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but turn treatment choice, into a challenging decision for
elderly patients or for patients with comorbidities. It is then
appropriate to modulate treatment intensity and to carefully
define treatment objectives in the single patient.
Recently objective tools have been suggested to assess the
patients status approach of elderly patients and a three group
model seems appropriate to:
• FIT, those patients with no comorbidities and candidates
for chemotherapy at full doses
• UNFIT, those patients with intermediate comorbities and
candidates for adapted treatment
• FRAIL, those patients with severe comorbities and
candidates for palliative intent.
For CLL, the most common instruments used for this
are based on Eastern Cooperative Oncology Group (ECOG)
Performance Status valutation, Comorbidity Index Rating
Scale for Geriatrics (CIRS-G) to measure comorbidity with
a cut-off of 6 and creatinine clearance with a cut-off of
70 ml/min.
Tucci et al. evaluated DLBCL patients, aged
65 years, with
the “Comprehensive Geriatric Assessment” (CGA) prior to
therapy using activity of daily living (ADL) scale with a full
score 6, instrumental ADL with a full score 8, and CIRS to define
patient fitness status. CGA identified age-related problems
not typically identified by medical history and physical
examinations in approximately half of older cancer patients.
FIT patients were
80 years, with 5 ADL, 7–6 IADL and from 5
to 8 grade 2 comorbidities; FRAIL patients were
80 years, with
ADL
4, IADL
5 and at least 1 grade 3–4 comorbidities or >8
grade 2 comorbidities. In this study, CGA has been confirmed
as very efficient in identifying elderly patients with DLBCL
who could benefit from a curative approach. Considering
patients treated with curative intent overall, the survival of
FIT patients was significantly better than the survival of non-
fit patients (88% vs. 56%) (
p
=0.0001).
Currently, Fondazione Italiana Linfomi (FIL) is conducting a
prospective study with the aim of validating the use of CGA on
a large series of elderly patients with DLBCL (
65 years) and to
test aCGAbased approach to the
patient.Sofar 800 patients out
of 1000 planned have been enrolled. Interestingly, preliminary
data showed that 59% of patients were not FIT.Treatment with
curative intent (full doses R-CHOP-like regimens) was used in
94% and 65% of FIT and UNFIT cases; surprisingly, curative
intent was declared also in 38% of FRAIL cases. Six percent,
25% and 26% of FIT, UN and FR patients were treated with
an attenuated R-CHOP-like immunochemotherapy regimen.
Palliative regimens were used in 36% and 10% of FR and UN
patients respectively. Rituximab and doxorubicin containing
regimen seems to be the reference treatment for FIT, UN and
also for a significant proportion of FR patients but the actual
value of using this approach for non-FIT patients is not clear
and will be assessed with this project.
Disclosure of interest:
None declared
S40
QUALITY OF LIFE
Stefania Migliuolo
Europa Donna, Milan, Italy
EuropaDonna Italia,amember of the breast cancer coalition
“Europa Donna”, whose members are affiliated groups from
47 countries throughout Europe, is an independent non-profit
organisation that represents the interests of Italian women
regarding breast cancer to local and national authorities.
The movement is aimed to raise awareness on breast cancer,
ranging from screening to diagnosis and therapeutic approach
and to mobilise the support of Italian women in pressing for
appropriate screening and optimal treatments.
The advocacy priority actions of Europa Donna Italia are:
• establishing population-based mammography screening
programmes in all Italian Regions, according the European
Guidelines. In view of life expectancy increase, Europa
Donna Italia aims to obtain free mammography screening
also for women over 70 years of age.
• implementing Breast Units in every Italian Regions,
accordingly with the EU and Italian guidelines.
A Breast Unit is a fully equipped, quality assured, dedicated
breast center that provides competent and comprehensive
care. In a Breast Unit any patient, be she young or elder, is
cured by a multidisciplinary team of breast specialists:
each specialist is important to assure the most appropriate
screening, diagnosis and treatment (from genetics and
prevention, through treatment and patient support).
Researches have shown that Breast Units patients have
shown a reduction of preventable breast cancer mortality by
18%; this result has been achieved thanks to:
• the action and support of the multidisciplinary team and
its synergy;
• the reduction of treatment-related stress in cancer
patients;
• the opportunity to adjust treatment according to a
personalized care path.
The multidisciplinary approach — which requires the
presence of a volunteer association to support the patient —
is associated with a better perception of the patient’s quality
of life not only physically but also socially: the elderly cancer
patient, who often suffers from co-morbidities, can receive
special benefits from it.
The therapeutic care model of the Breast Unit is nowadays
considered a model for the approach and treatment to other
tumors.
Disclosure of interest:
In the role of CEO of a Healthcare
communication agency, I had/have relationships with the
following Pharmaceutical companies, creating and managing
communication projects: Novartis, Pfizer, PfizerCH, Fidia,
Sanofi, Menarini, Gilead, Merckserono. In the role of volunteer
for Europa Donna, in medical and scientific congresses and
meetings, I exclusively represent Europa Donna organization