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Diagnosis and treatment of the three “Ds” (Depression, Delirium, and Dementia) in older patients with cancer
S14
Critical Reviews in Oncology/Hematology 68 (2008)
paper and/or on screen available in the patients’ notes. ESAS has been validated in many different languages and settings but mostly in the field of palliative care and medicine. Under our hands, it has proved useful to show progress and/or deterioration on treatment and it is used on a daily basis both on the ward and in the clinic. ESAS was initially constructed as an auto-questionnaire but it may be filled-in with the help of health professionals or of the family thus becoming a true common language. As many cancers are now treated like chronic conditions and with more people living a longer time, ESAS appears a convenient way to determine how patients and cancer can co-exist. Reference(s) [1] CROH 2003; 47: 281–286.
F16 08.00–09.20 Diagnosis and treatment of the three “Ds” (Depression, Delirium, and Dementia) in older patients with cancer T. Rabinowitz *. University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA Worry that one has cancer or receiving a definitive cancer diagnosis are likely to cause distress at key times during cancer diagnosis and treatment including: (1) discovery of a lesion, (2) signs or symptoms of a malignancy, (3) confirmation of cancer, (4) staging procedures, (5) treatment initiation, (6) ending treatment, and (7) “watching and waiting”. In addition, many cancer treatments and some types of cancer may cause neuropsychiatric symptoms such as confusion, forgetfulness, agitation, or depression that are often misdiagnosed or misattributed and therefore inappropriately treated. If unrecognized or untreated, these conditions may adversely affect a person’s cancer treatment and prognosis, leading to poorer outcomes and greatly diminished quality of life. Elders with cancer are at particular risk for developing these conditions for several important reasons including: (1) having a pre-existing untreated mood disorder, (2) having pre-existing cognitive impairment (this may range from mild cognitive impairment (MCI) to full-blown dementia), and (3) polypharmacy. This talk will present the differential diagnosis and treatment of three common psychiatric conditions in elderly patients with cancer: depression, delirium, and dementia. In addition, preventive and screening strategies will be discussed. F17 08.00–09.20 Interdisciplinary approach and optimal management of chemotherapy-induced nausea and vomiting (CINV) and mucositis L. Surprenant *, D. Jacob *. St. Mary Hospital center, Montr´eal, Qu´ebec, Canada In today’s health care environment, patient care concerns are complex. Meeting these concerns requires that a professional team work together to design, implement, and evaluate patient care. Most collaborative practice research has occurred in specialty areas and has linked improved patient outcomes to interdisciplinary collaboration. The presentation of the case of a 70 y man with gastric cancer will demonstrate that a collaborative approach led by a nurse navigator (infirmi`ere pivot) and a pharmacist in the specialty area of oncology can identify patients at risk, empower patients to be informed and active participants in a care plan and assume self efficacy, and improve patient outcomes in managing chemotherapy-induced symptoms. The symptoms that will be discussed include chemotherapy-induced nausea and vomiting and mucositis. The presentation will include a review of each symptom to enhance the audience’s understanding and provide practical tips to optimize management of these symptoms.
Abstracts
08.00–09.20
Session IX B: Colorectal cancer F18 08.00–09.20 The role of surgery in elderly patients with colorectal cancer R. Audisio *. University of Liverpool, Liverpool, United Kingdom The increasing prevalence of colorectal cancer within the elderly population has been repeatedly confirmed; as for all solid tumours (with the only exception of cervical cancer) malignant tumours of the large bowel are highly prevalent amongst senior patients. Evidence has also been gathered to prove under-management of this age group and very little has been done to amend the situation. Poor histological confirmation and substandard staging associates with a minimalist management and results into a poor cancer-related survival (Lewis AA. Br Med J 1988; Fallahzadeh H. Am J Surg 1991). In the late 1980’s an 11% operative mortality was reported on elective series of elderly CRC patients – this was significantly increasing with the number of associated diseases. For a couple of decades reports and reviews have been trying to reassure us that elective surgery is feasible and represents a reasonably safe option, but these reports were predominantly based on well selected series where the frail patient has always been excluded. A way forward here is to replace an inaccurate rule of thumb with a Comprehensive Geriatric Assessment tool (CGA) in making the decision to operate or not (PACE Participants. CROH 2008). Obstructive conditions should be prevented as this associates with a 7-fold increase in post-operative mortality (from 7% to 48%). Unfortunately, recent national cancer registry data confirm how more than 2/3 obstructions present in the elderly (Iversen LH. BJS 2008). In the case of bowel obstruction, especially if this affects the descending colon, the temporary palliation with a stent as a bridge-to-surgery seems a reasonable option: this associates to >90% success rate and a minimal mortality (1%). This procedure should be popularised and made more widely available. On the other side of the spectrum, early lesions can be safely excised with a trans-anal approach. Transanal Endoscopic Microsurgery (TEM) seems to be more effective that traditional surgery to remove large polyps or invasive cancer if confined to the Mucosa only (T1) provided they rest within 10−15 cms from the anal verge. (Moore JS. DC&R 2008). Laparoscopic hand-assisted resection is associated with reduced postoperative pain and it seems a feasible option for frail elderly subjects, achieving similar results in the Elderly as among younger cohorts. (Chautard J. J Am Coll Surg 2008). Careful selection allows liver metastases to be treated successfully, with a median hospital stay of 10−15 days and a 5% mortality. The resected patients show a survival advantage which lasts for over 5 years in one third of patients. (de Liguori Carino N. CROH 2008). Alternative technique can also be utilised (i.e. radiofrequency ablation) (Abitabile P. EJSO 2007). A critical analysis of the Total Mesorectal Excision (TME) series recruited into the Dutch Trial surprisingly noticed a lack of advantage in the elderly sub-group; this is explained with an excess of operative mortality. (Rutten HJT. Lancet Oncology 2008). Large anecdotal evidence confirms how selected series of elderly colorectal cancer patients can undergo surgical treatment. Future randomised clinical trials should incorporate Geriatric Assessment tools; treatment should be tailored and individualised. F19 Chemotherapy for the elderly − Gercor’s experience
08.00–09.20
Ch. Tournigand *. Hˆopital Saint Antoine, Paris, France Colorectal cancer is predominantly a problem of the elderly: the prevalence of colorectal cancer increases significantly with age, with 40% of patients in Europe being >75 years of age at the time of initial diagnosis. Furthermore, the number of elderly patients with colorectal cancer is expected to increase significantly over the next two decades. Over the past 25 years important advances have occurred in the management of colorectal cancer, in younger as well as in elderly patients. The proportion of patients resected
Critical Reviews in Oncology/Hematology 68 (2008)
paper and/or on screen available in the patients’ notes. ESAS has been validated in many different languages and settings but mostly in the field of palliative care and medicine. Under our hands, it has proved useful to show progress and/or deterioration on treatment and it is used on a daily basis both on the ward and in the clinic. ESAS was initially constructed as an auto-questionnaire but it may be filled-in with the help of health professionals or of the family thus becoming a true common language. As many cancers are now treated like chronic conditions and with more people living a longer time, ESAS appears a convenient way to determine how patients and cancer can co-exist. Reference(s) [1] CROH 2003; 47: 281–286.
F16 08.00–09.20 Diagnosis and treatment of the three “Ds” (Depression, Delirium, and Dementia) in older patients with cancer T. Rabinowitz *. University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA Worry that one has cancer or receiving a definitive cancer diagnosis are likely to cause distress at key times during cancer diagnosis and treatment including: (1) discovery of a lesion, (2) signs or symptoms of a malignancy, (3) confirmation of cancer, (4) staging procedures, (5) treatment initiation, (6) ending treatment, and (7) “watching and waiting”. In addition, many cancer treatments and some types of cancer may cause neuropsychiatric symptoms such as confusion, forgetfulness, agitation, or depression that are often misdiagnosed or misattributed and therefore inappropriately treated. If unrecognized or untreated, these conditions may adversely affect a person’s cancer treatment and prognosis, leading to poorer outcomes and greatly diminished quality of life. Elders with cancer are at particular risk for developing these conditions for several important reasons including: (1) having a pre-existing untreated mood disorder, (2) having pre-existing cognitive impairment (this may range from mild cognitive impairment (MCI) to full-blown dementia), and (3) polypharmacy. This talk will present the differential diagnosis and treatment of three common psychiatric conditions in elderly patients with cancer: depression, delirium, and dementia. In addition, preventive and screening strategies will be discussed. F17 08.00–09.20 Interdisciplinary approach and optimal management of chemotherapy-induced nausea and vomiting (CINV) and mucositis L. Surprenant *, D. Jacob *. St. Mary Hospital center, Montr´eal, Qu´ebec, Canada In today’s health care environment, patient care concerns are complex. Meeting these concerns requires that a professional team work together to design, implement, and evaluate patient care. Most collaborative practice research has occurred in specialty areas and has linked improved patient outcomes to interdisciplinary collaboration. The presentation of the case of a 70 y man with gastric cancer will demonstrate that a collaborative approach led by a nurse navigator (infirmi`ere pivot) and a pharmacist in the specialty area of oncology can identify patients at risk, empower patients to be informed and active participants in a care plan and assume self efficacy, and improve patient outcomes in managing chemotherapy-induced symptoms. The symptoms that will be discussed include chemotherapy-induced nausea and vomiting and mucositis. The presentation will include a review of each symptom to enhance the audience’s understanding and provide practical tips to optimize management of these symptoms.
Abstracts
08.00–09.20
Session IX B: Colorectal cancer F18 08.00–09.20 The role of surgery in elderly patients with colorectal cancer R. Audisio *. University of Liverpool, Liverpool, United Kingdom The increasing prevalence of colorectal cancer within the elderly population has been repeatedly confirmed; as for all solid tumours (with the only exception of cervical cancer) malignant tumours of the large bowel are highly prevalent amongst senior patients. Evidence has also been gathered to prove under-management of this age group and very little has been done to amend the situation. Poor histological confirmation and substandard staging associates with a minimalist management and results into a poor cancer-related survival (Lewis AA. Br Med J 1988; Fallahzadeh H. Am J Surg 1991). In the late 1980’s an 11% operative mortality was reported on elective series of elderly CRC patients – this was significantly increasing with the number of associated diseases. For a couple of decades reports and reviews have been trying to reassure us that elective surgery is feasible and represents a reasonably safe option, but these reports were predominantly based on well selected series where the frail patient has always been excluded. A way forward here is to replace an inaccurate rule of thumb with a Comprehensive Geriatric Assessment tool (CGA) in making the decision to operate or not (PACE Participants. CROH 2008). Obstructive conditions should be prevented as this associates with a 7-fold increase in post-operative mortality (from 7% to 48%). Unfortunately, recent national cancer registry data confirm how more than 2/3 obstructions present in the elderly (Iversen LH. BJS 2008). In the case of bowel obstruction, especially if this affects the descending colon, the temporary palliation with a stent as a bridge-to-surgery seems a reasonable option: this associates to >90% success rate and a minimal mortality (1%). This procedure should be popularised and made more widely available. On the other side of the spectrum, early lesions can be safely excised with a trans-anal approach. Transanal Endoscopic Microsurgery (TEM) seems to be more effective that traditional surgery to remove large polyps or invasive cancer if confined to the Mucosa only (T1) provided they rest within 10−15 cms from the anal verge. (Moore JS. DC&R 2008). Laparoscopic hand-assisted resection is associated with reduced postoperative pain and it seems a feasible option for frail elderly subjects, achieving similar results in the Elderly as among younger cohorts. (Chautard J. J Am Coll Surg 2008). Careful selection allows liver metastases to be treated successfully, with a median hospital stay of 10−15 days and a 5% mortality. The resected patients show a survival advantage which lasts for over 5 years in one third of patients. (de Liguori Carino N. CROH 2008). Alternative technique can also be utilised (i.e. radiofrequency ablation) (Abitabile P. EJSO 2007). A critical analysis of the Total Mesorectal Excision (TME) series recruited into the Dutch Trial surprisingly noticed a lack of advantage in the elderly sub-group; this is explained with an excess of operative mortality. (Rutten HJT. Lancet Oncology 2008). Large anecdotal evidence confirms how selected series of elderly colorectal cancer patients can undergo surgical treatment. Future randomised clinical trials should incorporate Geriatric Assessment tools; treatment should be tailored and individualised. F19 Chemotherapy for the elderly − Gercor’s experience
08.00–09.20
Ch. Tournigand *. Hˆopital Saint Antoine, Paris, France Colorectal cancer is predominantly a problem of the elderly: the prevalence of colorectal cancer increases significantly with age, with 40% of patients in Europe being >75 years of age at the time of initial diagnosis. Furthermore, the number of elderly patients with colorectal cancer is expected to increase significantly over the next two decades. Over the past 25 years important advances have occurred in the management of colorectal cancer, in younger as well as in elderly patients. The proportion of patients resected