Role of the geriatrician in the management of older patient with cancer = Il ruolo del geriatra nella gestione del paziente oncologico anziano

The risk of cancer increases with age and the population growth will lead to an increased incidence of cancer in the elderly. Presently, faced to emerging demands on health care, improvement of life expectancy, and concomitant development of procedures, this “oncogeriatric” population requires specific clinical management. Many specific issues may influence cancer treatment decision including the physicians' propensity to consider an old age as an obstacle to provide an optimal treatment, and to fear an increased disability and worsening of chronic conditions occurring with cancer and its treatment. Therefore it’s very important to stratify older patients according to their biological status, to be able to recommend the most appropriate type of treatment in a personalized fashion. The optimal management should involve tumour assessment and careful geriatric evaluation. Comprehensive Geriatric Assessment (CGA) provides an evaluation of the main geriatric domains, may assist in early identification of patients’ strengths and weaknesses, geriatric problems requiring specific interventions, and may lead to the development of individual plans in order to facilitate cancer treatment program. Moreover, CGA should be seen as a dynamic tool able to progressively integrate new specific instruments to better assess the risk of treatment procedures. However, the CGA is time and resource-consuming and requires the expertise of geriatricians. Thus, it remains poorly incorporated in routine clinical practice. Consensus guidelines consider a “two-step approach” as a reasonable strategy, where the first step involves a geriatric screening test to identify patients who are at high risk of being frail and the second step foresees a complete CGA to be performed by geriatricians. A total of 17 different tools have been studied in 44 different trials to evaluate the best screening test in oncogeriatrics. During my PhD I participated to several research projects in oncogeriatrics at the Policlinico San Martino, in Genoa, Italy, and at the Comprehensive Cancer Center Lèon Bèrard, in Lyon, France. Two studies were completed and published: - Geriatric assessment in oncology: moving the concept forward. The 20 years of experience of the Centre Léon Bérard geriatric oncology program. - Objectives: to explore the use of MGA in treatment decision and to identify MGA parameters likely to influence the planned cancer treatment. - Performance of two frailty screening tools in older patients with solid cancer: a comparison of SAOP2 and G8. - Objective: to compare the performance of two screening tools for frailty, G8 and Senior Adult Oncology Program (SAOP2) for their accuracy in identifying vulnerable patients. The others studies are still in progress.