Home » Over 70: the age-friendly cancer center is born

Over 70: the age-friendly cancer center is born

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AN oncology CENTER designed for the elderly with cancer: just for them, only for them. A dedicated place where patients, by nature the most fragile and complex, are welcomed and accompanied on a personalized path, which starts from diagnosis, passes through treatment and surgery and ends at discharge. And it also goes beyond discharge.

IS Certain, the structure we are talking about, or the Romagna Center for Cancer in the Elderly. The project, under the scientific direction of Riccardo Audisio, an oncological geriatrician at the University of Liverpool and Gothenburg, will be operational next autumn with a capacity to accommodate one thousand patients a year suffering from solid tumors. The pilot project will be in Ravenna and Faenza, but the goal is to extend it throughout Romagna. This is a transversal project, which arises from the collaboration with Ausl Romagna, IRST (Romagnolo Institute for the Study of Tumors) Meldola, University of Bologna, IOR (Romagnolo Oncological Institute) and starts from the operative units of surgery and oncology of Ravenna, directed by Giampaolo Ugolini and yes Stefano Tamberi respectively, but involves all hospital professionals: a network of multiple skills at the service of a complex challenge.

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An uncomfortable theme

“The care of the elderly with cancer is a topic that is rarely talked about, yet very topical”, says Ugolini: “Most cancer patients are elderly. And little is said about it because it is an uncomfortable subject, both for surgeons and oncologists. The fact is that treating, and surgically intervening, a young patient who only has cancer is easier than taking care of an elderly person. Treating an elderly patient involves evaluating a long range of factors, starting with comorbidities and life expectancy in relation to comorbidities. We have seen with Covid how these elements give a different weight to diseases: the elderly have died more due to Sars-Cov-2 because they had other diseases, and because they are more complex to treat “.

So, in summary, comorbidities and frailties are the special needs of the elderly. However, there is a great variability among the over 70. This variability must also be taken into account in a perspective of personalization of treatments, which is then the point of view of CeRta. “There is the 80 year old who runs the marathon and the 70 year old who struggles to climb the stairs. The mere fact of being 80 – adds Ugolini – does not at all mean that the horizon is short: the statistics tell us that the life expectancy of an 80-year-old woman in good condition is about 13 years, if this woman has any medical problems. he is 9 years old, if he has more medical problems than almost 5 years, for men the numbers are a bit lower but similar ”.

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Cancer and the elderly, the geriatrician makes a difference

Tiziana Moriconi



The elderly excluded from studies

And this is the clinical context. Then there is the epidemiological context: most of the diagnoses of cancer today are made in patients over 70 years old and for some pathologies, for example colon cancer, the peak of incidence is just around 70 years old. . “An interesting fact concerning this disease and that screening ends in Italy at the age of 70”, Isacco Montroni takes the floor: “And this explains why so many patients arrive in the emergency room with very large tumors. These are the elderly that no one studies and whom no one is screened for. And therefore tumors do not emerge unless the situation is very compromised, but their disease could have been diagnosed 3-4 years earlier ”. The fact is – adds the surgeon – that the difficulty of treating cancer in the elderly depends on several misunderstandings and they are: the poor knowledge of life expectancy and the little importance given to biological age, which is what tells us whether or not a patient is suitable for surgical or medical treatment. “The tests for calculating the biological age are valid and fast, but you need to understand who you are in front of and not stop at the date of birth, which is an immutable number that does not always have a great significance in some contexts. And finally, the fact that the elderly do not study ”.

For years, age has been considered an exclusion factor in large randomized clinical trials, but keeping the over 65s out of the trials generates knowledge that is suitable for young patients, which is then applied above all to older patients, since they are the ones who they get sick more. It is therefore not surprising that the final results, those of the real world, are different from those obtained in experimental contexts. “We have created a scientific literature that is based on outcomes, (that is, on objectives to achieve disease-free survival, progression-free survival, in short, the classic oncological outcomes, ed.) That have little to do with people’s quality of life elderly “, underlines Montroni:” No one has asked the elderly what they really want, what their goal is: they care whether or not they will survive an intervention, whether they will go back to being independent or not from the point of view of their ability to live after cancer. Here, these outcomes are rarely the primary objectives of scientific studies. What we have tried to do, in designing the Center in Ravenna, but also in our scientific history, is to generate studies that had functional recovery and quality of life as their primary objective “.

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A photograph of the real world

Quality of life and functional recovery are the focus of a study called GO SAFE (an acronym that stands for Geriatric Oncology Surgical Assessment and Functional recovery after Surgery), of which Ugolini and Montroni are co-authors. “GO SAFE has already produced several results published on the basis of a sample of a thousand over seventy with an average age of 80 – resumes Ugolini – This study is the result of a collaboration with the Cancer Center of Meldola, with the European Society of Surgical Oncology, the European Society of Geriatric Oncology, and involved 26 European and US hospitals. In addition to measuring a series of scientific data, such as complications and mortality, we wanted to put ourselves on the side of the patients, and we asked the whole sample what their quality of life was before the surgery, 3 months and 6 months after the operation. for cancer. We wanted a photograph of the real world, which was not in literature before ”.

Identify the predictors

Another GO SAFE dataset is currently undergoing final review. The goal of the new publication was to identify predictors that would allow early assessment of quality of life and functional recovery after cancer surgery in the elderly. In fact, there are preoperative predictors of frailty, that is, elements that indicate, before surgery, if the patient will have a good quality of life afterwards. “We have identified these predictors – explain the two surgeons – and we can define what will be the goal for that single patient, his goal. Not only that, if we are able to modify those predictors with a pre-operative rehabilitation of the patient, we can make a patient operable or treatable who maybe at the time of diagnosis was not. In other words, we can put him in the conditions to face an intervention within a reasonable time ”.

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A great prejudice

There is a huge age-related prejudice: elderly people are often denied treatments and even surgery when, on the other hand, medical treatment or surgery could guarantee a maintenance and sometimes an improvement in their quality of life. The interesting fact that came out of the GO SAFE study, in fact, is that the vast majority of patients after surgery manage to maintain and even improve their quality of life compared to before the surgery.

Una target therapy globale

The new center will be characterized by multidisciplinarity: surgeons, oncologists, radiotherapists, physiatrists, nutritionists, psychologists, nurses will take care of each patient and establish a personalized path for each one, a sort of target therapy but in a global sense, not only molecular. The idea is that the complexity of the elderly with cancer cannot be faced alone, but only by working together. The starting point is cancer diagnosis and disease staging. The second step is frailty screening, to obtain an assessment of the patient’s life expectancy and the elements to keep in mind in deciding the treatment path. If the patient has geriatric problems, he is evaluated by a geriatrician who is the specialist in the complexity of the elderly.

Once this information has been obtained, the multidisciplinary group meets and chooses a tailor-made treatment path, both medical and surgical. “Often we have more than one option to submit to patients and family members, and we choose together”, explains Ugolini: “Usually the sick elderly person has an elderly caregiver like him, with autonomy difficulties. In these cases we can count on the contribution of the Romagna Oncology Institute, a voluntary organization that takes care of many things, for example transport to the radiotherapy center. At the end of the process, when we see that the person cannot go home because he is alone or has a spouse who is unable to take care of him, we try to organize the post-operative in rehabilitation facilities. We have thought of everything ”, he concludes:“ A before, a during and an after ”.

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