【Wan Qingyi Care】Promoting geriatric oncology to improve the survival rate of cancer treatment in the elderly

Text: Chen Xiaoquan Organizer: Liang Yingxiu

Cancer is closely related to aging. Even if the elderly do not suffer from cancer, they may also face the attack of other chronic diseases at the same time as their organs gradually age.

Therefore, a person’s quality of life is not only extremely important, but also one must know how to preserve one’s health in order to live a healthy and long life.

(KUALA LUMPUR): The majority of cancer patients worldwide are elderly, and this figure has increased over time. We can see in Figure 1 that the global population aged 65 or over will reach 1,548.9 million in 2050, double that of 2019, while the population aged 65 or over in East Asia and Southeast Asia will increase from 260 million rose to 572.5 million. From these data, it can be seen that the global population is aging.

Data show that among men aged 60 to 69,

32% have cancer, 26% are 70 to 79 years old, and 15% are over 80 years old;

26% for women aged 60 to 69,

22% are 70 to 79 years old, and 16% are over 80 years old.

We can see from the data that

Men aged 60 or over accounted for 73% of the total cancer cases,

For women it was 64%.

undertreatment and overtreatment

Associate Professor Ravindran Kanesvaran, deputy director of the Department of Medical Oncology and senior consultant at the National Cancer Center of Singapore, pointed out that cancer is a disease related to aging. Other diseases, such as diabetes, kidney disease, heart disease, etc. Therefore, whether it is a cancer patient or an ordinary person, the quality of life is extremely important.

He said that elderly cancer patients are heterogeneous (heterogeneous) or multiphase, and here are two examples. The cancer patients were also the same age, one was in better shape, and the other was weaker.

“Although the former suffers from cancer, but because there are no comorbidities, the aging of organ functions is slow under the proper regimen. With less medication, the burden on the body is naturally reduced, and the life expectancy can be prolonged, so survival is the primary concern.”

The other has comorbidities and cancer, so he has to take multiple medications, and naturally he has to face the side effects of the drugs. When his physical condition is not ideal, let alone survival, all he can focus on at the moment is the quality of life. improve.

“From these two examples, we can see that the two people have completely different concerns.”

Clinically, doctors divide cancer patients into two categories, namely undertreatment and overtreatment. “The undertreatment group refers to the use of less intensive cancer treatment for healthy elderly cancer patients, allowing patients to obtain greater benefits from cancer treatment, or for elderly cancer patients without interfering with the patient’s gap, at a non-invasive level. Manipulative interventions in the treatment of cancer.”

He said that the over-treatment group refers to the treatment of cancer that may worsen the symptoms of cancer patients, which may shorten the original life expectancy of cancer patients, or strengthen the body of elderly cancer patients, and then implement lower-intensity cancer treatment, so that patients can survive the treatment. benefit from.

“For the vulnerability of patients, doctors cannot judge with the naked eye alone. More tests are needed to understand the patient’s constitution.”

Elderly cancer research lacks data to confirm

Geriatric oncology plays an important role in addressing the problem of older cancer patients, and there is a concerted modern effort to improve cancer care for older adults.

“It is a pity that we lack data to confirm the treatment of tumors in the elderly.”

In the United States, 63% of cancer patients are aged 65 and over, but in the 164 clinical trials conducted by the Southwest Cooperative Oncology Group (SWOG), only 25% of cancer subjects aged 65 and over were enrolled, because In many cases, the elderly are unable to participate in the research due to their medical condition, so the results of these studies are not representative.

He said that the Eastern Cooperative Oncology Group (ECOG) and Karnofsky Scale scores are used in the current practice of tumor assessment, but neither of these two methods can correctly predict the functional impairment of the elderly. Therefore, comprehensive elderly care can be used. Assessment (CGA) Portfolio to assess:

1. Functional status: ECOG-PS, Activity of Daily Living (ADL), GUG test.

2. Cognitive status: Clock Drawing Test (Clock Drawing Test, CDT), Short Intelligence Test (MMSE).

3. Comorbidities: Charlson Comorbidity Index (CCI)

4. Geriatric syndrome

5. Medication

6. Nutritional status (BMI, DNI)

7. Emotional status (GDS)

The above combination is to more accurately assess the physical condition of cancer patients, so that cancer patients can complete the entire course of cancer treatment, whether it is targeted therapy, chemotherapy or radiotherapy.

Save time and reduce the risk of infection

Make good use of technology for remote screening

50% of cancer morbidity and mortality occur in Asia, but only China, Singapore, Japan, Hong Kong, Malaysia, India, Korea, Philippines, and Israel have Geriatric Oncology (GO) clinics using a consultation model , to carry out relevant research and data collection.

“Now is the time for physicians and families to work together to improve cancer care for older adults and make the difference with younger patients.”

Assessment to maintain standard of care

Ravindran said that in the past, family members would live together, but now most of them live separately, and the elderly can only live alone, especially in Western countries, even Singapore and Malaysia.

He took himself as an example, “I practice medicine in Singapore, my father lives in Ipoh, and my sister lives in Kuala Lumpur. It is difficult to return to China during the MCO period in Malaysia. Even if my sister lives in Kuala Lumpur, she must obtain a permit to return home. Suffering without standard care for so long.”

Geriatric assessments should remain standard of care, and under the pandemic, telemedicine assessments can be implemented for elderly patients for remote screening in the currently restricted environment, such as G8 or VES-13.

Now it is even possible to use technological products to complete remote screening, but for the elderly who are not good at operating technology, it is a great challenge. Remote screening not only saves time, but also eliminates the need for the elderly to go to the hospital and bear the risk of infection.

Raise public cancer awareness

However, medical costs are a huge burden for the elderly, with most countries in Asia spending 5% to 10% of their GDP on health care and other expenses on education or other things, he said. This is why it is extremely important to lobby the government and let the public understand the work of SIOG, and to raise public awareness of cancer. Once the elderly suffer from cancer, if they get the right treatment immediately, it can reduce the economic burden of elderly cancer patients.

Therefore, the public should also actively participate in relevant activities, not to let the activities just be “empty”. What is important is to provide high-quality care for elderly cancer patients, so as to achieve a better balance between life and cancer.

Geriatric Oncology Clinic

Towards a global milestone

The International Society of Geriatric Oncology (SIOG) aims to strengthen the capacity of medical professionals in the field of geriatric oncology to optimize the care of older cancer patients.

Founded in 2000, the society is the leading international organization in the field of geriatric oncology. The society has more than 1,900 members from 80 countries. They gather every year to discuss and share the latest research results and innovative topics, and provide advanced courses around the world to educate oncologists to understand the daily operations of the society.

Global Dialogue on Cancer and Aging

In order to meet the needs of elderly cancer patients, in 2021, the Society and the International Alliance on Aging (IFA) will jointly hold a global dialogue on the aging population with cancer, which is a milestone event.

SIOG’s Geriatric Oncology Clinic plans to go global, namely:

USA and Canada

◆The academic center has a dedicated geriatric oncology clinic

◆Provide training scholarships

◆Actively promote research projects

Europe

◆Some countries have geriatric oncology programs

◆Provide national guidelines

◆Transnational Research Cooperation Group

latin america

◆Multidisciplinary geriatric oncology clinics in Brazil and Mexico

Asia

◆High-income Asian countries have dedicated geriatric oncology clinics

◆Powerful database and research platform

◆Public policy advocacy begins in some parts of low- and middle-income countries

oceania

◆Multidisciplinary Geriatric Oncology Clinic in Australia

◆The Australian Society of Clinical Oncology actively develops the Geriatric Oncology Program

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