual with severeillness because such people are excluded from trials; and (3) individualsbecome increasingly unique in their particular combination of health,function, and preferences with advancing age. As a result, rather thanrelying on age cut-offs to decide when to stop screening senior adults, amore rationale approach is to make individualized screening decisionsin which risks and benefits are weighed and patient preferences areconsidered.This lecture presents a framework to guide how to think through cancerscreening decisions in senior adults in which individual characteristics(health/life expectancy) and preferences are incorporated into screeningdecisions regarding common cancers (e.g., breast, cervical, colorectal,and prostate cancer). Our framework for individualizing cancer screeningdecisions involves (1) estimating life expectancy, (2) estimating potentialbenefits of screening, (3) considering potential harms of screening, and(4) weighing potential benefits and harms according to an individual’svalues and preferences. Life expectancy affects the likelihood of receivingbenefit versus harm from screening because the benefit of screening doesnot occur immediately. In general, patients with a life expectancy ofless than 5 years are unlikely to derive survival benefit from cancerscreening, whereas they are still at risk for harms. Harms of screeninginclude (1) complications from procedures to follow-up inaccurate testresults, (2) identification and treatment of clinically unimportant diseasethat would not have progressed to symptoms in a patient’s lifetime, and(3) psychological distress. Finally, since many cancer screening decisionsin senior adults cannot be answered solely by quantitative estimates ofbenefits and harms, considering the estimated outcomes according to apatient’s own values and preferences is critical for informed individualizedscreening decisions.In summary, cancer screening decisions in senior adults should not followa one-size-fits-all approach based on age. Rather, understanding potentialbenefits and harms of medical interventions and being aware of patientwishes are core principles of good medicine and should be applied tocancer screening decisions in senior adults.

F10 14.20–15.35Can geriatric syndromes be prevented?

T. Vu*. CHUM-Hopital Saint-Luc, Montreal, Quebec, Canada

Aging refers to all time-related processes that occur in the life of a personand is associated with both beneficial and deteriorative effects. Senescencespecifically refers to the deteriorative changes that decrease physiologicaland functional capacity. Frail older adults are in a vulnerable state ofhealth, arising from the interaction of medical and psychosocial problems,resulting in a decreased ability to respond to stress, and associated with adecline in functional performance. Frailty determinants are complex andmultiple and delay in their correction can put the older adults at risk of fastdecline. Early screening of modifiable frailty risk factors (cognitive status;mood; communication; mobility and balance; incontinence; nutrition;

medication use; comorbidity; functional activity and social support) allowsto set up a plan for a personalized and optimal patient care.

15.35–17.05

Session VII: In Depth reviews: Surgery for the senioradults with cancer

F11 15.35–17.05What surgeons can do for older patients with cancer

R. Audisio*. University of Liverpool, Liverpool & Whiston Hospital,Prescot, United Kingdom

The prevalence of solid tumours is well described and recognised, with allsolid tumours affecting with the exception of cervical cancer.The sole anagraphic age cannot be taken into serious account. No bi-ological markers have been made available in drawing a cut-off lineand definitions on the basis of physiological differences have provenunreliable. The health status in the elderly is a much more complexissue. Tolerance to stress is reduced as well as functional reserve, socio-economical support and cognitive physiological status, whilst the numberof associated conditions expands. But it is well known that comorbiditiesand functional status are independent. Correlation between performancestatus and ADL/IADL is moderate and patients with comorbidities donot have a higher risk of developing complications. Of course a highprevalence of comorbidities affects patients accrual into surgical series.They do impact on short term surgical outcomes, particularly when surgeryis most challenging; they also negatively impact on long term overallsurvival. Comorbidity is prognostically more important in situations werethe prognostic impact of the tumour is small and vice versa.A separate still crucial issue is the assessment of malnourishment; over50% of residents in nursing homes in the US and over 60% of hospitalisedelderly people in the European Union show signs of malnourishment.Malnourishment on its own predisposes to adverse treatment outcomes,increases mortality and morbidity as well as expanding hospital stay andcosts as well.In any case elderly cancer patients do seek for surgical treatment. It is truethat they are less likely to challenge the Physician’s authority and they arecomfortable with somebody else making the decision. But they ask forbest standards of care whilst appreciating the good use of health servicemoney and desire radical curative surgery. No reason can justify rationingcare on the basis of chronological age. Surgical treatment is effective in theyoung as well as in the elderly sub-setting; it has been proven that qualityof life and ADL expands even in the frailest elderly after a successfuloperation. Surgical, anaesthesiological and nursing strategies as well asphysiotherapy are to be optimised and tailored to oncogeriatric patients.Geriatric assessment tools play a major role in identifying those individualswho are exposed to a higher risk of developing post operative complicationand lengthening hospital stay. Our previous experience on PACE hasgenerated a new research project (PREOP) which will soon be started.This is to facilitate accurate patient selection which should never bebased on a “rule-of-thumb” or the mere number of comorbidities. Weadvocate an unbiased selection based on quick and effective screeningtools. This would allow comparison of surgical outcomes, better consentingand treatment planning, active management of comorbidities, personalisedand individualised care and hopefully resulting into an improved survival.

F12 15.35–17.05Laparoscopic colorectal surgery in octogenarians & nonagenarians

D. Geisler, J. Marks*, E. Carlos, G. Marks. Lankenau Hospital,Wynnewood, Pennsylvania, USA

Introduction: Advanced age is a recognized risk factor for morbidity andmortality in conventional colorectal surgery. Reports suggest laparoscopiccolorectal surgery (LCS) may be associated with decreased morbidity andmortality in the general population. The purpose of this report is to providedata relative to the impact of advanced age on the safety of LCS.Methods: From a prospective database consisting of 241 consecutive LCSpatients, a group of 23 patients (9.5%) with an average age of 84 years