Page 39 - Swsthya Winter Edition Vol 1 Issu 3 DEC 2020 Circulation copy BP

SURGERY
[8]
functional, mental, and nutritional status . the virus. Whilst data is still emerging and 8. Hurria, A., et al., Validation of a Prediction
follow-up of ongoing trials is too short Tool for Chemotherapy Toxicity in Older
Adults With Cancer. J Clin Oncol, 2016.
In the curative setting, chemotherapy to allow robust conclusions, the SIOG
34(20): p. 2366-71.
should be considered when appropriate Working Group has developed a number of
9. Extermann, M., et al., Predicting the risk of
and in the presence of a clear survival recommendations on the management of
chemotherapy toxicity in older patients:
benefit. Whenever possible, a shorter older adults with cancer which are outlined the Chemotherapy Risk Assessment Scale
(1)
schedule should be preferred. In the in the full article recently published . for High-Age Patients (CRASH) score.
palliative setting, shared decision-making Cancer, 2012. 118(13): p. 3377-86
should take into account the hazards of References 10. Bos, A.C., et al., Timing of adjuvant
worsening symptoms and functional status, chemotherapy and its relation to survival
which could lead to missing the opportunity 1. Adapting care for older cancer patients among patients with stage III colon cancer.
to treat. After attaining ongoing disease during the COVID-19 pandemic: Eur J Cancer, 2015. 51(17): p. 2553-61
Recommendations from the International 11. Burdett, S., et al., Adjuvant chemotherapy
remission, discontinuing chemotherapy
Society of Geriatric Oncology (SIOG) for resected early-stage non-small cell
may be an option, especially if alternative
COVID-19 Working Group. Battisti NML, lung cancer. Cochrane Database Syst Rev,
non-myelosuppressive agents are available,
Mislang AR, Cooper L, O'Donovan A, 2015(3): p. Cd011430.
such as endocrine therapy for HR-positive
Audisio RA, Cheung KL, Sarrió RG, Stauder 12. Kupstas, A.R., et al., Effect of Surgery Type
breast cancer patients. R, Soto-Perez-de-Celis E, Jaklitsch M, on Time to Adjuvant Chemotherapy and
Williams GR, O'Hanlon S, Alam M, Cairo Impact of Delay on Breast Cancer Survival:
Chemotherapy regimens with less C, Colloca G, Gil LA Jr, Sattar S, Kantilal K, A National Cancer Database Analysis. Ann
frequent dosing should be preferred to Russo C, Lichtman SM, Brain E, Kanesvaran Surg Oncol, 2019. 26(10): p. 3240-3249.
minimise the need for hospital visits. R, Wildiers H. J Geriatr Oncol. 2020 Jul
16:S1879-4068 Online ahead of print.
When available, oral agents should be Authors
2. Armitage, R. and L.B. Nellums, COVID-19
favoured over intravenous treatments:
and the consequences of isolating the
capecitabine could replace fluorouracil in Professor Riccardo A. Audisio, MD,
elderly. Lancet Public Health, 2020. 5(5):
the management of colorectal malignancies PhD(Hon), FRCS, FEBS
p. e256.
without compromising outcomes. Primary 3. Petretto, D.R. and R. Pili, Ageing and SIOG Past President
prophylaxis with granulocyte colony- COVID-19: What is the Role for Elderly Department of Surgery
stimulating factors is also advisable for People? Geriatrics (Basel), 2020. 5(2). Institute of Clinical Sciences
patients receiving cytotoxic drugs in view 4. Mohile, S., et al., Perspectives from the Blå Stråket 5
of an increased risk of myelosuppression in Cancer and Aging Research Group: Caring Sahlgrenska University Hospital
for the vulnerable older patient with cancer
the older age group. 413 45 Göteborg, Sweden
and their caregivers during the COVID-19
crisis in the United States. J Geriatr Oncol,
Adjuvant chemotherapy can be delayed Dr. Nicolò Matteo Luca Battisti
2020. 11(5): p. 753-760.
within the accepted timing for each tumour Clinical Research Fellow in Medical
5. Mortality and pulmonary complications
type: patients with colorectal or lung in patients undergoing surgery with Oncology
cancer can have their chemotherapy safely perioperative SARS-CoV-2 infection: an Department of Medicine - Breast Unit
[9,10]
postponed for up to 8 weeks and for international cohort study. Lancet, 2020. The Royal Marsden NHS Foundation Trust
those with breast cancer for up to 12 weeks 6. Dearnaley, D., et al., Conventional versus London, United Kingdom
[11] hypofractionated high-dose intensity-
after surgery .
modulated radiotherapy for prostate Anna Mislang, MD, FRACP
cancer: 5-year outcomes of the randomised,
Chronological age alone should not Flinders Centre for Innovation in Cancer
non-inferiority, phase 3
preclude any oncologic treatment in older Flinders Medical Centre
7. CHHiP trial. The Lancet Oncology, 2016.
adults. On the other hand, such decision Bedford Park, South Australia
17(8): p. 1047-1060.
should consider individual circumstances
which are likely to influence their impact
on survival or symptom control, including
life expectancy, comorbidities and
tumour biology, prioritizing the patients’
preferences.
COVID-19 is an emerging and rapidly
evolving condition that warrants
personalised care as suggested by
careful GA and depending on the disease
prevalence together with the penetrance of
the pandemic. SIOG has outlined the urgent
need to protect vulnerable patients and
mitigate the projected negative outcomes
in this age group. This is unlikely to be the
last pandemic that mankind will encounter;
it is therefore imperative that we take this
unique opportunity to learn and design
tailored management for both present and
future use. It should also be acknowledged
that the previously mentioned
recommendations may lead to scattered
implementation, depending on the stage
of the pandemic and the distribution of source: https://www.folio.ca/will-you-be-old-and-unbefriended/
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