Expert oncologists have agreed to combat ageism and improve clinical management in haemato-oncology today at the Blood Cancer in the Elderly European Expert Forum, Rome.

Prof. Gordon McVie, European Institute of Oncology and Managing Editor of

ecancer, welcomed over 1,000 conference attendees keen to ensure that the elderly have the same access to care, including innovative and expensive drugs, as anyone else. "The inclusion of elderly patients in clinical trials is one of the clinical challenges that need to be tackled" he stated, a message reiterated by several other speakers.

Prof. Robin Foa, University 'La Sapienze', Rome, introducing a session focused on past, present, and future challenges in haematological malignancies in the elderly, remarked how the current failure to distinguish between chronological and biological age was responsible for a lack of tailored treatment. Chronological age, he suggested, is not relevant for the choice of treatment in the elderly, and it is much better to distinguish between fit and frail patients as the basis for choosing treatment.

Prof. Balducci, Moffitt Cancer Center, Florida, USA, saw undertreatment as a major issue, with age as a "risk factor for not receiving adequate treatment". He also suggested that randomized controlled trials (RCT) were not able to cover the variabilities and comorbidities of elderly cancer patients, and though important, were not the only way to build knowledge.

Prof. Reinhard Stauder, Medical University Innsbruck, Austria, noted the role of anaemia, as it affects a large number of people - 2 million in Italy alone - and can become an increasing risk factor that needs to be taken into proper account.

Prof. Lazzaro Repetto, Istituto Nazionale Ricovero e Cura Anziani, Rome, suggested that clinicians should always use a 'comprehensive geriatric assessment' (CGA) to define a senior oncology patients and assess for frailty, giving both prognostic and predictive values. A CGA is a multidisciplinary diagnostic instrument designed to collect data on the medical, psychosocial and functional capabilities and limitations of elderly patients.

Prof. Mario Boccadoro, University of Turin, Italy, suggested that clinicians should "always define the aim of cancer therapy", using a "curative setting in healthy patients likely to die because of cancer and a palliative setting in frail patients or where the tumour won't shorten life expectancy". He also suggested that clinicians identify frail patients and on that basis define the treatment intensity, grouping patients according to Low dose, Intermediate dose, and High dose. The assessment of the frail patient, as pointed out in the introductory remarks by Foa, becomes essential when deciding aggressiveness of therapy. Boccadoro concluded by stating that "there is a pressing need to avoid the established, but wrong, equation 'elderly = unfit = palliative care'; to do this, a CGA becomes fundamental".

The day was concluded on a consensus that treatment problems encountered by elderly blood cancer patients stem from the lack of an established definition of an unfit patient. This needs to change and will bring to the stratification of patients and of treatment doses. The assessment and definition of the patient (fit, unfit, frail) lies at the border between the disciplines of haematology and oncology and requires an interdisciplinary effort. This meeting is a first step in this direction.