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A B S T R A C T S
S3
hundred thousand people per year; in the over 70 is more than
50%, mainly prostate for men and breast cancer for women.
As result of these data, in Italy the interest for geriatric
oncology is constantly increasing. A recent survey carried
out among the Italian oncologists pointed out that, although
a specific care pathway for the elderly patient is available
only in 10% of the Oncology Departments, approximately
95% of oncologists acknowledges the vital importance of an
appropriate evaluation of the functional status for the older
patient with cancer. In this sense, some experiences like
those of Regione Piemonte and Regione Lombardia Local
Health Units are ongoing in Italy.
As regard of the international clinical research scenario,
several Italian oncologists are active members of the ETF
(Elderly Task Force) of the EORTC (European Organisation for
Research andTreatment of Cancer) and they actively take part
in some clinical protocols carried out by this task force.
In Italy the role of geriatric oncology is recently becoming
more evident, as pointed out by the involvement of GIOGer
(Italian Group of Geriatric Oncology) as founding partner of
the FICOG (Federation of the Italian Cooperative Oncology
Groups) and by the availability of a specific chapter of geriatric
oncology in the guidelines of AIOM (Italian Association of
Medical Oncology).
Disclosure of interest:
None declared
S05
Romain Corre
CHU Pontchaillou Pneumology, Rennes, France
The speaker abstract has not been received at the time of
publication.
S06
GERIATRIC ONCOLOGY PRACTICE IN TROPICAL AREA:
EXPERIENCE IN FRENCH GUIANA AND POSSIBLE RULES FOR
IMPLEMENTATION IN LOW AND INTERMEDIATE INCOME
COUNTRIES
Jean-Pierre Droz
Centre Léon-Bérard, Environment and Cancer Reasearch Unit, Lyon,
France
Introduction:
Management of cancer in tropical areas
is characterized by a small proportion of elderly patients,
different cancer epidemiology (virus induced cancers),
advanced diseases and often low or intermediate incomes
countries. Cancer patients managed at the Saint-Laurent
Hospital, French Guiana, are representative of these
characteristics except that the health care system is the same
than in main France.
Objective:
1) To describe elderly cancer patients’ manage-
ment at the Saint-Laurent Hospital, French Guiana, focusing
on health status screening and difficulties which were
encountered. 2) To translate the possible solutions to low and
intermediate income countries.
Methods:
Elderly patients (pts) (age >70 years) were pros-
pectively identified among all new pts between 01/09/2014
and 31/05/2016. Elderly pts’ frailty screening was prospectively
performed based on the G8 tool and assessment in health
status groups based on Activity daily Living (ADL), Cumulative
Illness Score Rating-Geriatrics (CISR-G) and malnutrition
(weight loss). Pts and cancer characteristics were collected:
age, sex, language, nationality, medical coverage, and
primary tumor, extension (local-L, locally advanced-LA and
metastatic-M).
Results:
Twenty-three out of 111 new cancer pts (20%)
were aged more than 70 years. There were 10 women and 13
men. Median age was 76 years (extremes 70–94 years). There
were 14 French, 7 Surinamese, 2 Haitian pts. Language was:
Sranantongo 10 pts, French 7 pts, Creole 4 pts and Hmong 2
pts. Ten patients benefited from the National Health Security,
7 of Emergency Medical Assistance, 5 of Universal Medical
Coverage and one had no medical coverage. Cancer extension
was: L 3 pts, LA 10 pts, M 10 pts.
G8 screening tool value was 0 to 16 and only 6 pts had a
value >14. Health groups were: fit 4 pts, frail 9 pts, disabled/
severe comorbidities 7 pts and too sick 3 pts. Dementia was
present in 3 pts. The item “self-rated health” was difficult to
assess in 15 pts, due to lack of understanding and wording
(rated 0.5: “don’t know”). Correlation between G8 and
components of Health Status is poor. Correlation between
cancer extension and G8 and health status groups is poor.
The following problems emerge from these observations:
cancers are diagnosed at advanced stage, the treatment
being palliative, a screening tool as G8 is difficult to apply
due to cultural specificities which preclude the use of a
questionnaire and Western concepts of health. Therefore
clinical assessments, which can be performed by a health
professional, seem more appropriate (comorbidities, very
frequent in older in this setting, evaluation of ADL, measure
of BMI and albumin).
Additionally in low and intermediate income countries:
limitation to treatment access is important. Considering
treatment the most important is the access to potent
analgesics, to radiotherapy which is the best palliative
treatment. Use of medical treatment is difficult due to the
cost and wide difficulty to manage complications. An accurate
evaluation of risk/benefit/cost may help to include patients
in drug-access programs. Another important aspect of public
health is to promote prevention and more immediately
effective, early diagnosis. This implies a strong effort in
education and a proximity health professional networking.
Conclusion:
geriatric oncology has an increasing impor-
tance in low and intermediate incomes countries but must
be adapted to the economy, health organization and cultural
differences. Health status can be screened easily through
medical assessment by well-trained health professional.
Palliative treatments are the first present priority. Prevention
and early diagnosis are the most important objectives to
develop in the near future.This can be done through education
which requires transcultural mediation to make possible the
appropriation of these concepts by people of non-western
cultures.