Elisabeth Carola

PRODIGE 34-FFCD 1402-ADAGE: Adjuvant chemotherapy in elderly patients with resected stage III colon cancer: A randomized phase 3 trial.

Gastroenterology and Digestive Oncology, CHU Avicenne, APHP, Bobigny, France Oncology, Centre Antoine Lacassagne, Nice, France Oncogeriatry, ICM Val d’Aurelle, Montpellier, France Oncology, CH Senlis, Senlis, France Federation Francophone de Cancerologie Digestive, Burgundy University, INSERM U866, Dijon, France Geriatry, CHU Henri Mondor, APHP, Creteil, France Geriatry, Centre Gerontologique Departemental, Marseille, France Gastroenterology, CH de la Roche sur Yon, La Roche sur Yon, France Oncology, CHU Saint-Antoine, APHP, Paris, France rance Hepato-Gastroenterology and Digestive Oncology, CHU La Timone, APHM, Marseille, F

Alterations in comprehensive geriatric assessment decrease survival of elderly patients with cancer

INTRODUCTION A comprehensive geriatric assessment (CGA) evaluating several domains of health is recommended for elderly patients with cancer. Effects of altered domains on the risk of death in this population need to be clarified. The aim of this study was to estimate the independent association of each CGA domain to overall survival (OS). METHOD Patients included in the ONCODAGE cohort completed a CGA at baseline. Cox models (one per domain) estimated the hazard ratio (HR) of death for each CGA domain. Directed Acyclic Graphs (DAGs) selected specific sets of adjustment factors for each model. RESULTS The analysis included 1264 patients (mean age: 78 years, women: 70%). Median follow-up was 5.2 years, and 446 patients died. Each altered domain had a detrimental effect on survival, sometimes dependent on gender, age, education or time from inclusion. Nutritional status had a time-varying effect, with higher mortality rates if altered only within the first 3 years of follow-up. In case of altered mobility, the risk of death was higher only for the youngest patients and, in case of altered autonomy, only for the youngest women. An altered neurological state led to higher mortality rates; this effect increased with the level of education. Patients with altered psychological status or more than four comorbidities at baseline had also higher mortality rates. CONCLUSIONS Patients with an altered CGA domain have a higher risk of death than those without any alteration. The effect of some alterations is different in some subgroups or at a given time of the treatments.

Adjuvant Therapy of Colorectal Cancer in Older People

Colorectal cancer (CRC) is the fourth cause of cancer deaths. More than one-third of colon cancers are stage III at presentation; their 5-year relative survival is 69 %.

Faut-il modéliser l’EGS ?

Standardised geriatric assessment amply proves its value in the elderly by reducing the rates of mortality and hospital admission through the interventional measures that it generates. It also improves the survival of the elderly with metastatic cancer. Its everyday use by untrained teams remains problematic and timeconsuming. Screening tools are currently being validated. Modelling of standardised geriatric assessment might help to define the features, which are predictive of the toxicity of chemotherapy. The use of these tools poses the problem of coordination among the variety of personnel who are essential to ensure that the care pathway is optimal.RésuméL’évaluation gériatrique standardisée (EGS), par les interventions qu’elle engendre, a largement prouvé son intérêt dans la population âgée générale en diminuant le taux de mortalité et d’hospitalisation. Elle améliore aussi la survie des patients âgés atteints de cancer en situation métastatique. Son utilisation au quotidien par des équipes non entraînées reste difficile et chronophage. Des outils de dépistage sont en cours de validation. Unemodélisation de l’EGS pourrait contribuer à dégager des facteurs prédictifs de chimiotoxicité. L’utilisation de ces outils pose le problème de la coordination des différents acteurs indispensables pour proposer un parcours de soins optimal.

Compte rendu du 7e Congrès de la SIOG La Haye 2–4 novembre 2006

RésuméLes auteurs proposent dans cet article un compte-rendu des thèmes essentiels du 7e Congrès de la SIOG (Société internationale d’oncologie gériatrique); La Haye 2–4 novembre 2006. La place et les modalités de l’évaluation gériatrique, les moyens de prédire les toxicités, la question de la polymédication des patients âgés et les données récentes pour les cancers les plus fréquents ont été au centre du Congrès.AbstractThe authors provide a report on the 7th meeting of the International Society of Geriatric Oncology (SIOG), held in The Hague, Netherlands, November 2–4th 2006. The major issues addressed at the meeting included the role of geriatric assessment and screening tools, toxicity prediction methods, polymedication in elderly patients and recent data on the most frequently occurring cancers.