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National organization of geriatric oncology care: The french model
2013 SIOG Speaker Abstracts
changes and ineffective production of hematopoietic cells, resulting in cytopenias and symptoms thereof. Thus, MDS represent one of the most frequent and serious hematologic diseases of the elderly. MDS are commonly classified based on World Health Organization (WHO) categories. These categories are typically based on blast cell counts, signs of dysplasia in peripheral blood or bone marrow cells as well as evaluation of karyotype. Significant differences in survival among these groups, as well as varying likelihood of developing secondary acute myeloid leukemia (sAML) have been described. Due to highly individual courses of MDS and in order to individualize therapeutic decisions, prognostic scores are needed. Actually, several scoring systems are applied in clinical practice. The gold standard in prognostication in MDS remains the International Prognostic Scoring System (IPSS), which has been updated recently (IPSS-R). Based on the number and degree of cytopenias, blast counts, cytogenetic risk groups and age the IPSS-R defines different risk groups for overall survival and leukemic evolution. The transfusion need of patients was integrated as a relevant parameter in the WHO classification-based prognostic scoring system (WPSS). Patient-associated parameters like age or performance status have been introduced and established as prognostic parameters in MDS recently. Thus, the impact of distinct comorbidities or possible cumulative effects on clinical outcome of MDS has been described by several groups. Scores applied in MDS so far were the Charlson Comorbidity Index (CCI), the hematopoietic cell transplantationcomorbidity index (HCT-CI) as well as the Adult Comorbidity Evaluation-27 (ACE-27). Based on HCT-CI scoring a MDS-specific comorbidity index (MDS-CI) was developed. This presentation will give an overview on the relevance of the integration of age and comorbidities in clinical risk scoring and in prediction of toxicities and completion of chemotherapy in MDS-patients. In addition, options for future developments will be highlighted. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.222
S13
Abstract: As life expectancy increases, the number and proportion of elderly patients with cancer are rising. Consequences in terms of Public Health are major and the national health systems should deal with it, including both patient care and research. To organize geriatric oncology care, the French National Cancer Institute (INCa) decided in 2006 to create a regional network of geriatric oncology units in France. The first step occurred in 2006/ 2007 with the accreditation of 15 pilot UCOG (Geriatric Oncology Coordination Unit). Each of them have been evaluated annually and audited by an international advisory board before a new call for tender was launched in 2011/2012. Currently, the full territory coverage is ensured by 24 regional UCOGs, including five with interregional duties. All are coordinated by both an oncologist and a geriatrician. They have to deal with cancer care in their territory with the objective to ensure that geriatric oncology management is structured and feasible in all community hospitals. They have also to train physicians to older patient cancer care, to inform patients and public and to promote geriatric oncology research with the objective to include more than 5% of elderly with cancer in clinical trials. All UCOG are grouped and coordinated in the Fédération Française des UCOG and with the INCa. To support geriatric oncology on a supranational basis, a society has been launched recently, name SoFOG (Société Francophone d’Oncologie Gériatrique), French division of SIOG. It is linked to a periodical (Journal d’Oncogériatrie) and an annual meeting to disseminate good clinical practice in France with 200 to 300 participants per year. Among its objectives, it will develop guidelines in cooperation with other French specific cancer societies. Besides that, clinical research is active based on active research networks: the GERICO supported by the UNICANCER group of cancer centers, most French oncology cooperative groups and on the UCOGs which perform transversal, geriatry-based, clinical trials such as ONCODAGE. Overall, thanks to strong government incitation and support, organization of geriatric oncology in France is clear and functional. Currents efforts aim at consolidating this organization and make it able to better participate to the development of geriatric oncology on an international basis. Disclosure of Interest: None Declared. Keywords: None
S20 Francilian oncogeriatric group (FROG)'s focus on management of elderly patients with bladder cancer
doi:10.1016/j.jgo.2013.09.224
D. Ghebriou⁎. Medical Oncology, Centre Hospitalier Argenteuil, Argenteuil, France Abstract: Bladder cancer is diagnosed more often in the elderly. The most effective treatment strategies are mostly very aggressive and are not applicable to all patients in a very heterogeneous population. However, effective options exist to treat the most vulnerable subjects. A multidisciplinary approach including a geriatric assessment is essential for optimal adaptation of treatment. The FRancilian Oncogeriatric Group (FROG) conducted a comprehensive literature search in order to review the applicable therapeutic options according to oncological and geriatric settings. International recommendations are essential to harmonize the management of elderly patients with bladder cancer. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.223
S21 National organization of geriatric oncology care: The french model Pierre Soubeyran⁎. Medical Oncology, Institut Bergonié, Bordeaux, France
S22 How to integrate geriatrics into oncology care: Nursing perspectives B.A. Esbensen⁎. Research Unit, Glostrup Hospital, Glostrup, Denmark Abstract: Over the coming decades, the numbers of elderly will increase, and through improved lifestyles and better treatment longevity has increased, and with it, the risk of contracting cancer. How elderly people live with cancer has until now attracted limited research. The overall aim of this presentation is to focus on available research within the field. Furthermore, to discuss how it is possible to integrate geriatrics into oncology care from a nursing perspective. The presentation will be based on existing research focusing on factors with significant meaning to elderly with cancer, such as quality of life, dependency, hope, social network, financial issues, dominating complaints (fatigue and pain), and considerations about end of life. Health care professionals need to take time to listen to and counsel the elderly regarding their concerns as both an elderly person and as a person with cancer. In which way health care professionals will be able to be conscious about elderly with cancer as a heterogeneous group will be discussed. For that reason it is significant to identify the specific meaning that the cancer has for the individual elderly, and to
changes and ineffective production of hematopoietic cells, resulting in cytopenias and symptoms thereof. Thus, MDS represent one of the most frequent and serious hematologic diseases of the elderly. MDS are commonly classified based on World Health Organization (WHO) categories. These categories are typically based on blast cell counts, signs of dysplasia in peripheral blood or bone marrow cells as well as evaluation of karyotype. Significant differences in survival among these groups, as well as varying likelihood of developing secondary acute myeloid leukemia (sAML) have been described. Due to highly individual courses of MDS and in order to individualize therapeutic decisions, prognostic scores are needed. Actually, several scoring systems are applied in clinical practice. The gold standard in prognostication in MDS remains the International Prognostic Scoring System (IPSS), which has been updated recently (IPSS-R). Based on the number and degree of cytopenias, blast counts, cytogenetic risk groups and age the IPSS-R defines different risk groups for overall survival and leukemic evolution. The transfusion need of patients was integrated as a relevant parameter in the WHO classification-based prognostic scoring system (WPSS). Patient-associated parameters like age or performance status have been introduced and established as prognostic parameters in MDS recently. Thus, the impact of distinct comorbidities or possible cumulative effects on clinical outcome of MDS has been described by several groups. Scores applied in MDS so far were the Charlson Comorbidity Index (CCI), the hematopoietic cell transplantationcomorbidity index (HCT-CI) as well as the Adult Comorbidity Evaluation-27 (ACE-27). Based on HCT-CI scoring a MDS-specific comorbidity index (MDS-CI) was developed. This presentation will give an overview on the relevance of the integration of age and comorbidities in clinical risk scoring and in prediction of toxicities and completion of chemotherapy in MDS-patients. In addition, options for future developments will be highlighted. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.222
S13
Abstract: As life expectancy increases, the number and proportion of elderly patients with cancer are rising. Consequences in terms of Public Health are major and the national health systems should deal with it, including both patient care and research. To organize geriatric oncology care, the French National Cancer Institute (INCa) decided in 2006 to create a regional network of geriatric oncology units in France. The first step occurred in 2006/ 2007 with the accreditation of 15 pilot UCOG (Geriatric Oncology Coordination Unit). Each of them have been evaluated annually and audited by an international advisory board before a new call for tender was launched in 2011/2012. Currently, the full territory coverage is ensured by 24 regional UCOGs, including five with interregional duties. All are coordinated by both an oncologist and a geriatrician. They have to deal with cancer care in their territory with the objective to ensure that geriatric oncology management is structured and feasible in all community hospitals. They have also to train physicians to older patient cancer care, to inform patients and public and to promote geriatric oncology research with the objective to include more than 5% of elderly with cancer in clinical trials. All UCOG are grouped and coordinated in the Fédération Française des UCOG and with the INCa. To support geriatric oncology on a supranational basis, a society has been launched recently, name SoFOG (Société Francophone d’Oncologie Gériatrique), French division of SIOG. It is linked to a periodical (Journal d’Oncogériatrie) and an annual meeting to disseminate good clinical practice in France with 200 to 300 participants per year. Among its objectives, it will develop guidelines in cooperation with other French specific cancer societies. Besides that, clinical research is active based on active research networks: the GERICO supported by the UNICANCER group of cancer centers, most French oncology cooperative groups and on the UCOGs which perform transversal, geriatry-based, clinical trials such as ONCODAGE. Overall, thanks to strong government incitation and support, organization of geriatric oncology in France is clear and functional. Currents efforts aim at consolidating this organization and make it able to better participate to the development of geriatric oncology on an international basis. Disclosure of Interest: None Declared. Keywords: None
S20 Francilian oncogeriatric group (FROG)'s focus on management of elderly patients with bladder cancer
doi:10.1016/j.jgo.2013.09.224
D. Ghebriou⁎. Medical Oncology, Centre Hospitalier Argenteuil, Argenteuil, France Abstract: Bladder cancer is diagnosed more often in the elderly. The most effective treatment strategies are mostly very aggressive and are not applicable to all patients in a very heterogeneous population. However, effective options exist to treat the most vulnerable subjects. A multidisciplinary approach including a geriatric assessment is essential for optimal adaptation of treatment. The FRancilian Oncogeriatric Group (FROG) conducted a comprehensive literature search in order to review the applicable therapeutic options according to oncological and geriatric settings. International recommendations are essential to harmonize the management of elderly patients with bladder cancer. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.223
S21 National organization of geriatric oncology care: The french model Pierre Soubeyran⁎. Medical Oncology, Institut Bergonié, Bordeaux, France
S22 How to integrate geriatrics into oncology care: Nursing perspectives B.A. Esbensen⁎. Research Unit, Glostrup Hospital, Glostrup, Denmark Abstract: Over the coming decades, the numbers of elderly will increase, and through improved lifestyles and better treatment longevity has increased, and with it, the risk of contracting cancer. How elderly people live with cancer has until now attracted limited research. The overall aim of this presentation is to focus on available research within the field. Furthermore, to discuss how it is possible to integrate geriatrics into oncology care from a nursing perspective. The presentation will be based on existing research focusing on factors with significant meaning to elderly with cancer, such as quality of life, dependency, hope, social network, financial issues, dominating complaints (fatigue and pain), and considerations about end of life. Health care professionals need to take time to listen to and counsel the elderly regarding their concerns as both an elderly person and as a person with cancer. In which way health care professionals will be able to be conscious about elderly with cancer as a heterogeneous group will be discussed. For that reason it is significant to identify the specific meaning that the cancer has for the individual elderly, and to