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Often in these patients fatigue is one symptom within a

cluster of other symptoms such as anemia, depression and

sleep disorders that may contribute to the development

of cancer-related fatigue. Moreover, the elderly are often

affected by several co-morbidities (i.e., metabolic, endocrine

and cardiovascular disorders) which may cause fatigue.

The pathogenesis of cancer-related fatigue is not yet well


Each patient, especially if elderly, should be screened for

fatigue at their initial visit and during the routine subsequent

visits. Elderly patients are often reluctant to report fatigue

to their clinicians, mainly because they consider fatigue as

an unavoidable side effect. Therefore, health care providers

should help elderly patients to disclose and describe the

fatigue they are experiencing, its intensity and duration,

the factors that exacerbate or relieve fatigue and its impact

on functioning. An assessment tool may help patients to

talk about their fatigue. Unfortunately, no instruments have

been specifically developed for elderly cancer patients. The

most efficient way of recording fatigue is by using a simple

unidimensional severity scale such as a verbal rating scale

(none, mild, moderate and severe fatigue) or a numeric rating

scale (0–10 scale where 0 equals no fatigue and 10 equals the

worst imaginable fatigue). The Brief Fatigue Inventory which

has only nine items to measure, it is easy to use and could be

studied as measurement tool in elderly cancer patients.

MASCC is now elaborating guidelines on cancer-related

fatigue. Unfortunately, only few data are available on

elderly cancer patients. Therefore, I will try to adapt MASCC

guidelines concerning treatment of cancer-related fatigue to

elderly cancer patients.

Both pharmacological and not pharmacological interven-

tions will be presented. Education of the patient and physician

regarding this topic is necessary.

About 20 randomized placebo-controlled studies on

psychostimulants (methylphenidate, dexmethilphenidate,

dexamphetamine, modafinil and armodafinil) have been

published. No one carried out specifically in elderly cancer

patients. The results of these studies are contrasting and does

not permit us to drawn firm conclusions on the efficacy of

psychostimulants in the control of cancer-related fatigue.

The same is true for antidepressants which are efficacious

for depression but not against fatigue. The only efficacious

drug is dexamethasone that in a double-blind study in

terminal cancer patients reduced significantly the fatigue

with respect to placebo. Among the non-pharmacological

treatments physical exercise and psychosocial interventions

demonstrated some impact on the control of cancer-related


Disclosure of interest:

None declared




Siri Rostoft

Oslo university Hospital, Department of Geriatric Medicine, Oslo,



To highlight why cognitive dysfunction is one of

the most important comorbidities to assess in older cancer



The prevalence of cognitive dysfunction

and dementia increases with higher chronological age.

As the population of older patients with cancer increases,

professionals dealing with such patients need to develop

skills in recognizing, diagnosing, and dealing with cognitive



PubMed search of papers addressing cognitive

dysfunction in older patients with cancer as well as personal

clinical and research experience


Cognitive dysfunction and dementia influences

every part of the treatment trajectory for cancer patients

such as understanding information about the disease and

treatment options and contributing to the decision making,

and compliance both with the prescribed treatment and

warning signs of side effects. Additionally, both cognitive

impairment and dementia impacts life expectancy. The

risk of delirium during treatment is higher in patients with

preexisting cognitive impairment, and preventive strate-

gies should be put in place. In most cases, patients with

cognitive impairment need extensive supervision from

health personnel or caregivers during the course of the

cancer treatment. If cognitive impairment goes unnoticed by

the treating physician, the patient will be a higher risk of a

negative outcome.


Doctors treating older patients with cancer

need to look actively for signs of cognitive impairment

because this comorbidity has immediate implications for

every step of the treatment trajectory.

Disclosure of interest:

None declared



Patrick Roth

University Hospital Zurich, Department of Neurology, Oslo, Norway

Approximately half of the patients diagnosed with

glioblastoma are 65 years or older and the incidence for

gliomas in the elderly population is rising for unknown

reasons. Glioblastoma, as the most frequent and most

malignant subtype, is associated with a particularly poor

prognosis. Various molecular markers have gained increasing

interest in the last years in patients suffering from glioma. In

the elderly, most gliomas display an unfavorable molecular

composition such as the absence of IDH mutations. The

available treatment options include surgery, radiation therapy

and alkylating chemotherapy, mainly with temozolomide.

Data presented at the ASCO meeting 2016 indicate that

temozolomide-based radiochemotherapy is superior to

radiotherapy alone in elderly glioblastoma patients. This

survival benefit is largely restricted to patients with tumors

harboring a methylation of the O6-methylguanine-DNA-

methyltransferase (MGMT) promoter. In patients who are

considered ineligible for combined treatment modality, post-