ÆLDRE OG KRÆFT. Introduktion. Trine Lembrecht Jørgensen Læge, ph.d., post. doc. University of Southern Denmark. Odense University Hospital

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1 ÆLDRE OG KRÆFT Introduktion Trine Lembrecht Jørgensen Læge, ph.d., post. doc University of Southern Denmark Odense University Hospital

HISTORISK UDVIKLING AF ÆLDRE OG KRÆFT National Cancer Institute and National Institute on Ageing sponsor a symposium Perspectives on prevention and treatment of cancer in the elderly 1983 1988 1990

2 HISTORISK UDVIKLING AF ÆLDRE OG KRÆFT National Cancer Institute and National Institute on Ageing sponsor a symposium Perspectives on prevention and treatment of cancer in the elderly Dr BJ Kennedy encouraged the study of ageing and cancer during the Presidential Address at ASCO 1988 The Venice statement 2 Cancer in the elderly: why treated so badly? 1998 First edition of Comprehensive Geriatric Oncology released International Society of Geriatric Oncology (SIOG) formed First onco-geriatric guidelines published on the use of haematopoietic growth factors in elderly patients receiving cytotoxic chemotherapy 3 US Geriatric Oncology Consortium founded to initiate trials and raise awareness of problems of elderly patients World Health Organization 58th General Assembly resolution on Strengthening Active and Healthy Ageing Comprehensive Geriatric Assessment guidelines by the SIOG 4 National Comprehensive Cancer Network (NCCN) guidelines published practice guidelines for senior adult oncology JOURNAL of GERIATRIC ONCOLOGY 1. Aapro M. J Geriatric Oncol 2010;1: Fentiman IS, et al. Lancet 1990;335: Balducci L. NCCN Clinical Practice Guidelines in Oncology Senior Adult Oncology November 1, Bokemeyer C, et al. Onkologie 2002;25: Extermann M, et al. Crit Rev Oncol Hematol 2005;55:

3 DEFINITION AF EN ÆLDRE KRÆFTPATIENT Octogenarians Nonagenarians

4 NORDISK CANCER POPULATION 2010 ALL 100% 80% 60% 40% 20% 0-69 years old 70 + years old 0% Source: NORDCAN

5 HVORFOR BESKÆFTIGE SIG SPECIELT MED ÆLDRE KRÆFTPATIENTER?

6 HVORFOR BESKÆFTIGE SIG SPECIELT MED ÆLDRE KRÆFTPATIENTER? Population af ældre vokser Ældre har høj incidens af kræft Populationen af ældre kræftpatienter vokser markant Ældre er underrepræsenteret i kliniske forsøg Ældre tåler generelt kræftbehandlingerne dårligere end yngre

7 ÆLDRE KRÆFTPATIENTER I DK År 65 år 80 år ,5 % 4,2 % ,5 % 6,3 % 2010: 60% af kræfttilfælde 65 år 2030: 69% af kræfttilfælde 65 år ,0 % 8,8 %

8 Inklusion af patienter 65 år I amerikanske studier (Southwest Oncology Group [SWOG] ) N = in 164 trials Hutchins LF, et al. N Engl J Med 1999;341:

9 DET ER ALTSÅ INDLYSENDE AT ÆLDRE KRÆFT- PATIENTER ER UNDERREPRÆSENTERET I RCT

10 Randomiserede kliniske studier reflekterer ikke den daglige kliniske praksis

11 Sorafenib in renal cell cancer Retrospective subgroup analysis of the Renal Cancer Global Evaluation Trial Advanced renal cell carcinoma Young (N=787) Old (N=115) 87%! Age < 70 Age 70 13%! Randomization N=407 Placebo N=381 Sorafenib N=45 Placebo N=70 Sorafenib Eisen et al. J Natl Cancer Inst. 2008;100:

12 PFS Eisen et al. J Natl Cancer Inst. 2008;100:

13 HOW DO WE IDENTIFY OLDER CANCER PATIENTS, WHO CAN BENEFIT FROM TREATMENT?

14 OLDER ADULTS A HETEROGENEOUS POPULATION

15 TREATMENT DECISIONS BASED ON CGA? Good shape: Same treatment as younger patients 50% of year-old and 25% of year-old patients Standard Treatment Vulnerable: intervention, then standard treatment Frail: intervention, then adapted treatment or palliation Geriatric Intervention Too sick for intervention

16 SIOG 10 PRIORITIES Education Clinical practice Research

17 SIOG 10 PRIORITIES - RESEARCH Develop, test and disseminate easy screening tools. Create clear and operational definition of vulnerability/ frailty applicable in oncology. Increase the relevance of trials for older patients. Require large phase III trials to oversample older patients. Extend phase II and III trials to patients with high levels of comorbidity with stratified accruals or extension cohorts. Design specific trials for older cancer patients. Promote multidisciplinary basic/translational research on the interface of aging and cancer.

18 AGECARE Academy of Geriatric Cancer Research

19 RESEARCH PLAN Seven work packages 1. Epidemiology and genetic epidemiology 2. Cancer biology and molecular biomarkers 3. Surgery 4. Radiation therapy 5. Medical treatment 6. Supportive care (comorbidity and polypharmacy) 7. Supportive care (complications and adverse effects) AgeCare

20 VENICE STATEMENT Cancer in the elderly: why so badly treated? Fentiman IS et al. Lancet 1990;335:

21 STATEMENT 2015 Cancer in the elderly: why so badly treated?

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