The pioneers of oncogeriatrics are making babies

TO the Georges Pompidou European Hospital (HEGP), a patient over 90 years old with cancer is not systematically sentenced to palliative care. “In these very old patients, we perform chemotherapy, curative interventions for their cancer,” said Prof. Olivier Saint-Jean, head of the geriatrics department at this Parisian hospital. It would be totally unthinkable in other countries. However, the HEGP professionals are not keen on chemotherapy. Simply, “France is at the forefront of oncogeriatrics,” says Professor Saint-Jean.

This is why the ARC, the Association for Research on Cancer, has just published a brochure entitled “Understanding oncogeriatrics”. Aim of the operation: to make this new practice, born out of the encounter between geriatrics and oncology, known to the general public. Until what age can we do chemotherapy? What are the promising avenues of research for seniors with cancer? All these questions, addressed in the ARC brochure, deserve to be asked when we know that a third of new cancer cases diagnosed each year occur in those over 70 years of age.

To be up to the challenge, the medical community began to organize itself in the early 2000s. Without really creating a new discipline, oncologists and geriatricians have gradually developed tailor-made care for people. elderly with cancer. A work of goldsmith which should make it possible to avoid two types of errors: “Either we treat like a young adult and there, we have major complications related to the fact that the treatment is not adapted to the physiological condition of the patient. age. Either we say to ourselves, at 80, I’m not going to bother him. Which is a mistake insofar as it is quite possible to have recourse to curative therapies. By developing a geriatric care plan in support of the cancer care plan, these professionals find that they improve their patients’ prognosis.

Questions to Prof. Olivier Saint-Jean, Head of the Geriatrics Department at the Georges Pompidou European Hospital (HEGP).

Also treat the over 90s

What is the role of the pilot coordination units in geriatrics?
Prof. Olivier Saint-Jean. To be labeled “Pilot Unit” and respond to the Inca’s call for tenders, we had to submit projects in three areas: education, information and research. Secondly, we benefited from long-term loans which enabled us to recruit medical and para-medical professionals. There are currently about fifteen pilot coordination units in geriatrics (UPCOG), spread over the entire territory. This first allows a practice to emerge, but also to have places where we can show that we can have excellent results in the coordination with oncologists and in the care of these elderly patients.

Have these pilot units already proven their effectiveness?
Prof. OS-J. Yes, since in France, we are really ahead of our ability to treat cancer in very old patients. In my department, for example, there are patients over 90 years old to whom we do chemotherapy as well as curative surgeries for their cancer. These are things that are totally unimaginable in other countries. But beware, we are not chemotherapy “diehards”. We now want all patients to be able to benefit from these supports that we knit in our units.
Interview with CC

A geriatric assessment

To go further and promote collaboration between these two specialties which did not know each other, these pioneers created, in 2005, the Group for the exchange of practices in oncogeriatrics (GEPO-G / France). The same year, the National Cancer Institute (Inca) also embarked on the adventure by developing an “oncogeriatrics mission”. Objectives: “to improve the level of knowledge, to have a sufficient number of trained professionals, to obtain that all patients over 75 years of age with cancer benefit from a geriatric evaluation and to provide information on risk factors”.
To provide itself with the means to achieve its ambitions, the Inca has encouraged the creation of around fifteen pilot coordination units in geriatrics. In June, the Inca should take stock of advances in oncogeriatrics but this practice has, it seems, already proven its worth. In his report on the next Cancer Plan, Professor Jean-Pierre Grünfeld indeed recommends “ deploy the pilot units throughout the country by 2011 ” and multiply their number by two.
However, all septuagenarians with cancer will not be entitled to this specific care. “Faced with the number of cancers, the supply of geriatricians is too modest”, explains Prof. Saint-Jean. This is why the 15 pilot units are already working on the development of a “Sorting” elderly patients who will not fail to rush to the doors of oncogeriatric services.

Cecile Coumau