Oncogeriatric development through time: the challenge of cancer care transformation " Matti Aapro, M.D. (Switzerland)
Percentage of total population aged 60 years or older 2002 " Percentage'aged' 60'years'or'older'' in'2002:' 0–9' 10–19' 20–24' United'Na*ons.'Popula*on'Division.'Department'of'Economic'' No'data' and'Social'Affairs.'Popula*on'Ageing.'2002'
WHERE ARE THE ELDERLY R. Audisio EORTC EGAM 2007 World Health World Health Department of Chronic Diseases and Health Promotion Organization Organization
Mean age of global population is increasing 55 50 Japan China Median age (years) 45 India 40 Mexico United States 35 Pakistan South Korea 30 25 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 20 Year Figure taken from United Nations World Population Prospects at http://esa.un.org/unpp/index.asp?panel=2 15
Percentage of total population aged 60 years or older 2050 " Percentage'aged' 60'years'or'older'' in'2050:' 0–9' 10–19' 20–24' United'Na*ons.'Popula*on'Division.'Department'of'Economic'' No'data' and'Social'Affairs.'Popula*on'Ageing.'2050'
Are all older patients functionally the same? 6 received from R. Audisio
Life expectancy in senior adults: a large variability reflecting health status variability Top 25th percentile (FIT seniors) 50th percentile (MEDIAN life expectancy) Domains Cognition 25 Lowest 25th percentile (FRAIL seniors) Comorbidity Health Emotional conditions Life expectancy, years 20 18 Function status Geriatric syndromes 14.2 15 groups 12.4 Nutrition 10.8 Pharmacy 9.3 10 7.9 Socioeconomic 6.7 6.7 conditions 5.8 4.9 4.7 4.3 5 3.3 3.2 2.3 2.2 1.5 1 0 70 years 75 years 80 years 85 years 90 years 95 years 7 Walter LC et al. JAMA 2001, 285, 2750-2756
Short history of cancer treatment in older patients 1 US Geriatric National Oncology Comprehensive Consortium Cancer Network founded to (NCCN) guidelines initiate trials published practice and raise National Cancer The Venice International guidelines for awareness Institute and statement 2 Society senior adult of problems National Institute of Geriatric oncology 5 Cancer in the 2010 of elderly on Ageing sponsor Oncology 2006 elderly: why patients a symposium 2005 (SIOG) so badly 2003 formed Perspectives 2002 treated ? on prevention JOURNAL 2000 World Health and treatment 1998 Organization 58th 1990 of cancer in of GERIATRIC First onco- 1988 General Assembly the elderly geriatric 1983 ONCOLOGY resolution on First edition of guidelines Strengthening Comprehensive published Active and Dr BJ Kennedy Geriatric on the use Healthy Ageing encouraged the Oncology of haematopoietic study of ageing ESMO HANDBOOK released growth factors Comprehensive and cancer during in elderly patients Geriatric the Presidential receiving Address at cytotoxic Assessment ASCO 1988 chemotherapy 3 guidelines by the SIOG 4 1. Aapro M. J Geriatric Oncol 2010;1:2–3; 2. Fentiman IS, et al. Lancet 1990;335:1020–2 3. Balducci L. NCCN Clinical Practice Guidelines in Oncology Senior Adult Oncology November 1, 2006 4. Bokemeyer C, et al. Onkologie 2002;25:32–9 5. Extermann M, et al. Crit Rev Oncol Hematol 2005;55:241–52
On May 2005 the 58th World Health Assembly adopted two resolutions: - Strengthening Active and Healthy Ageing - Cancer Prevention and Control Following the adoption of these resolutions WHO is intensifying: • its global action against cancer • its action to develop the health care of older persons. World Health Department of Chronic Diseases and Health Promotion Organization
CANCER IS ON THE POLITICAL AGENDA ! The United Nations General Assembly adopted by consensus the resolution titled "Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases" (document A/66/L.1). – High-Level Meeting on NCDs, 19-20 September 2011
UN Political Declaration ! We, Heads of State and Government and representatives of States and Governments, assembled at the United Nations on 19 and 20 September 2011, … .. ! 21. Recognize that the conditions in which people live and their lifestyles influence their health and quality of life and that poverty, uneven distribution of wealth, lack of education, rapid urbanization, population ageing and the economic social, gender, political, behavioural and environmental determinants of health are among the contributing factors to the rising incidence and prevalence of noncommunicable diseases;
UN Political Declaration ! Chapter 45 ! (e) Pursue and promote gender-based approaches for the prevention and control of non-communicable diseases founded on data disaggregated by sex and age in an effort to address the critical differences in the risks of morbidity and mortality from non- communicable diseases for women and men;
Growing interest has led to the formation of a geriatric oncology society, member of UICC GIOGer EUGMS SIOG/ISGO President: R. Audisio (UK) President-elect: A. Hurria (USA ) FNCLCC Past President: M. Extermann (USA) EORTC GEPOG Treasurer: C. Steer ( AUS) GeriONNE www.siog.org
www.siog.org • Arma senectutis artes exercitationesque virtutum • The arms best adapted to old age are culture and the active exercise of the virtues Cicero, De Senectute
WHY CICERO You may be sure, my dear Scipio and Laelius, that the arms best adapted to old age are culture and the active exercise of the virtues. For if they have been maintained at every period -if one has lived much as well as long- the harvest they produce is wonderful, not only because they never fail us even in our last days (though that in itself is supremely important), but also because the consciousness of a well-spent life and the recollection of many virtuous actions are exceedingly delightful. Cicero, De Senectute
We cannot � simply � apply principles of clinical studies validated in younger patients EORTC workshop on clinical trial methodology in older individuals with a diagnosis of solid tumors A.G. Pallis, A. Ring, C. Fortpied, B. Penninckx, M.C. Van Nes, U. Wedding, G. von Minckwitz, C.D. Johnson, L. Wyld, A. Timmer, F. Bonnetain, L. Repetto, M. Aapro, A. Luciani, H.Wildiers On behalf of the EORTC Elderly Task Force Annals Oncology, 2011
The SIOG guidelines ! Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R. Lancet Oncol 2012 Apr; 13:e148-60 ! Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper. Aapro M, Bernard-Marty C, Brain EG, Batist G, Erdkamp F, Krzemieniecki K, Lenoard R, Lluch A, Monfardini S, Ryberg M, Soubeyran P, Wedding U. Ann Oncol. 2011;22:257-67
UICC World Cancer Declaration
Martine Extermann, MD Moffitt Cancer Center Tampa, FL, USA
SIOG/ISGO 2012 MEETING MANCHESTER, U.K. OCTOBER 25-27, 2012 www.siog.org 23
Recommend
More recommend
