- Email: [email protected]
F18 Operative management of elderly patients with lung cancer
Faculty abstracts, Saturday, October 17, 2009
S11
76 years in the Tyrol registry. The clinical course in MDS is characterized by cytopenias in one or more cell lines and the risk of transformation into acute myeloid leukemia (AML). As the number of older individuals in the western world is markedly growing, the relevance of MDS in clinical practice is increasing continuously. The introduction of novel therapies over the past decade has dramatically altered the treatment options in MDS patients. These include improved supportive care, effective ironchelators, erythropoiesis-stimulating factors (ESF) as well as immunomodulating agents like thalidomide or lenalidomide. Most importantly the methyltransferase inhibitor azacitidine was demonstrated recently to alter the natural history of the disease and to prolong overall survival even in elderly patients (75+) significantly. Hematopoietic stem cell transplantation (HSCT), including reduced intensity procedures, may result in curative options applicable in selected older adults. In elderly individualized treatment algorithms should consider patient-specific factors, including performance status, functional capacities and comorbidities. Assessment strategies should be applied and tested for their relevance as prognostic factors. In addition assessment might serve to predict individual tolerability to therapeutic strategies. Advanced age should not exclude elderly MDS patient from appropriate treatment and age per se should not be considered as a surrogate marker for functional decline or comorbidities. Clinical scoring systems in use, the integration of geriatric assessment into individualized risk-assessment and treatment algorithms in MDS patients will be discussed. Results from clinical studies and implications for the treatment of elderly MDS patients will be presented.
pain, in fact, up to 45% of patients may feel their pain is under-treated while hospitalized increasing morbidity and mortality [9]. Postoperative cognitive impairment can be classified as postoperative delirium (PD) or postoperative neuro-cognitive disorder (POCD). Fluctuating levels of consciousness and temporary abnormalities in memory and perception characterize PD. POCD is a condition with a variable time course characterized by impaired concentration, language comprehension, and social integration. These characteristics can become evident days to weeks after surgery. Delirium was an independent predictor of higher 6-month mortality and longer hospital stay in patients receiving mechanical ventilation [9]. Monk et al. [10] showed that elderly are at significant risk for postoperative long-term cognitive problems and that POCD is an independent risk factor for death in the first year after surgery. Primary prevention of the regarding risk factors such as cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration seems to be the most effective treatment strategy [11]. In conclusion, perioperative medicine will have to deal with increasing cancers in elderly patients. Preoperative evaluation with geriatric risk assessment, attention to pain management, and avoidance of postoperative complications, such as postoperative delirium and pulmonary and cardiac complications are main factors for good outcome in onco-geriatric patients. Patients would benefit from complete care with active participation of multi-disciplinary team. Further research into tailored treatment of elderly cancer patients regarding preoperative evaluation, optimum surgery for individual cancers and adjuvant therapy is needed.
F15 Treatment of elderly patients with multiple myeloma
Reference(s)
M. Boccadoro *. University of Torino, Torino, Italy Abstract not available at time of printing. F16 Aggressive lymphoma: How to characterize and treat elderly patients non fit for standard treatment L. Tr¨umper *. Universit¨atsmedizin G¨ottingen, Comprehensive Cancer Center, Georg-August-University of G¨ottingen, Germany
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]
Yancik et al Cancer, 1998. PACE Participants et al. Crit Rev Oncol Hematol, 2008. Samet et al. JAMA, 1986. Repetto et al. J Clin Oncol, 2002. Vulto et al. Radiother Oncol, 2006. Janssens et al. Lancet Infect Dis, 2004. Barrier et al. Am J Surg, 2003. Bernadi et al. Cancer Treat Rev, 2006. Ely et al. JAMA, 2004. Monk et al. Anesthesiology, 2008. Inouye et al. N Engl J Med, 1999.
Abstract not available at time of printing.
F18 Operative management of elderly patients with lung cancer
08.00–09.20
M.T. Jaklitsch *. Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
Parallel Session V-b: Surgery & caregivers in geriatric oncology F17 Preoperative risk stratification and postoperative management in elderly cancer patients M. Schmidt, J.-P. Breuer, A. Ramme, K. Miescke, C. Spies *. Department of Anaesthesiology and Intensive Care Medicine, Campus Charit´e Mitte and Campus Virchow-Klinikum, Charit´e − Universit¨atsmedizin Berlin, Germany Two-thirds of all solid tumors occur in patients aged 65 years or older [1]. Although surgical techniques have improved, fear of increased postoperative morbidity and mortality often results in suboptimal cancer surgery in elderly patients [2,3]. Thereby, evidence suggests that outcome in many elderly patients may be as good as in younger patients if surgical risk is carefully evaluated [3,4]. Not age alone but senescence-associated organspecific functional deterioration (cardiovascular, respiratory, renal etc.) and co-morbidities are the crucial factors for peri-operative risk stratification and management [6,7]. To avoid under- respectively over-treatment reliable instruments for risk assessment are strongly needed. Comprehensive geriatric assessments were developed to evaluate functional status, comorbidities, mental status, and nutritive state activities of onco-geriatric patients and to predict the individualized risk of cancer surgery. The increasing use of a complete geriatric assessment can lead to a more individualized patient treatment plan [8]. Within the postoperative care in the elderly pain control and cognitive assessment are of major importance. Elderly often communicate less
Operative risk assessment is a semi-quantitative measurement of the magnitude of surgery and its influence on the patient’s ability to withstand the physiologic alterations to the body as a result of the surgery. In regards to lung cancer surgery, the operative intervention is removing lung parenchyma and influencing right ventricular afterload. Many variables affect the outcome: physiologic age of the patient, amount of lung removed, function of remaining lung, strength of the heart, and completeness of cancer removal. Traditional operative risk assessment in thoracic surgery has been based on time-honored endpoints. These include pulmonary function tests, cardiac echo, cardiac stress test, history of a recent myocardial infarction, and underlying organ function. Thoracic surgeons have limited experience with assessing functional status, despite years of research that have established functional status as the most important prognosticator of end result. Elderly patients with early loss of function are adept at hiding modest impairments from the untrained eye. Specific recommendations regarding measuring functional status and impairment will be the focus of this presentation and will include: Brief Geriatric Assessments, BODE index, and interventions to improve baseline status prior to surgery. F19 Costs and policy aspects of caregiving in standard and experimental geriatric oncology L. Balducci *. Moffitt Cancer Center, Tampa, Florida, USA Purpose of the study: To establish the burden of the caregiver of the older cancer patient during usual and experimental treatment. Specific question: Does experimental treatment increase the caregiver burden and stress. Cost is assessed both in economical and human terms.
S11
76 years in the Tyrol registry. The clinical course in MDS is characterized by cytopenias in one or more cell lines and the risk of transformation into acute myeloid leukemia (AML). As the number of older individuals in the western world is markedly growing, the relevance of MDS in clinical practice is increasing continuously. The introduction of novel therapies over the past decade has dramatically altered the treatment options in MDS patients. These include improved supportive care, effective ironchelators, erythropoiesis-stimulating factors (ESF) as well as immunomodulating agents like thalidomide or lenalidomide. Most importantly the methyltransferase inhibitor azacitidine was demonstrated recently to alter the natural history of the disease and to prolong overall survival even in elderly patients (75+) significantly. Hematopoietic stem cell transplantation (HSCT), including reduced intensity procedures, may result in curative options applicable in selected older adults. In elderly individualized treatment algorithms should consider patient-specific factors, including performance status, functional capacities and comorbidities. Assessment strategies should be applied and tested for their relevance as prognostic factors. In addition assessment might serve to predict individual tolerability to therapeutic strategies. Advanced age should not exclude elderly MDS patient from appropriate treatment and age per se should not be considered as a surrogate marker for functional decline or comorbidities. Clinical scoring systems in use, the integration of geriatric assessment into individualized risk-assessment and treatment algorithms in MDS patients will be discussed. Results from clinical studies and implications for the treatment of elderly MDS patients will be presented.
pain, in fact, up to 45% of patients may feel their pain is under-treated while hospitalized increasing morbidity and mortality [9]. Postoperative cognitive impairment can be classified as postoperative delirium (PD) or postoperative neuro-cognitive disorder (POCD). Fluctuating levels of consciousness and temporary abnormalities in memory and perception characterize PD. POCD is a condition with a variable time course characterized by impaired concentration, language comprehension, and social integration. These characteristics can become evident days to weeks after surgery. Delirium was an independent predictor of higher 6-month mortality and longer hospital stay in patients receiving mechanical ventilation [9]. Monk et al. [10] showed that elderly are at significant risk for postoperative long-term cognitive problems and that POCD is an independent risk factor for death in the first year after surgery. Primary prevention of the regarding risk factors such as cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration seems to be the most effective treatment strategy [11]. In conclusion, perioperative medicine will have to deal with increasing cancers in elderly patients. Preoperative evaluation with geriatric risk assessment, attention to pain management, and avoidance of postoperative complications, such as postoperative delirium and pulmonary and cardiac complications are main factors for good outcome in onco-geriatric patients. Patients would benefit from complete care with active participation of multi-disciplinary team. Further research into tailored treatment of elderly cancer patients regarding preoperative evaluation, optimum surgery for individual cancers and adjuvant therapy is needed.
F15 Treatment of elderly patients with multiple myeloma
Reference(s)
M. Boccadoro *. University of Torino, Torino, Italy Abstract not available at time of printing. F16 Aggressive lymphoma: How to characterize and treat elderly patients non fit for standard treatment L. Tr¨umper *. Universit¨atsmedizin G¨ottingen, Comprehensive Cancer Center, Georg-August-University of G¨ottingen, Germany
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]
Yancik et al Cancer, 1998. PACE Participants et al. Crit Rev Oncol Hematol, 2008. Samet et al. JAMA, 1986. Repetto et al. J Clin Oncol, 2002. Vulto et al. Radiother Oncol, 2006. Janssens et al. Lancet Infect Dis, 2004. Barrier et al. Am J Surg, 2003. Bernadi et al. Cancer Treat Rev, 2006. Ely et al. JAMA, 2004. Monk et al. Anesthesiology, 2008. Inouye et al. N Engl J Med, 1999.
Abstract not available at time of printing.
F18 Operative management of elderly patients with lung cancer
08.00–09.20
M.T. Jaklitsch *. Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
Parallel Session V-b: Surgery & caregivers in geriatric oncology F17 Preoperative risk stratification and postoperative management in elderly cancer patients M. Schmidt, J.-P. Breuer, A. Ramme, K. Miescke, C. Spies *. Department of Anaesthesiology and Intensive Care Medicine, Campus Charit´e Mitte and Campus Virchow-Klinikum, Charit´e − Universit¨atsmedizin Berlin, Germany Two-thirds of all solid tumors occur in patients aged 65 years or older [1]. Although surgical techniques have improved, fear of increased postoperative morbidity and mortality often results in suboptimal cancer surgery in elderly patients [2,3]. Thereby, evidence suggests that outcome in many elderly patients may be as good as in younger patients if surgical risk is carefully evaluated [3,4]. Not age alone but senescence-associated organspecific functional deterioration (cardiovascular, respiratory, renal etc.) and co-morbidities are the crucial factors for peri-operative risk stratification and management [6,7]. To avoid under- respectively over-treatment reliable instruments for risk assessment are strongly needed. Comprehensive geriatric assessments were developed to evaluate functional status, comorbidities, mental status, and nutritive state activities of onco-geriatric patients and to predict the individualized risk of cancer surgery. The increasing use of a complete geriatric assessment can lead to a more individualized patient treatment plan [8]. Within the postoperative care in the elderly pain control and cognitive assessment are of major importance. Elderly often communicate less
Operative risk assessment is a semi-quantitative measurement of the magnitude of surgery and its influence on the patient’s ability to withstand the physiologic alterations to the body as a result of the surgery. In regards to lung cancer surgery, the operative intervention is removing lung parenchyma and influencing right ventricular afterload. Many variables affect the outcome: physiologic age of the patient, amount of lung removed, function of remaining lung, strength of the heart, and completeness of cancer removal. Traditional operative risk assessment in thoracic surgery has been based on time-honored endpoints. These include pulmonary function tests, cardiac echo, cardiac stress test, history of a recent myocardial infarction, and underlying organ function. Thoracic surgeons have limited experience with assessing functional status, despite years of research that have established functional status as the most important prognosticator of end result. Elderly patients with early loss of function are adept at hiding modest impairments from the untrained eye. Specific recommendations regarding measuring functional status and impairment will be the focus of this presentation and will include: Brief Geriatric Assessments, BODE index, and interventions to improve baseline status prior to surgery. F19 Costs and policy aspects of caregiving in standard and experimental geriatric oncology L. Balducci *. Moffitt Cancer Center, Tampa, Florida, USA Purpose of the study: To establish the burden of the caregiver of the older cancer patient during usual and experimental treatment. Specific question: Does experimental treatment increase the caregiver burden and stress. Cost is assessed both in economical and human terms.