Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Landi F. Valutazione del Geriatric Assessment. ASMaD 2015
1. Prof Francesco Landi
Dept. of Geriatrics, Neurosciences and Orthopaedics
Catholic University of the Sacred Heart, Rome - Italy
Valutazione del
Geriatric Assessment
2.
3. The best sentence in the English language
is not ‘I love you’ but ‘It’s benign’.
Woody Allen, Deconstructing Harry 1998
10. Is this patient going to die of cancer or with cancer ?
Is this patient going to live long enough to suffer the consequences
of cancer ?
Is my patient able to tolerate the treatment ?
Are some complications of cancer treatment more common in
older individuals?
Is the social network of my patient adequate to support him or her
during the treatment ?
The Geriatric evaluation of elderly patients with cancer
11. Is this patient going to die of cancer or with cancer?
The Geriatric evaluation of elderly patients with cancer
Is this patient going to live long enough to suffer the consequences
of cancer ?
12.
13. When should one be considered “ELDERLY”….
65 years
70 years
80 years
It depends on…
I am uncertain
14.
15. all
n = 95
Alive at ICU
Dimission
n = 56
Alive 1 yr
follow up
n = 14
p
Sex M/F 57/38 39/17 10/4 NS
Age ≥60 n (%) 47 (50) 32 (57) 5 (29) 0.02
Median ± SD 59 ± 14 59 ± 12 57 ± 14
Performance status ≥2 40 (42) 19 (33) 4 (23) 0.02
Ab. Cytogenetic prognosis
• good
• average
• bad
8 (8)
51 (54)
20 (21)
4 (8)
33 (65)
14 (27)
1 (5)
13 (76)
3 (18)
NS
FAB 0
1
2
3
4
5
6
5 (6)
16 (20)
21 (26)
3 (4)
20 (25)
9 (11)
6 (8)
5 (10)
7 (14)
12 (24)
3 (6)
11 (22)
6 (12)
5 (10)
1 (7)
1 (7)
3 (20)
1 (7)
5 (33)
2 (13)
2 (13)
NS
AML status
induction
remission
relapse
49 (51)
1 (2)
45 (47)
28 (56)
1 (2)
21 (42)
23 (70)
1 (1)
9 (29)
NS
G. Colloca, M. Extermann1
, L. Balducci ASCO 2010
Prognostic value of age in older patients with acute
myeloid leukemia (AML) admitted to intensive care
400,00300,00200,00100,000,00
FOLLY
1,0
0,8
0,6
0,4
0,2
0,0
CumSurvival
Follow up 1 yr
Performance status
≤ 1
≥ 2
Soppravvivenza
16. Is this patient going to die of cancer or with cancer ?
Is this patient going to live long enough to suffer the consequences
of cancer ?
The Geriatric evaluation of elderly patients with cancer
Is my patient able to tolerate the treatment ?
17. Conclusions Standard adjuvant chemotherapy is superior to capecitabine
in patients with early-stage breast cancer who are 65 years of age or
older. (ClinicalTrials.gov number, NCT00024102 [ClinicalTrials.gov]
H.Muss, E.Winer et coll, CALGB investigators; NEJM 360:2055-65 2009
Chemotherapy and the elderly
18. Kaplan–Meier Estimates of Relapse-free and Overall Survival According to Treatment Group.
H.Muss, E.Winer et coll, CALGB investigators; NEJM 360:2055-65 2009
19. Is this patient going to die of cancer or with cancer ?
Is this patient going to live long enough to suffer the consequences
of cancer ?
The Geriatric evaluation of elderly patients with cancer
Is my patient able to tolerate the treatment ?
20. Fitness does not mean
you can all do the same
exercise
Assessing the older patient for cancer treatment
21. Standard evaluation
– Performance status
• At baseline
• A few months before
– Organ function
• Creatinine clearance
• Liver tests…
– Nutritional status
• Weight, albumin…
21
In-depth evaluation of health status
22. All older cancer patients
Community Hospital
Long Term Care
Facility Hospice
SCREENING (oncologist or geriatrician)
ONCOLOGIST
Interdisciplinary Team:
Oncologist, Geriatrician, Physical therapist,
Professional Nurse, Psycho-oncologist,
Social Worker……….
Modified approach
FRAIL
PRE-FRAIL/FRAILFIT
Usual Care
GERIATRICIAN (CGA)
Geriatric palliative care
Palliative Oncology
Balducci L, Colloca G et all. Surg Oncol. 2010 Sep;19(3):117-23
23. Development of frailty with advancing age.
Lang PO, Zekry D Gerontology. 2009;55(5):539-49.
24. Walston J, Ferrucci L,Fried L, J Am Geriatr Soc. 2006 Jun;54(6):991-
1001
Molecular and DiseaseMolecular and Disease
Oxidative Stress
Mitochondrial Deletion
Shortened Telomeres
DNA Damage
Cell Senescence
Oxidative Stress
Mitochondrial Deletion
Shortened Telomeres
DNA Damage
Cell Senescence
Gene variationGene variation
Inflammatory
disease
Inflammatory
disease
Inflammation
Neuroendocrine
Dysregulation
Interleukin 6
IGF-1
Dehydroepiandrosterone-
sulfate
Sex steroids
Anorexia
Sarcopenia, osteopenia
•Immune function
•Cognition
•Clotting
•Glucose Metabolism
Impaired PhysiologicalImpaired Physiological ClinicalClinical
Slowness
Weakness
Weight Loss
Low Activity
Fatigue
Slowness
Weakness
Weight Loss
Low Activity
Fatigue
25. What does a CGA bring?
Extermann M, Aapro M. Hematol/Oncol Clins North Am 2000;14:63–77.
Setting Intervention Risk reduction for
mortality
Elderly Comprehensive
geriatric assessment
14%
Breast cancer Adjuvant chemotherapy 15.3%
Myocardial infarction Beta-blocker 22%
26. Is this patient going to die of cancer or with cancer ?
Is this patient going to live long enough to suffer the consequences
of cancer ?
Is my patient able to tolerate the treatment ?
Are some complications of cancer treatment more common in
older individuals?
The Geriatric evaluation of elderly patients with cancer
29. Is this patient going to die of cancer or with cancer ?
Is this patient going to live long enough to suffer the consequences
of cancer ?
Is my patient able to tolerate the treatment ?
Are some complications of cancer treatment more common in
older individuals?
Is the social network of my patient adequate to support him or her
during the treatment ?
The Geriatric evaluation of elderly patients with cancer
32. How to decide?
Adverse events to avoid Control the disease
Patient’
s will
Life expectancy
33. Contestualizzare (tipologia di neoplasia vs. aspettativa di vita)
Caratteristiche del paziente: performance, comorbidità, sindromi
geriatriche, polifarmacoterapia
Tipologia di paziente tramite CGA
Rivalutazioni ravvicinate per valutare la perdita di autonomia, lo
stress da caregiver, la tossicità farmacologica
Un nuovo paziente, long term survivors con effetti collaterali e
tossici a lungo termine dei nuovi farmaci
TAKE-HOME MESSAGE
Hinweis der Redaktion
In one developed countrIn one developed country, the United States, for which complete epidemiologic data are available, cancer is second only to heart disease as the leading cause of death. Cancer deaths account for slightly less than one-quarter of all deaths in the United States, substantially ahead of other common causes of death.
y, the United States, for which complete epidemiologic data are available, cancer is second only to heart disease as the leading cause of death. Cancer deaths account for slightly less than one-quarter of all deaths in the United States, substantially ahead of other common causes of death.
Population trends in the United States by age and race/origin, 1980 to 2030. Data for 1980 and 1990 are derived from the United States Census for these years.1,3 Data from 2000 onward are derived from the 2000 Census and projections for population growth thereafter.2
Projected cases of all invasive cancers in the United States by age and sex. (*) Nonmelanoma skin cancers were excluded from projections. Variation in cancer incidence, 1992 to 2005. All rates are age-adjusted using the year 2000 standard population. All sites of invasive cancer (excluding nonmelanoma skin cancer) were included in this analysis.
Projected cases of all invasive cancers in the United States by age and sex. (*) Nonmelanoma skin cancers were excluded from projections.
La neoplasia si trasforma essa stessa in una comorbidità, considerare i nuovi farmaci (inibitori angiogenesi) e comorbidità sempre più frequenti diabete ipertensione e scompenso cardiaco
