Tag Archives: ESMO

Geriatric Oncology: The Elephant in the Empty Room

Kerri Wachter/Elsevier Global Medical News

It’s easy to tell which oncology topics are hot and which are not here at the Multidisciplinary Cancer Congress in Stockholm. Metastatic breast cancer? Thousands of people pushing their way into the cavernous meeting hall.  Advanced non-small cell lung cancer? I practically had to bribe the doorman to let me in.  Geriatric oncology? (crickets chirping)  It was kind of lonely in the geriatric oncology meeting room, one that was a tiny fraction of the size of the main hall.

Yes, it’s difficult to study cancer therapies in elderly patients.  They may have  comorbidities and poor performance status.  They may have impaired cognition or be unsuitable candidates for surgery. They may be frail. Then again, they may be none of those things. In fact, they may be in better health than younger patients. As one oncologic surgeon put it, “chronologic age should not be a primary factor in the decision-making process” for cancer treatment in elderly patients.

Courtesy Flickr/User TBOARD/Creative Commons License

What is clear is that we’re going to need lots of interest and research in geriatric oncology, now that the baby boomers are approaching old age. So far we have no good tools for separating the elderly patients who can handle more aggressive treatment from those who can’t.  We have little data on the effects of cancer treatments on elderly patients because they are typically excluded from trials. We don’t even have a clear definition of “elderly.”

The fact that we’re ill prepared to care for the growing population of elderly cancer patients  is the elephant in the room. Sadly, it’s a small room that’s pretty empty.

—Kerri Wachter (@knwachter on Twitter)

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Filed under Geriatric Medicine, IMNG, Oncology

Family matters in cancer care

Family: can’t live with them, can’t live without them.

The upcoming holiday season calls the sanity of this adage into question, but when a member of the clan is diagnosed with cancer, there’s nothing like family to ease the way forward. Or is there?

 A team of Argentinian researchers evaluating the influence of family on the care of cancer patients found that 50% of physicians acknowledged at least one negative feeling for the relatives. Wrath, anger, rejection, and anguish were all noted, with women physicians more likely to feel anguish, and anger rising to the top of the list among male physicians. 

“Negative emotions must be considered since the above mentioned emotions may be an obstacle to the correct performance of the professional,” Luisina Ongania and colleagues reported at the European Society for Medical Oncology meeting in Milan. 

Before physicians cry foul, however, the survey showed that relatives had secrets of their own. 

"The Secret" by Edmund Blair Leighton, image in the public domain

 

 A stunning 95% of physicians said they had been asked by relatives to hide information of an adverse diagnosis or prognosis from the patient. 

Only 35% of the sample – made up of 50 oncologists, surgeons, pathologists, pulmonologists, and NIC providers – rejected this demand.  

Contrary to the image of women as chatterbox cream puffs, female physicians were more likely to snub a request for secrecy than men (40% vs. 32%), as were seasoned practitioners when compared with those with less than 10 years of clinical experience (40% vs. 32%). 

The influence of family can place doctors at an “ethical crossroads” in relation to respect for the patient’s autonomy, the researchers, from the Centro Médico Austral OMI in Buenos Aires, noted in their poster. 

Proponents of family centered care argue that engaging families in the hospital and even the ED can provide medical teams with valuable clinical and social information and calm patients who find themselves in a frightening and unfamiliar setting. Conversely, family members who witness the massive medical efforts launched to save their loved one are said to be more accepting of the outcome, even when the patient dies. (Click here for related story).

Exactly how hospitals, EDs, and clinicians should navigate these tricky waters is unclear, although all physicians in the survey argue that it’s important to receive information and training about how to work with relatives. Only 16% believed they’d received enough of this training.

Getting relatives to behave in the hospital, or even at the holiday dinner table, may be a harder nut to crack. 

By Patrice Wendling (on twitter @pwendl)

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Filed under Emergency Medicine, Hospice and Palliative Care, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology, Practice Trends, Psychiatry