Breast cancer is a condition that predominantly affects older adults. Therefore, it is critical that oncology research accommodates the specific needs and challenges associated with treating this population. The St. Gallen International Breast Cancer Conference, held in 2019, presented a diverse array of perspectives on geriatric oncology. The insights garnered show a considerable shift towards personalized and age-appropriate care strategies for senior breast cancer patients.
The growing emphasis on geriatric oncology is underpinned by the demographic reality of aging populations worldwide. A keynote discussion led by Dr. Nicolò Matteo Luca Battisti from the Department of Medicine, Breast Unit, at The Royal Marsden NHS Foundation Trust (Sutton, Surrey, United Kingdom), highlighted the intersection of advanced age with oncological treatment. The perspectives shared, later encapsulated in an article in the “Journal of Geriatric Oncology” with a doi of 10.1016/j.jgo.2019.04.014, reinforced the notion that age should be a critical factor in developing treatment plans.
The conference focused on several key areas: the therapeutic use of hormonal and immunological antineoplastic agents, combined chemotherapy protocols, decision-making in clinical settings, and the impact of frailty and aging on disease management. One of the central threads through these discussions was the importance of geriatric assessment in tailoring cancer treatments for the elderly.
As we delve deeper into the takeaway messages from the St. Gallen conference, it is important to consider the implications for clinical practices and ongoing research in geriatric oncology.
Geriatric Assessment in Breast Cancer Care
The geriatric assessment is a multidimensional tool that allows healthcare professionals to analyze an older patient’s functional status, comorbidities, cognition, psychological state, social support, nutritional status, and pharmacological profile. Dr. Battisti emphasized the need for this comprehensive evaluation to be integrated into clinical practice. It serves as a guide to identify vulnerabilities that may not be apparent through standard oncological assessments and helps in designing a care plan that addresses the unique needs of older patients.
Tailoring Therapeutics
In the realm of pharmacological intervention, the conference exhibited a growing interest in optimizing the use of antineoplastic agents for the elderly. Discussions underscored the importance of selecting antineoplastic agents, whether they are hormonal, immunological, or inhibitors like Poly(ADP-ribose) polymerase (PARP) inhibitors, with an eye toward a patient’s geriatric assessment. This personalization of treatment is intended to maximize efficacy while minimizing adverse effects, which can be particularly debilitating for older patients.
Decision-Making and Shared Decision-Making (SDM)
Another significant aspect of geriatric oncology highlighted at the St. Gallen conference was the concept of shared decision-making. The traditional paternalistic model, where the physician makes the treatment decisions, is increasingly giving way to a more collaborative approach that incorporates the patient’s values and preferences. This shift is especially relevant when treating elderly patients, who may prioritize quality of life, treatment burden, and functional independence differently than younger patients.
Disease Management and Surgical Interventions
With regard to breast cancer management, the conference highlighted the need for careful consideration of surgical interventions such as mastectomy and lymph node excision. Age-related factors like frailty, which was an area of focus at the conference, can impact a patient’s ability to recuperate from surgery and might prompt clinicians to consider less invasive options such as sentinel lymph node biopsy over axillary lymph node dissection. Moreover, the use of adjuvant chemotherapy in the older population requires careful monitoring and adjustment, as side effects can be more pronounced in this demographic.
Clinical Trials and Elderly Inclusion
The representation of older adults in clinical trials continues to be a point of contention. A significant portion of clinical data derives from a younger cohort, leaving uncertainties regarding the efficacy and tolerability of cancer treatments in the geriatric population. Many speakers at the St. Gallen conference called for the need to include more older adults in clinical trials to bridge this knowledge gap and to design trials with geriatric-specific endpoints.
References
1. Battisti, N.zM. L., Dubianski, R., et al. (2019). Perspectives on geriatric oncology research presented at the 2019 St. Gallen international breast cancer conference. Journal of Geriatric Oncology, 10(5), 673-676. doi: 10.1016/j.jgo.2019.04.014
2. Biganzoli, L., Wildiers, H., Oakman, C., Marotti, L., Loibl, S., Kunkler, I., … & Cardoso, F. (2012). Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). The Lancet Oncology, 13(4), e148-e160.
3. Extermann, M., & Hurria, A. (2007). Comprehensive geriatric assessment for older patients with cancer. Journal of Clinical Oncology, 25(14), 1824-1831.
4. Hamaker, M. E., Wildes, T. M., Rostoft, S., & Launer, L. J. (2017). Thinking about the box: considering the elderly breast cancer patient’s geriatric domain in the adjuvant setting. The Breast, 34, S95-S100.
5. Wildiers, H., Heeren, P., Puts, M., Topinkova, E., Janssen-Heijnen, M. L., Extermann, M., … & Artz, A. (2014). International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. Journal of Clinical Oncology, 32(24), 2595-2603.
Keywords
1. Geriatric Oncology Research
2. Breast Cancer in Older Adults
3. Geriatric Assessment Oncology
4. Antineoplastic Agents Elderly
5. Clinical Trials Geriatric Oncology