Oncogeriatrics, a new specialty to help elderly cancer patients

Prevention, care pathways, therapeutic novelties… Now open to the international scene, the 9th MAO (Monaco Age Oncology) brought together, from March 22 to 24, the world of oncology (more than 600 specialists in total) around the complex issues of care and treatment of elderly cancer patients. A real specialty called oncogeriatrics. “The MAO provides a reference framework in which to share discoveries and mutual experiences, cross our eyes, and advance knowledge of diseases and available therapies, for the benefit of this population of patients”, summarizes Dr. Rabia Boulahssass, member of the MAO organizing committee. Meeting with this specialist, geriatrician and head of the functional coordination unit in oncogeriatrics at the University Hospital of Nice.

Why is the management of cancer in the elderly a societal issue?

Already for a demographic reason. The population is ageing: today one inhabitant in five is over 65 in the European Union. However, we also know that the risk of developing a chronic disease and cancer in particular increases with age. Result: 60% of people currently affected by cancer are over 65 years old. Another telling figure: nearly 2 out of 3 cancers occur in individuals over the age of 75.

What specific questions does the care of elderly patients raise?

One of the major questions, in particular when dealing with very old patients – over 90 years old – is that of the risk of excessive treatment. How far to go? Is the treatment suitable or not? These are questions that we must ask ourselves, by collectively evaluating the benefits and risks of treatments, on a case-by-case basis. Neither abandonment nor relentlessness: the objective is to provide the right care.

A very ethical approach…

Absolutely. If the technique, the science, the therapeutic progress are important, it is also necessary to take into account the ethical aspect, and the alternatives.

Regarding the patients themselves, what do they generally claim?

It is very variable. Recently, we were treating a nonagenarian patient who, following a first line of chemotherapy that had not produced results, wanted to receive a second line of treatment. However, the team, after carrying out an assessment of her state of health, felt that it was too heavy, that she would not be able to bear it. We explained to her that it was unreasonable, but that we could give her other types of care, which were just as important.

How do patients react in this type of situation?

When we take the time, when we respect the autonomy of decision, when we clearly explain that we are going to provide the best support towards care that favors comfort and quality of life, even if we have exceeded the therapeutic prospects , we are generally heard. Collegiality and work with intra- and extra-hospital palliative care teams can make it possible to provide the patient with appropriate care.

Does the patient always have the last word in all cases?

The patient, from a legal point of view, always has the right to refuse a therapeutic project. On the other hand, he cannot demand treatment if the team, after having assessed the benefits and the risks, considers that it is unreasonable. An oncologist can accept risks, but moderate.

What recourse for the patient if he does not agree with the medical decision?

He is always entitled to seek a second opinion. But, these situations of opposition, I insist, are rather rare; in 95% of cases, we reach an agreement.

What place do families have in this colloquium?

They are immediately involved. We also interact with them, by discussing the purposes of the processing, the conditions for prosecution and the limits beyond which we cannot go. These discussions take place prior to treatment.

What about therapy now?

They have made a lot of progress, particularly with regard to breast and ovarian cancer, and we are also managing to cure elderly patients.

Do these patients over 80 or 90 also have access to innovative therapies?

Absolutely. And even to clinical studies, knowing that most of them no longer set an age limit. On the other hand, the patients must meet the inclusion criteria: the absence of certain comorbidities, a history of cancer, etc.

Is the elderly patient, regardless of his place of care, sure to have the optimal treatments, adapted to his state of health?

Yes, insofar as any oncologist who takes care of a person aged 75 and over with cancer can establish a score called G8 (for 8 questions). This geriatric screening tool, recommended by the INCa within the framework of the Cancer Plans, makes it possible to assess the patient’s fragility. If this score is good, the patient does not need a geriatric assessment; he can be treated like any other younger patient. On the other hand, in the event of a poor score, the oncologist can, if he wishes, refer his patient to a referent in oncogeriatrics for an appropriate consultation and a geriatric assessment.

What do you think, beyond the ethical and therapeutic aspects, the most important in the care of our seniors?

When it comes to elderly patients, the most important thing is to work as a team: community nurses, pharmacists, attending physicians, oncologists… We all have to be around the patient. And on a daily basis.

“The most important thing is to work as a team: city nurses, pharmacist, attending physician, oncologists… We all have to be around the patient. And on a daily basis.” Photo F.C.