SIOG 2013

Treating with radiotherapy in geriatric oncology

Dr Jesper Grau Eriksen - University of Southern Denmark

Geriatric oncology has a huge part in our clinic because the patients are getting older and older and, for example, for head and neck oncology, which is my speciality, one-third of the patients are actually 70 years or older. So geriatric oncology is a substantial part of the daily work.

How is Denmark tackling geriatric oncology?

We are still just in the starting phase of addressing the special issues of the elderly, frail patients but we need to do this because the population is increasing in age and there are different needs for the elderly patients compared to the younger ones; especially we have to take care of the comorbidities and we have to take care of the multipharmacy before starting treatment. We know that, from large Danish population based trials, we do know that, at least for head and neck oncology, that the elderly patients do just as well on curative radiotherapy as the younger ones but they die of their comorbidities. So the real task is to design trials and design programmes that take these issues into consideration before delivering curative radiotherapy. And basically the same goes for giving chemotherapy as well.

We need randomised trials in the older population?

For some diseases, for some conditions, we can, of course, do approximations from studies done in younger populations but there are certainly some issues where it’s very important that we do trials, phase II and even, if possible, phase III trials in the elderly population, or at least design the trials in a way so we take special care of the issues that are important for the elderly population. I do believe that we could do trials that are both for the younger generation and the older generations but we should design them in a way so we are able to take care of their issues as well, the special issues of the elderly as well.

In Denmark right now, as far as I know, there are no trials that are carried out only for the elderly generation or the frail but there are certainly an evolving number of trials that are coming up and will come up in the years to come and what we have changed a lot in our attitudes the last couple of years is that we do not have an upper age limit of trials any more. So just ten years ago it was very difficult to get into a trial if you were more than 65 years old; today there will be no age limit for a lot of the trials. And certainly the clinical experience is that if you take good care of your patient, or better care than you would do with the younger ones, and take care of their special needs then it’s also possible to deliver curative radiotherapy to an 80 year old person or chemotherapy to the elderly and with an increasing number of biological drugs that gives us even more opportunities in the very old part of the population.

As a radiation oncologist, what are the needs for elderly patients?

What we have especially focussed on is the nutrition and support of nutritional needs during radiotherapy. For a radiotherapy of the upper part of the body, the pharynx, the larynx and the oesophagus, there are special needs for taking care of the nutritional status and support this during therapy. In general, you can say elderly people can do well during a curative course of radiotherapy but if something goes wrong it often goes really wrong so you need to take these situations up front and take care of these problems before they actually happen. In our clinic we have established a nurse-based outpatient clinic which works closely together with dieticians and the doctors so we can offer them extra service, extra focus on their problems and more close follow-up, not just during radiotherapy but also in the period after radiotherapy.

What is the importance of the SIOG meeting?

There are several important issues here. For Denmark, the side meeting is putting more focus on the geriatric oncology patient and it will certainly help us boosting geriatric oncology in Denmark, for sure. So that’s probably the more national part and, seen in a more international perspective, being together with colleagues here from all over the world that have different inputs, have different viewpoints on how to progress in this field, it’s extremely stimulating to talk to them and get good ideas of how to proceed, not just in the everyday clinic but also when conducting trials.