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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



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%) (



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


far 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



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


• 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


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