VII.3 The comprehensive geriatric assessment
1
S16 Critical Reviews in Oncology/Hematology 60 (2006) Abstracts – The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used. – It is worthy to note that CGA is an individualized assessment leading to a true care program and management of older individuals. It requires geriatric skills. MGA and screening tools may help to detect problems that can possibly interfere with cancer treatment. MGA is more adapted to population studies and clinical research programs. 13.00–14.15 Room: Jacob Pronk Midday Session VII: Supportive care for the elderly cancer patient VII.1 13.00–13.20 Differences in supportive care for elderly cancer patients: differences with younger patients G. Zulian. Abstract not available at the time of printing. VII.2 13.20–13.40 Application of the G-CSF guidelines in elderly cancer patients L. Repetto. Abstract not available at the time of printing. VII.3 13.40–14.00 The comprehensive geriatric assessment VII.4 14.00–14.15 Limit-values for anaemia in elderly patients: theory and practice 14.30–15.15 Room: Jacob Pronk Session VIII: SIOG Guidelines Moderator: Silvio Monfardini VIII.1 14.30–14.45 The use of bisphosphonates in elderly cancer patients: SIOG guidelines R. Coleman. University of Sheffield, UK Bone is the most common site for metastasis in cancer and is of particular clinical importance in breast and prostate cancers due to the prevalence of these diseases. Bone metastases result in considerable morbidity and complex demands on health care resources. Additionally, in many patients metastatic bone disease is a chronic condition affecting their lives over years rather than months. Bisphosphonates have been shown to reduce skeletal morbidity across a wide range of cancer types affecting bone. Quite appropriately, they are increasingly used alongside specific anti- cancer treatments to prevent skeletal complications. However specific rec- ommendations on their use in elderly patients is lacking. A SIOG task force reviewed information from the literature (in PubMed) on bisphosphonates in elderly patients with bone metastases published until December 2005. Additional pertinent data was obtained from the manufacturers. Bisphosphonates are recommended in the elderly with bone metastases to prevent skeletal-related events (SREs). Intravenous formulations are pre- ferred for the treatment of hypercalcemia. It is recognized that zoledronic acid, ibandronate and pamidronate can effectively contribute in relieving metastatic bone pain. Creatinine clearance should be monitored in every patient, and a less renally toxic agent should be used where evidence of similar efficacy is available. The assessment and optimization of hydration status is recommended. Due to the risk from osteonecrosis of the jaw, routine oral examination and treatment of dental problems by a dental team is recommended before bisphosphonates and on a regular basis throughout treatment. Physicians should choose the most appropriate bisphosphonate. Safety precautions are particularly important in elderly patients. Further research is needed on the optimum use of bisphosphonates in elderly patients. VIII.2 14.45–15.00 SIOG guidelines: chemotherapy in elderly patients S. Lichtman. Memorial Sloan Kettering Cancer Center, New York, USA This presentation will summarize the work of the Chemotherapy Taskforce of the International Society of Geriatric Oncology. There has not been a truly systematic review of the literature with regard to patient age for over twenty years. Much has changed since that time. The epidemiologic change and its effect on medical oncology practice which was first recognized by Yancik is now here. It is imperative that clinicians have a critical analysis of the available data to make important treatment decisions. The International Society of Geriatric Oncology has taken on a number of analyses of the literature with regard to patient age. This has included geriatric assessment, hematopoietic growth factors and surgery. It was therefore a natural extension of this work to develop a committee to systematically explore the available literature with regard to chemotherapy and aging. This review is to be comprehensive and hopefully will be able to development meaningful guidelines and recommendations for the practicing clinicians. The committee is composed of physicians who have a recognized record in geriatric oncology. After consultation with the committee members, it was decided to break down the body of work by chemotherapy classes and explores issues regarding pharmacology, toxicity, drug interactions and combinations. The committee members are: Stuart M. Lichtman, MD Memorial Sloan-Kettering Cancer Center, New York Daniel Budman, MD North Shore-Long Island Jewish Health System, New York Vicki Morrison, MD University of Minnesota Etienne Chatelut, MD Institut Claudius Regaud, Toulouse Hans Wildiers, MD UH Gasthuisberg, Leuven Christopher Stiers, MD Murray Valley Private Hospital, Wodonga, Victoria, Australia Brigitte Tranchand, MD Facult´ e M´ edecine Lyon-Sud Matti Aapro, MD Multidisciplinary Oncology Institute, Genolier, Switzerland VIII.3 15.00–15.15 Renal function and chemotherapy V. Launay-Vacher. Department of Nephrology, Piti´ e-Salpˆ etri` ere Hospital, Paris, France Cancer patients receiving chemotherapy for their disease are at risk for renal toxicity. Indeed, they often present with several risk factors such as dehydration or old age that may favor anticancer drugs nephrotoxicity. Furthermore, the results of the IRMA study, a national observational study including near 5000 French cancer patients from 14 oncology centers, showed that 57.4% with Cockcroft-Gault and 52.9% with aMDRD had abnormal renal function according to the international K-DOQI definition and stratification of renal insufficiency. Those patients with RI, together with other known risk factors, are therefore at a high risk for drug-induced nephrotoxicity, and especially anticancer drugs. Anticancer drugs nephrotoxicity may result from different mechanisms. It may be induced by dehydration secondary to diarrhea or vomit- ing or by a direct toxicity to the glomerulus (adriamycin, mitomycin, pamidronate, ... ) or to the tubule (cisplatin, methotrexate, ifosfamide, zoledronate, ... ). In addition, hemolytic and uremic syndrome has also been reported secondary to mitomycin, fluorouracil, or gemcitabine ther- apy. In those patients, identification and, whenever possible, elimination of risk factors should be performed systematically prior to anticancer therapy. To reduce the renal risk, when two drugs with similar activities are available, the less nephrotoxic should be chosen. Furthermore, co- administration of other medications with potential nephrotoxicity should be contra-indicated, and drugs withdrawn and/or replaced with a less or non-nephrotoxic one. Specific procedures for preventing drug-induced nephrotoxicity should be used when necessary, eg. saline solution hy- dration during cisplatin therapy. Finally, evaluation of renal function by estimation of creatinine clearance with the Cockcroft-Gault or the aMDRD formulae should be routinely performed before and during the follow-up
Transcript of VII.3 The comprehensive geriatric assessment
S16 Critical Reviews in Oncology/Hematology 60 (2006) Abstracts
– The task force cannot recommend any specific tool or approach aboveothers at this point and general geriatric experience should be used.
– It is worthy to note that CGA is an individualized assessment leadingto a true care program and management of older individuals. It requiresgeriatric skills. MGA and screening tools may help to detect problemsthat can possibly interfere with cancer treatment. MGA is more adaptedto population studies and clinical research programs.
13.00–14.15 Room: Jacob Pronk
Midday Session VII: Supportive care for the elderlycancer patient
VII.1 13.00–13.20Differences in supportive care for elderly cancer patients: differenceswith younger patients
G. Zulian.
Abstract not available at the time of printing.
VII.2 13.20–13.40Application of the G-CSF guidelines in elderly cancer patients
L. Repetto.
Abstract not available at the time of printing.
VII.3 13.40–14.00The comprehensive geriatric assessment
VII.4 14.00–14.15Limit-values for anaemia in elderly patients: theory and practice
14.30–15.15 Room: Jacob Pronk
Session VIII: SIOG GuidelinesModerator: Silvio Monfardini
VIII.1 14.30–14.45The use of bisphosphonates in elderly cancer patients: SIOGguidelines
R. Coleman. University of Sheffield, UK
Bone is the most common site for metastasis in cancer and is of particularclinical importance in breast and prostate cancers due to the prevalenceof these diseases. Bone metastases result in considerable morbidity andcomplex demands on health care resources. Additionally, in many patientsmetastatic bone disease is a chronic condition affecting their lives overyears rather than months. Bisphosphonates have been shown to reduceskeletal morbidity across a wide range of cancer types affecting bone.Quite appropriately, they are increasingly used alongside specific anti-cancer treatments to prevent skeletal complications. However specific rec-ommendations on their use in elderly patients is lacking. A SIOG task forcereviewed information from the literature (in PubMed) on bisphosphonatesin elderly patients with bone metastases published until December 2005.Additional pertinent data was obtained from the manufacturers.Bisphosphonates are recommended in the elderly with bone metastases toprevent skeletal-related events (SREs). Intravenous formulations are pre-ferred for the treatment of hypercalcemia. It is recognized that zoledronicacid, ibandronate and pamidronate can effectively contribute in relievingmetastatic bone pain. Creatinine clearance should be monitored in everypatient, and a less renally toxic agent should be used where evidence ofsimilar efficacy is available. The assessment and optimization of hydrationstatus is recommended. Due to the risk from osteonecrosis of the jaw,routine oral examination and treatment of dental problems by a dental teamis recommended before bisphosphonates and on a regular basis throughouttreatment.Physicians should choose the most appropriate bisphosphonate. Safetyprecautions are particularly important in elderly patients. Further researchis needed on the optimum use of bisphosphonates in elderly patients.
VIII.2 14.45–15.00SIOG guidelines: chemotherapy in elderly patients
S. Lichtman. Memorial Sloan Kettering Cancer Center, New York, USA
This presentation will summarize the work of the Chemotherapy Taskforceof the International Society of Geriatric Oncology. There has not been atruly systematic review of the literature with regard to patient age for overtwenty years. Much has changed since that time. The epidemiologic changeand its effect on medical oncology practice which was first recognized byYancik is now here. It is imperative that clinicians have a critical analysis ofthe available data to make important treatment decisions. The InternationalSociety of Geriatric Oncology has taken on a number of analyses ofthe literature with regard to patient age. This has included geriatricassessment, hematopoietic growth factors and surgery. It was thereforea natural extension of this work to develop a committee to systematicallyexplore the available literature with regard to chemotherapy and aging. Thisreview is to be comprehensive and hopefully will be able to developmentmeaningful guidelines and recommendations for the practicing clinicians.The committee is composed of physicians who have a recognized recordin geriatric oncology. After consultation with the committee members, itwas decided to break down the body of work by chemotherapy classesand explores issues regarding pharmacology, toxicity, drug interactionsand combinations. The committee members are:
Stuart M. Lichtman, MD Memorial Sloan-Kettering Cancer Center, New YorkDaniel Budman, MD North Shore-Long Island Jewish Health System,
New YorkVicki Morrison, MD University of MinnesotaEtienne Chatelut, MD Institut Claudius Regaud, ToulouseHans Wildiers, MD UH Gasthuisberg, LeuvenChristopher Stiers, MD Murray Valley Private Hospital, Wodonga, Victoria,
AustraliaBrigitte Tranchand, MD Faculte Medecine Lyon-SudMatti Aapro, MD Multidisciplinary Oncology Institute, Genolier,
Switzerland
VIII.3 15.00–15.15Renal function and chemotherapy
V. Launay-Vacher. Department of Nephrology, Pitie-Salpetriere Hospital,Paris, France
Cancer patients receiving chemotherapy for their disease are at risk forrenal toxicity. Indeed, they often present with several risk factors suchas dehydration or old age that may favor anticancer drugs nephrotoxicity.Furthermore, the results of the IRMA study, a national observational studyincluding near 5000 French cancer patients from 14 oncology centers,showed that 57.4% with Cockcroft-Gault and 52.9% with aMDRD hadabnormal renal function according to the international K-DOQI definitionand stratification of renal insufficiency. Those patients with RI, togetherwith other known risk factors, are therefore at a high risk for drug-inducednephrotoxicity, and especially anticancer drugs.Anticancer drugs nephrotoxicity may result from different mechanisms.It may be induced by dehydration secondary to diarrhea or vomit-ing or by a direct toxicity to the glomerulus (adriamycin, mitomycin,pamidronate, . . . ) or to the tubule (cisplatin, methotrexate, ifosfamide,zoledronate, . . . ). In addition, hemolytic and uremic syndrome has alsobeen reported secondary to mitomycin, fluorouracil, or gemcitabine ther-apy. In those patients, identification and, whenever possible, eliminationof risk factors should be performed systematically prior to anticancertherapy. To reduce the renal risk, when two drugs with similar activitiesare available, the less nephrotoxic should be chosen. Furthermore, co-administration of other medications with potential nephrotoxicity shouldbe contra-indicated, and drugs withdrawn and/or replaced with a lessor non-nephrotoxic one. Specific procedures for preventing drug-inducednephrotoxicity should be used when necessary, eg. saline solution hy-dration during cisplatin therapy. Finally, evaluation of renal function byestimation of creatinine clearance with the Cockcroft-Gault or the aMDRDformulae should be routinely performed before and during the follow-up
