Page 37 - Swsthya Winter Edition Vol 1 Issu 3 DEC 2020 Circulation copy BP

SURGERY

Adjusting Care for Older Cancer Patients

During the COVID-19 Outbreak:

the SIOG Recommendations

Professor Riccardo A. Audisio, MD, PhD(Hon), FRCS, FEBS
SIOG Past President
Department of Surgery
Institute of Clinical Sciences
Blå Stråket 5
Sahlgrenska University Hospital
Göteborg, Sweden
Prof Riccardo A. Audisio
Dr. Nicolò Matteo Luca Battisti
Clinical Research Fellow in Medical Oncology
Department of Medicine - Breast Unit
The Royal Marsden NHS Foundation Trust
London, United Kingdom
Dr Anna Mislang, MD, FRACP
Flinders Centre for Innovation in Cancer
Flinders Medical Centre
Bedford Park, South Australia

Short resume: bearing the highest burden of malignant benefits of the decision to undertake cancer
disease (one in two cancer is detected treatment. During the pandemic it becomes
The COVID-19 pandemic poses several after age 65). even more imperative that such approach
challenges and distresses primarily senior 2. It is possible to prioritise those patients is followed to avoid the risk of over- or
adults, the age-group predominantly demanding active oncological treatment under-treatment and minimise the risk of
affected by cancer. by means of Geriatric Assessment tools. adopting an ageist approach.
3. Advantages and drawbacks of active To this purpose the International Society of
A careful evaluation of each elderly patient cancer treatments should be tailored Geriatric Oncology (SIOG) has established a
by means of a Geriatric Assessment is according to a holistic and patient- panel of experts with the aim of developing
mandatory, in order to avoid over-treating centred approach. a consensus and making recommendations
frail and vulnerable patients, while not on numerous aspects of cancer care specific
(1)
under-treating fit individuals. The COVID-19 outbreak has been posing to this age group .
numerous challenges, affecting people
Several geriatric-focused issues have been from all over the world, ethnicity, literacy, Older age and cancer diagnosis are
recognized, which might affect the senior religious orientation, but there is no predictors of negative outcomes of the
cancer patient beyond the malignant doubt that senior adults are the most COVID-19 infection. In this setting a careful
tumour: feeling of estrangement due to severely affected group. Amongst them are Geriatric Assessment (GA) is particularly
limited access to friends/family; decline numerous cancer patients, since more than valuable to assist decision-making. GA
in communication and comprehension one in two malignant tumours affect people may assist estimating physiologic reserve
from wearing masks and facial shield, aged 65-year and above. and adaptive capability, assessing risk-
more particularly so for hearing-impaired benefits of either providing or temporarily
patients who rely on lip reading and non- COVID-19 represents another competing withholding treatments, and determining
verbal cues; increased dependency on risk factor to take into account when patient preference to help inform treatment
others to provide basic needs such as drugs, undertaking therapeutic decisions for decisions. In a resource-constraint setting
food and home supplies. senior adults with cancer. The presence of during a pandemic, frailty screening tools
chronic conditions such as cardiovascular may be administered remotely to identify
An expert panel established by SIOG has disease, diabetes, chronic respiratory patients requiring a more Comprehensive
been set in place to develop a consensus disease, chronic renal impairment, GA.
and make recommendations on aspects of and cancer present worse outcomes,
cancer care in this age group. particularly for those patients with 3 or Therapeutic decisions should favour the
more comorbidities. In many older cancer most effective and less invasive approach
Key messages: patients where management could be with the lowest risk of side effects. In
challenging, the risks of morbidity and selected cases, this might require deferring
1. The senior adults are mostly distressed mortality from acquiring COVID-19 must or omitting surgery, radiotherapy or
by the COVID-19 pandemic besides be considered when assessing risks and chemo/immunotherapy especially when

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