SIOG National Representatives SIOG 2013 Reports

AUSTRALIA NR: Christopher Steer Geriatric Oncology in Australia – 2013 2013 has been a big year for geriatric oncology in Australia. The Clinical Oncological Society of Australia (COSA) special interest group has been very busy. We meet every 3 months via teleconference and face-to-face annually in November. Highlights include 1. Concept Development Day: Friday 22nd March 2013, Sydney. This was a day that provided an opportunity for interested clinicians and researchers to present a synopsis of a geriatric oncology clinical study they wished to develop. Researchers from around Australia and New Zealand presented their protocol ideas and received feedback from the group. Attendees included oncologists, nurses, palliative care clinicians, a hematologist, geriatrician and biostatisticians. A number of exciting ideas were discussed and the potential for collaboration was quite exciting. It is envisaged that mature protocols will emerge and hopefully be submitted to funding bodies for assessment. 2. Cancer Forum: Publication date - November 2013 - Geriatric Oncology theme Cancer Forum is the official publication of COSA and Cancer Council Australia. I am the coeditor with and Professor Jane Phillips. The November edition will feature articles from members from the COSA Geriatric Oncology Interest group, other Australian geriatric oncology related professionals and an article co-written by Supriya Mohile and Arti Hurria. This publication is distributed to all COSA members and will be available for access online. (www.cancerforum.org.au) 3. Clinical Oncological Society of Australia (COSA) Annual Scientific Meeting: Tuesday 12th – Thursday 14th November 2013, Adelaide Convention Centre. This is the major event on the group’s calendar in 2013. Adelaide is considered the home of geriatric oncology in Australia and the COSA meeting is the key multidisciplinary meeting in Australia. Nimit Singhal, a geriatric oncology interest group member and the medical oncologist in the geriatric oncology clinic at the Royal Adelaide Hospital has convened a very exciting programme. Geriatric oncology is one of the two major themes for the meeting along with gastrointestinal cancer. Our international speakers Janine Overcash and Harvey Cohen will help provide expert advice and guidance on the subject. We look forward to this with anticipation… it is not too late to register…. Adelaide awaits! 4. Pre COSA Clinical Professional Day Monday November 11th 2013. The day prior to the COSA meeting sees the interest group organizing a practical workshop regarding the implementation of geriatric oncology principles into the oncology clinic in the Australian setting. Janine Overcash and Harvey Cohen will provide international expertise but the aim is to teach local clinicians ways in which they can integrate geriatric oncology principles into the clinic in the most cost effective manner. This should be an intense but highly rewarding day…. It is not too late to attend.

AUSTRIA NR : Reinhard Stauder STATUS QUO

- Chair of the Geriatric Oncology group of the Austrian Society for Haematology and Oncology - Foundation and chair of the Geriatric Oncology group of the Tyrolean working group on clinical oncology

(TAKO) (Tyrol is one of the nine counties of Austria). A compendium on the treatment of elderly cancer patients was presented and released in November 2011 http://www.tako.or.at/files/Geriatrie_v1_2012.pdf.

- Education

o Lecture for medical students „Geriatrische Onkologie“ (Geriatric Oncology) Medical University, Innsbruck o Organisation of and lectures on Geriatric Oncology at the congresses of the Austrian, German and Swiss Societies of Hematology and Oncology

- Membership: Austrian Society for Geriatrics and Gerontology; Working group “Geriatric Oncology” of the German and Austrian Societies for Hematology and Oncology

- Foundation and chair of “Senioren-Krebshilfe” (Senior Cancer Aid) in 2009. Aims are to increase public awareness and to promote lobbying and fundraising to improve prevention, diagnosis, therapy and basic research in elder cancer patients (www.senioren-krebshilfe.at). A program for anemia screening was started.

- ESMO Faculty Member of Educational Committe group Elderly CHALLENGES / FUTURE Only few colleagues in Austria are members of SIOG; a lot of efforts are needed to convince colleagues that geriatric oncology is a discipline on her own. One idea might be to organize a “starter-package” to promote the ideas of SIOG: This starter package could include a DVD including presentations from last SIOG congress, the latest issue of JGO the link to the website of SIOG and an accompanying letter from SIOG president. The starter package should be send to the members of societies in relevant countries (Austria in our case) involved in cancer treatment like surgery, hematology, oncology, radiation therapy… (This idea was suggested three years ago and last year, but we were so far not able to realize it.) BELGIUM NR: Hans Wildiers

- From 2009-2012, our government has financed about 16 projects on implementation of geriatric assessment (mostly local projects but also 1 large project that included more than 3000 older patients in 3 years). Several publications came out of the various projects.

- The Belgian government decided to prolong the financing for the period 2012-15. There were 2 initiatives: o Funding of about 15 new projects, again mostly local but 1 very large projects including 7 of the 8

university hospitals in Belgium, and 13 regional hospitals. This project mainly focuses on implementation of geriatric interventions (based on the findings of the assessment), with close collaboration with geriatric departments. The big study included more than 3000 older patients in 10 months up till now (estimated total number of inclusions around 8000 pts).

o Establishment of a scientific committee, coordinated by Hans Wildiers, with 4 major tasks: � Coordination of the 15 ongoing projects � Make a summary of the projects from the period 2009-12 � Establish guidelines on the use of geriatric assessment and geriatric screening tools and

geriatric interventions, in collaboration with SIOG (3 guidelines are under construction within the SIOG framework)

� In 2015, summarize all the performed projects, and make recommendations for future implementation/reimbursement of geriatric assessment in Belgium

- On 30-11-2013, we will have our 2-yearly symposium on geriatric oncology integrating all the relevant

disciplines (medical oncology, radiotherapy, geriatrics, nursing, surgery). CANADA (English) NR: Shabbir Alibhai This is my third full year as the English national representative for Canada. Unfortunately on the English side there has not been much progress in terms of establishing geriatric oncology clinics, although 2 major cancer centres in Toronto, Canada’s largest city, are interested and in active discussions at various stages about establishing such a clinic.

I have continued to advocate for SIOG and for geriatric oncology in presentations that I have made at geriatric oncology, geriatric medicine, and oncology meetings locally and nationally. In 2013 I attended the Canadian Geriatrics Society annual scientific meeting in Toronto as SIOG’s national representative. I provided mentorship and advice to 3 trainees with possible interest in geriatric oncology. I am in advanced discussions with my local hospital, which is Canada’s cancer hospital, for a geriatric oncology clinic to be established. I look forward to meeting other NR’s at the meeting in a few weeks in Copenhagen. And I hope a North American site hosts an upcoming SIOG meeting so more of us in North America can benefit from the meeting. CANADA (French) NR: Flavia de Angelis 1) List of experts committed with cancer care to senior patients:

- Christine Dionne, Geriatrician, Hôpital de l’Enfant Jesus, Québec, QC - Doreen Wan-Chow-Wah, Geriatrician, Segal Cancer Centre, Jewish General Hospital, Montreal, QC - Flavia De Angelis, Medical Oncologist, Centre Hospitalier de l’Université de Sherbrooke, Hôpital

Charles LeMoyne, Greenfield Park, QC - Francine Gaba Idiamey, Geriatrician, Centre Hospitalier de l’Université de Montréal, Montreal, QC - Jean Archambault, Radiation Oncology, CHU de Québec_ Hotel Dieu de Québec, Québec, QC - Thomas Warkus, Gynecology-oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC

2) Clinical Activities: Dr De Angelis: geriatric oncology consultations represent around 20-30% of my ambulatory practice. Senior patients with “geriatric oncology problems” account for can sometimes represent around 50% off the hospitalized patients, a good part of our hospitalized patients, b but they are not always identified as “geriatric oncology patients”.. . Our hematology-oncology service has a very committed multidisciplinary team composed of nurses, pharmacists, social workers, nutritionists, psychologists (and a neuro-psychologist), occupational therapists, physiotherapists, physiatrist, music therapist, spiritual counsellor, sexologist, phonologist. Our hospital has also a general geriatric multidisciplinary team; a physical re-adaptation unit where some selected oncologic patients can have access to rehabilitation. We have and only one geriatrician that is are available to help us when needed. Dr Wan-Chow-Wah is a geriatrician who completed a fellowship in medical oncology at McGill University. She works with a specialized multidisciplinary team composed of physicians (D. Wan-Chow-Wah, J. Monette, F. Gaba, N. Belkhous, C. Pepe, J. Archambault), nurses (L. Alfonso, F. Strohschein, J. Tebo), occupational therapist, physical therapist, social worker, pharmacist, nutritionist, neuropsychologists, administrative assistants, and clinical administrator. Older patients with an active cancer diagnosis are referred for evaluation of suspected vulnerability to adverse effects of cancer treatment, impaired functional status, impaired mobility, multiple comorbidities, cognitive impairment, and/or polypharmacy. Dr. Francine Gaba is a geriatrician who completed a Geriatric Oncology fellowship at McGill University. She currently practices at Notre-Dame Hospital and remains actively involved in Geriatric Oncology at McGill University both clinically in the outpatient clinic and in research.

Dr Dionne is a geriatrician working in Quebec city. She is setting up a geriatric oncology consultation service at her hospital. Dr Archambault is a radiation oncologist trained in geriatric oncology. He works with Dr. Wan-Chow-Wah’s team and sees geriatric oncology patients in Quebec city. Dr Warkus is a gynecology oncologist working at a university hospital. He has a special interest in the treatment of elderly patients with gynecologic cancer. 3) Oral presentations Dr Gaba

- Congrès de la Société Québécoise de Gériatrie (SQG): Oncogériatrie : Évaluation du patient âgé atteint de cancer (15 novembre 2012)

- Département d’oncologie de l’Hôpital St-Mary: - Optimizing the care of older adults with cancer (6 février 2013)

Dr De Angelis

- « Cancer et vieillissement : faire face à l’incontournable ». Conférence scientifique du Département de Médecine de l’hôpital Charles LeMoyne. Greenfield Park, 3 avril 2013.

- « L’approche du patient âgé en Oncologie ». Longueuil, 13 Février 2013. - « L’oncologie et le vieillissement, perspectives de l’onco-gériatrie ». CSSS Richelieu-Yamaska Hôpital

Honoré-Mercier, 14 Décembre 2012. - “Treating cancer in older patients: the geriatric oncology point of view”. Invited speaker: Sanofi

Canadian Pharmacist Meeting. 26 mai 2012, Montréal, Qc. - “Le vieillissement et l’oncologie: defis du traitement du cancer colorectal chez les patients agés”.

Séance de formation continue CICM. 22 mai 2012, Longueuil, Qc. - “Le vieillissement et l’oncologie: defis en cancer digestif”. Invited speaker: Journée IROC 2012 ,

Université de Sherbrooke. 18 mai 2012, Orford, Qc. - Plenary session: “Geriatric Oncology: What oncologic aspects do geriatricians need to consider”.

Canadian Geraitric Society Meeting. 21 avril 2012, Québec, Qc. - “Head and Neck Cancer in the elderly: State of the Art”. Invited speaker: Scientific meeting of the

Head and Neck Department, Hôpital Genéral de Montreal. 23 Février 2012. - Scientific committee for the symposium: « Moving from rethoric to action : towards an integrated

oncogeriatric approach ». World Cancer Congress 2012, Montréal, Qc. 28 Aout 2012. Dr Wan-Chow-Wah’s team (McGill University) *Presenting author(s) Peer-Reviewed Conference Presentations - International

- *Strohschein,F. J., Schreiber, R. S., & Loiselle, C. G. (2013, June). Capturing processes as they unfold: Use of participant diaries to prospectively explore treatment decision making in a grounded theory study of older adults with colorectal cancer. Oral presentation at the 12th Annual Advances in Qualitative Methods Conference, Edmonton, Canada.

- *Strohschein, F. J., Wan-Chow-Wah, D., Bergman, H., & Loiselle, C. G. (2012, October). Understanding age-related influences on cancer treatment decision making: A review of grounded theory studies. Oral presentation at the Qualitative Health Research Conference, Montreal, Canada.

- *Strohschein, F. J., Wan-Chow-Wah, D., Bergman, H., & Loiselle, C. G. (2012, August). Treatment decision making among older adults with colorectal cancer: Attending to the influence of age. Rapid oral presentation at the UICC World Cancer Congress, Montreal, Canada. [GREAT Award (Conference funding), Ingram School of Nursing, McGill University]

Peer-Reviewed Conference Presentations – National

- *Strohschein, F. J. (2013, June). Cancer treatment decision making among older men and women with colorectal cancer. Poster presentation at the CIHR Canadian Student Health Research Forum/Canadian National Medical Student Research Symposium and CIHR Poster Competition, June 4-6, 2013, Winnipeg, Canada. [Canadian Students Health Research Forum Travel Award (Travel funding), Canadian Institutes of Health Research]

- *Strohschein,F. J., Bergman, H., & Loiselle, C. G. (2013, May). Processes of treatment decision making among older adults with colorectal cancer. Poster presentation at the 4th Annual Scientific Meeting of the Terry Fox Research Institute, May 9-11, 2013, Ottawa, Canada. [Trainee Travel Award (Travel funding), Canadian Institutes of Health Research &Terry Fox Research Institute]

- *Strohschein, F. J., Bergman, H., & Loiselle, C. G. (2012, October). Understanding cancer treatment decision making from the perspective of older adults: Qualitative studies informing person-centered care. Oral presentation at the 41st Annual Scientific and Educational meeting of the Canadian Association on Gerontology, Vancouver, Canada. 2012. [Travel Award (Conference travel funding), Quebec Network for Research on Aging]

- *Strohschein, F. J., Bottorff, J. L., Loiselle, C. G. (April, 2012). Navigating the Grounded Theory Maze: Implications for exploring processes of treatment decision making among older individuals with cancer. Oral presentation at the Annual Meeting of the Canadian Association of Psychosocial Oncology, Vancouver, Canada.

Peer-Reviewed Conference Presentations – Provincial

- *Strohschein, F. J., Loiselle, C. G., & Bergman, H. (2012, October). Processes of treatment decision making among older adults with colorectal cancer. Oral presentation at the 10thAnnual Research Days of the Quebec Network for Research on Aging, October 1-2, 2012, Montreal, Canada.

Peer-Reviewed Conference Presentations – Local

- Wan-Chow-Wah, D., *Mandilaras, V., Monette, J., Alfonso, L., Sourial, N., Gaba, F., Archambault, J., Strohschein, F., Pepe, C. (2012, May). Analysis of the health and functional status of older cancer patients referred to a Geriatric Oncology clinic. Poster presentation at the Combined Annual Research Day of the Health Outcomes Axis with the McGill Division of Geriatrics, Montreal, Canada. [Awarded prize for student poster competition].

Invited – National Conference Symposium

- *Wan-Chow-Wah, D., *Alfonso, L. V., & *Strohschein, F. J. (2012, October). Geriatric oncology: Optimizing the care of older adults with cancer. Lunch Symposium sponsored by SANOFI at the Annual Conference of the Canadian Association of Nurses in Oncology, October 11-14, 2012, Ottawa, Canada.

Invited – Academic Audience

- *Strohschein, F. J. (2013, March). Cancer treatment decision making among older adults with colorectal cancer. Oral presentation to Projet de développement stratique innovant (PDSI) Working Group, Jewish General Hospital, March 21, 2013, Montreal, Canada.

- *Wan-Chow-Wah, D. (2012, November). Geriatric Oncology: Optimizing the care of older adults with cancer. Division of Medical Oncology and Hematology/ Radiation Medicine Program, Princess Margaret Hospital,November 1, 2012, Toronto, Canada.

- *Wan-Chow-Wah, D. (2013, February). Assessment of the older cancer patient. Online interactive course on Geriatric Oncology offered by McGill University’s Centre for Continuing Education (educational grant from Sanofi Canada Inc.).

Invited - Clinical Audience

- *Strohschein, F. J. & *Gaba, F. (2013, February). Optimizing the care of older adults with cancer: The JGH consultation service for senior oncology patients. Oral presentation at Cancer Care Rounds, St. Mary’s Hospital, Montreal, Canada.

4) Education

- Clinical Fellowship in Geriatric Oncology. - Name of Institution: McGill University Health Centre/Jewish General Hospital (McGill University). - Number of fellowship positions: 2 (one year program) - Fellowship Program Director: Dr. Doreen Wan-Chow-Wah - Sherbrooke University Medical oncology and Hematology Residence Programs. Geriatric oncology is

part of the educational curriculum, under the supervision of Dr De Angelis. - Tebo, J. (2013, Jan) Cancer in Older Adults. Cancer Care Nursing Course, Department of Nursing,

Jewish General Hospital - McGill University Preceptorships:

Our geriatric oncology clinic (Consultation service for senior oncology patients) hosted 4 preceptors (between November 2012 and January 2013) 5) Research and ongoing projects Grants

- 2012-2013 A pilot RCT to evaluate the feasibility of a geriatric assessment. Puts M (PI). CIHR. $114,843

- 2012-2013 A systematic review of factors influencing older adults' decision to accept or refuse cancer treatment proposed by their physician. Puts M (PI), Fitch M, Howell D, Krzyzanowska M, Leighl N, Monette J, Wan-Chow-Wah D. CIHR. $51,835

Ongoing projects

- Evaluation of Sexuality and Sexual issues in relation to Gynecological Cancers in the Elderly Population Investigators: Vicky Hadid, Tobi Klein, Sylvie Aubin, Francine Gaba, Nancy Drummond, Joshua Press, Walter Gotlieb, Susie Lau

- Changing patterns of care among the elderly population following the introduction of robotic-assisted surgery in ovarian cancer: A prospective evaluation of QOL and surgical outcomes Susie Lau, Sylvie Aubin, Jeffrey How, Francine Gaba, Doreen Wan Chow Wah, Joshua Press, Zeev Rosberger, Walter Gotlieb

- Impact of robotic surgery on geriatric parameters of elderly patients suffering from a gynecological cancer F. Gaba1,2,3, Y. Wang4, D. Wan-Chow-Wah1,2,3, S. Lau4, J. Monette1,2,3, N. Belkhous1,L. Alfonso1,3, F. Strohschein1,2,3, J. Tebo1,3, A. Chirigiu1 and W. Gotlieb4

- Results of a Comprehensive Geriatric Assessment of Older Cancer Patients Referred to an outpatient geriatric oncology clinic

- Functional disability and presence of frailty markers in older cancer patients referred to a Geriatric Oncology clinic D. Wan-Chow-Wah1,2,3,J. Monette1,2,3,F. Gaba1,2,3,N. Belkhous1,L. Alfonso1,3, F. Strohschein1,2,3, J. Tebo1,3, A. Chirigiu1, and MTE Puts4

- Étude de phase I-II dans le cancer de l’oropharynx avancé dans la population d’âge avancé par une

réduction des volumes de traitement de radiothérapie administrée par une modulation d’intensité avec une chimiothérapie concomitante. Docteur Phuc Félix Nguyen-Tan (Chercheur principal) et al

- Consultation Service for Senior Oncology Patients (CSSOP) – Development of Patient Satisfaction Survey As an interprofessional team, with the active involvement of a patient representative, we have worked with the Patient Satisfaction Program Coordinator at the Jewish General Hospital, Paula Calestagne, to design a patient satisfaction questionnaire to administer to our patients and their family members. We are currently validating the English and French versions, and look forward to beginning distribution within the next few weeks.

- Consultation Service for Senior Oncology Patients - Development of patient/family information brochure Patients and family members coming to the Consultation Service for Senior Oncology Patients are often unsure of what to expect after referral. They often have questions during their first visit about why they have been referred and the services/care we offer. The goal of this project is to design and distribute an informational brochure, which provides this information in a clear, tangible way. This brochure includes: our mission, a list of our team members, an overview of what we do in the clinic and the types of concerns that we address, a summary of what to expect when referred to the clinic, and clinic contact information to answer any further questions. This brochure is in the final stages of development, and we look forward to beginning distribution in the next 1-2 months.

- Processes of Cancer Treatment Decision Making Among Older Men and Women with Colorectal Cancer. Doctoral Dissertation Project, Student: Fay. J. Strohschein, Ingram School of Nursing, McGill University; Supervisors: Dr. Carmen G. Loiselle; Dr. Howard Bergman Current Funding: Research Grant Fay J. Strohschein Co-Investigators: Carmen G. Loiselle, Howard Bergman, Rita S. Schreiber, Joan L. Botorff. Oncology Nursing Foundation Research Grant. Period of Grant: January 15, 2013 to January 15, 2015. Amount: $24,212 Awards Doctoral Training Award for Applicants with a Professional Degree (2011 – 2013), Fonds de recherché du Québec - Santé (1st year - $38 132, 2nd year $39 323) Fellowship (2009 – 2014), Psychosocial Oncology Research Training Program, funded by the Canadian Institutes of Health Research – Strategic Training Initiative in Health Research ($22 000 + conference/internship travel funding)

- Experiences of adults with cancer and comorbidities treated at an ambulatory cancer clinic with regards to coordination/continuity of care and access to health care Master’s Clinical Research Project. Student: Kia Duthie, Ingram School of Nursing, McGill University, Supervisors: Dr. Carmen G. Loiselle, Ms. Fay J. Strohschein

6) Publications

- V. Mandilaras, D. Wan-Chow-Wah, J. Monette, F. Gaba, M. Monette, L. Alfonso. The impact of cancer therapy on cognition in the elderly. Frontiers in Pharmacology, 2013, vol 4, article 48

- D. Wan-Chow-Wah, V. Mandilaras, J. Monette, L. Alfonso, N. Sourial, F. Gaba, J. Archambault, F. Strohschein, C. Pepe. Analysis of the health and functional status of cancer patients referred to a Geriatric Oncology clinic: An update. J Ger Onc, 2012, vol 3, suppl 1, pS75-S76

- Clausen, C., Strohschein, F. J., Faremo, S., Bateman, D., Posel, N., Fleiszer, D. (2012). Developing an interprofessional care plan for an elderly woman with breast cancer: From multiple voices to a shared vision. Clinical Journal of Oncology Nursing, 16, E18-E25.

- Puts MTE, Hardt J, Monette J, Girre V, Springall E, Alibhai SMH. Use of geriatric assessment for older adults in the oncology setting. A systematic review. Journal of the National Cancer Institute. 2012 Aug 8;104(15):1133-63. doi: 10.1093/jnci/djs285

- Puts M, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H. The fall rate of older community-dwelling cancer patients. Supportive Care in Cancer. 2013 Mar; Vol 21 (3):775-783.

- Mandilaras V, Wan-Chow-Wah D, Monette J, Gaba F, Monette M, Alfonso L. The impact of cancer therapy on cognition in the elderly. Frontiers in Pharmacology of Anti-Cancer Drugs, 19 April 2013 | doi: 10.3389/fphar.2013.00048

- Puts M, Monette J, Sourial N, Girre V, Bergman H, Batist G, Wolfson C and Monette M. The relationship of self-rated health with functional status, toxicity and mortality: results of a prospective pilot study with older newly-diagnosed cancer patients. Journal of Geriatric Oncology. 2013. In Press

7) Challenges In Québec we have a limited number of geriatricians and very few of them have a geriatric oncology expertise. Moreover, very few geriatricians have the available time to see older patients with cancer. Dr De Angelis is the only medical oncologist with geriatric oncology training. Our challenge is to increase awareness of our current work and to promote education by means of specific conferences and courses to medical students and other professionals working with senior patients with cancer. Another challenge is to increase knowledge exchange and collaboration between our different teams in Québec and to increase collaboration between our groups and other groups in Canada. CYPRUS NR: Demetris Papamichael Activities over the last 12 months:

- Update of the recommendations for managing colorectal cancer in older patients; manuscript in preparation. - Publication: Treatment of colorectal cancer in older patients. Audisio RA, Papamichael D. Nat Rev Gastroenterol Hepatol. 2012 Dec;9(12):716-25. doi: 10.1038/nrgastro.2012.196. Epub 2012 Oct 9. Review

FRANCE NR: Sylvie Perrin We are nearly at the end of the second national cancer plane (2009-2013): For the geriatric oncology: It was noted in the intermediary report of the second plane Cancer (04/04/2013): "The deployment of coordination units of oncogeriatric (UCOG) was finalized in late 2012. There are 24 inter UCOG (including 4 oncogeriatrics antennas). This system aims to provide support for elderly patients with

cancer, appropriate to its age and condition of the entire territory. The overseas regions devoid of units will be covered by a metropolitan UCOG. The creation of a federation of UCOG proposed by the Francophone Society of Geriatric should, under the control of the national Institute of Cancer (INCA), good linkages between these units inter-regional level.

For the third national plan cancer (2014-2018): For the geriatric oncology The Findings are: 1. Research

If multidisciplinary research was stimulated, the rate of elderly in trials remains very low. There is also a gap between the development of innovations in the standard population and the elderly population. Personalized care pathway, it is based more on the molecular characterization of the disease, do not take sufficient account of the individual characteristics of the patients in terms of comorbidities and disabilities, frequently found in the elderly. Objective Develop research on elderly patients with cancer Recommendations

- To generate clinical trials and studies of Humanities and Social Sciences ona aelderly patients with cancer by creating specific tenders.

- To benefit the elderly therapeutic innovations. 2. Training and care

There is a lack of geriatric expertise in many cancer treatment centers. The presence of a geriatrician desirable in multidisciplinary meeting used to oncologists in geriatric assessment and help in the selection of proposed treatments. The training of oncology geriatrics assessment should be done as DES, and that should be in parallel, geriatricians are trained in oncology.

Objective Help oncologists to care for patients Recommendations

- Requiring formal training in geriatric assessment in teaching of oncology and hematology for medical students.

- To enable medical oncologists, radiation oncologists and hematologists, oncologists access to a training geriatrics during their DES.

- Recommend mention the results of the geriatric assessment during the presentation in case of RCP elderly

In the last French national congress of SOFOG (In PARIS 18, 19, 20 of September 2013): About 300 people were there. The subjects were about innovations and the actuality in geriatric oncology. Nearly all the UCOG were represented. Since 2012 all the 24 UCOG are federated to work together to reach the goals of their missions financed by the INCA.

GREECE NR: Dimitrios Kardamakis

HELLENIC SOCIETY OF GERIATRIC ONCOLOGY ESTABLISHED IN 2004

MAIN EDUCATIONAL ACTIVITIES IN 2012

Athens International Symposium: Advances and perspectives in Geriatric Oncology Organized by HeSMO, Greece, and H. Lee Moffitt Cancer Center, Tampa, USA Under the auspices of the Hellenic Society of Geriatric Oncology 17 – 18 February 2012, Athens, Greece MAIN EDUCATIONAL ACTIVITIES IN 2013

6th National Symposium on Geriatric Oncology Organized by the Hellenic Society of Geriatric Oncology 7-8 December 2013, Athens, Greece

IRELAND NR: Anita O’Donovan Research The results of an Expert Consensus panel on Geriatric Assessment in Oncology will be presented at this year’s conference, and is the culmination of a six month research project, involving many experts in the field, as well as Irish stakeholders. This study will be the first of its kind in Ireland, and it is hoped that inclusion of relevant Oncology stakeholders will open the channels of communication with regard to treatment of older patients with cancer in Ireland and facilitate development of geriatric oncology in Ireland, as it remains relatively underdeveloped to date. Given the demographic changes predicted for the older Irish population, this is important. Irish society is getting older. Our population of over 65s is expected to rise significantly over the next 30 years in a phenomenon termed the “silver tsunami”. (1) In 2001 the total population of over 65s was 436,400 people. Estimates predict that by 2021 this could rise as high as 728,600(2). The National Clinical Programme for Older People (NCPOP) predicts that the percentage of over 65s in the total Irish population will increase from 11.4% to 18% in the next three decades(3). The National Clinical Programme for Older People works towards developing comprehensive, integrated and patient focused services for older people.(4). A 2012 NCPOP report highlighted the need for use of comprehensive geriatric assessments within Irish hospitals. A national study on cancer treatment in older patients is currently being investigated by the National Cancer Registry. TReat - Treatment Receipt in Elderly women diagnosed with cancer – (See more at: http://www.ncri.ie/research/projects/treat-treatment-receipt-elderly-women-diagnosed-cancer#sthash.RGBA56Iy.dpuf) The project is investigating the reasons for the low rates of cancer-related treatment in older women in Ireland, using a mixed methods approach. The study has focussed on three cancers – colon, breast and ovarian – and will involve three phases: (1) survey of clinicians involved in cancer care; (2) in-depth semi-structured interviews with consultants and nurses; (3) in-depth semi-structured interviews with patients. The rich data generated by the project will through light on the views, preferences and treatment-related decision making in older and younger patients; and clinicians' attitudes towards, and practices regarding, treatment of older and younger patients. Data collection and analysis is complete and papers are in preparation. A recent study by a colleague of mine, Suzanne Cahill et al (2012) highlighted the need for a major review of care for people with dementia in the acute hospital setting in Ireland. The review highlighted suboptimal staff training for general hospital staff in the recognition of dementia and in the provision of dementia-friendly care in the acute hospital setting. Inadequate staff training was also highlighted by a recent UK National Institute for Health Research (NHS) study on the ‘Care of Older People with Cognitive Impairment in General Hospitals’. This has implications for Oncology also. Another aspect of my current research is looking at the training, competence and confidence of junior doctors, working in Oncology, in cognitive assessment of elderly

patients, as well as the ability to recognise dementia and delirium. It is anticipated that the result of this study will be available by the next update for SIOG. Working in the academic setting, it has come to my attention that students have mixed attitudes towards older patients. To further investigate this, I am supervising two student projects about knowledge and attitudes towards older patients in both the medical and radiation therapy setting. The results of one of these Every educational institution, profession and country should examine these aspects to ensure competence in providing training and education for professionals in the field of medicine. Professional Activity The Trinity College Dublin Centre for Research in Ageing, Trinity EngAGE, is having its official launch on March 7th in Trinity College. The Committee has been active for almost a year in promoting interdisciplinary ageing research. I represent the interests of geriatric oncology on this committee, which is led by Professor Rose Anne Kenny, a prominent researcher and geriatrician in Ireland and internationally. Professor Kenny is Principal Investigator of The Irish Longitudinal Study on Ageing (TILDA), which has published a new report on multiple medication use in adults aged over 50 in Ireland, examining rates of polypharmacy and opportunities for cost savings and improved healthcare. Plans are at an advanced stage of development to put a MSc in Gerontology in place at Trinity College, and to participate in University of Third Age initiatives in the wider community. The Irish Department of Health has launched a National Positive Ageing Strategy which aims to act as a catalyst for action and innovation to promote the health, wellbeing and quality of life of people as they age in Ireland by focusing attention on issues relevant to older people across the policy development and service delivery process (April 2013). The National Positive Ageing Strategy contains; • A Vision Statement • Operating Principles • Four National Goals • Goal-specific Objectives • Cross-cutting Objectives • Priority Action Areas • Implementation and Monitoring Arrangement Central to this report is a commitment to improve access of older people to healthcare services, and combatting ageism, as well as utilising research to inform policy on the care of older Irish people. One of my medical oncology colleagues, Dr Anne Horgan, is currently organising our first national geriatric oncology conference, a positive step forward in the care of older Irish oncology patients. I have offered Anne some support from the SIOG perspective, and will ensure that SIOG will be actively promoted as part of the process and conference proceedings. The Irish Gerontological Association will host the IAGG conference in Dublin in 2015. The theme for this congress is “Unlocking the Demographic Dividend”. ISRAEL NR: Yakir Rottenberg In the last year, the following acitivities have been carried:

- ISCORT session focused on elderly patients – in the ISCORT (Israel Society of Clinical Oncology and RadioTherapy) which held in January 2013 in Eilat, a special session which focused on the Older Patient With Cancer was conducted. This session include varies of topics which focused on management of elderly cancer

patient (include: pharmacology view, geriatric assessment, life expectancy assessment and surgical assessment).

- Israel Society for Geriatric Medicine annual meeting – which is going to be at January 2014, unique session on oncology issues among elderly patients is going to be held.

ITALY NR: Andrea Luciani Centers where a Geriatric Oncology program is active in Italy:

- Lazzaro Repetto MD; Sanremo Hospital, Sanremo - Andrea Luciani MD, Paolo Foa MD; S. Paolo Hospital, Milan - Bruno Castagneto MD; San Giacomo Hospital, Novi Ligure - Arnoldi Ermenegildo MD; Papa Giovanni Hospital, Bergamo - Laura Biganzoli MD; Hospital of Prato, Prato - Silvana Leo MD; Vito Fazzi Hospital, Lecce - Vittorina Zagonel MD, Antonella Brunello MD, Cristina Falci MD; Istituto Oncologico Veneto, Padova

During the last year GioGER (Gruppo Italiano di Oncologia Geriatrica) was recomposed. A new website was built (www.gioger.org) and a new directory was elected. Dr Bruno Castagneto is the elected president and Dr Silvana Leo is the secretary. ERIBE is a multicentre GIOGER trial on elderly breast cancer patients elaborated by Silvana Leo currently on-going (see website for more information). Project of the Piedmont region "Percorso del paziente oncologico anziano" The Piedmont working group on Geriatric Oncology has developed a project on the diagnostic-therapeutic pathway on elderly cancer patients. The main unit of this project is the Centro Accoglienza Servizi (CAS) which is a part of all oncological department of the region and is composed of a medical oncologist, a nurse and administrative staff. Al patients are referred to the CAS by general practitioners, specialists or emergency department. All patients with more than 75 years old are evaluated with G8 screening tool. Those screened as fit, ie with a score > 14, are referred to the interdisciplinary group (GIC). Those with a score < 14 are referred to the oncogeriatric outpatients unit (composed of a geriatrician and an oncologist) were a deeper geriatric evaluation is performed. The "frail" patients are sent to the general practitioner or to the Palliative Care Unit (UOCP); while those "unfit" are sent to the GIC for an eventual tailored treatment. ROL (Rete Oncologica Lombarda) is an oncological network active in the Lombardy region. A geriatric oncology working pack was created and directed by Paolo Foa. The panel decided to adopt EORTC minimum dataset. Courses during past year:

- Refresher course on "Percorso di cura e trattamento riabilitativo della paziente operata di tumore alla mammella" in 2 editions (5 April 2013 and 8 November 2013)

- Refresher course "Il percorso diagnostico- terapeutico del paziente oncologico anziano (28 Marzo 2013).

- Practical and theorical course on geriatric oncology: “Valutare un anziano complesso e programmare un trattamento oncologico”, Genova April 18-19 2013.

Meeting: Annual meeting of the “Oncologia Geriatrica salentina” Lecce, 3rd of May 2013. KOREA NR: Jee Hyun Kim Korea is one of the fastest aging country in the whole world, with 11% of total population over 65 in 2010 and this is expected to rise to 38.2% in 2050. Yet, Korea is not prepared for rapid increase in older population and also for cancer in older population. There are very few geriatricians and geriatric oncologists, with scare educational and research activities on cancer in older patients. Fortunately, we are beginning to see some increase in the interest among medical society on the importance of geriatric oncology. Below are some of those early movements towards better cancer care in older patients in Korea. 1. 2012 National R & D Program for Cancer Control - Ministry of Health and Welfare: Grant 1220320 “Discovery and strategy development of core research agenda in Korean elderly cancer patients” (PI: Jee Hyun Kim) : Since the field of geriatric oncology is only beginning in Korea, National Grant to develop core research agenda (Korean version of SIOG 10 research priorities) were proposed and performed (results reported as poster presentation, 2013 SIOG) 1) Analysis of 2009 Korean Health Insurance Review and Assessment Service Data (400,000 out patients and 700,000 in patients) to assess proportion of cancer patients aged 65+, cost of medical care, treatment pattern in 65+ 2) Research trend analysis of Korean medical literature and Pubmed 3) Generation of core research topic in the field of geriatric oncology by interview/survey of clinicians 5 core research questions in Korean geriatric oncology were generated

1. How should we select older patients who can tolerate chemotherapy? – modeling chemotherapy toxicity/survival after chemotherapy in older patients with cancer in Korean patients

2. How can we predict postoperative complications? 3. Development of Korean version of abbreviated CGA for oncology practice 4. Treatment outcome of major cancers in older patients compared to younger in Korea 5. Design of elderly-specific clinical trials in Korea

2. 2013 National R & D Program for Cancer Control - Ministry of Health and Welfare: Grant 1320370 “Foundation research for optimal treatment of Korean older patients with cancer” (PI: Jee Hyun Kim) 3. Birth of Korean Cancer Study Group Geriatric Oncology Working Party With the acceptance of 2012 grant, 5 core research agenda were proposed as 3-year grant, 2013 National R & D Program grant, to perform 5 core research topics. In order to better perform Geriatric Oncology research, Korean Cancer Study Group Geriatric Oncology Working Party was organized in February 2013. Currently, 22 centers are members of Geriatric Oncology Working Party, and 2 multicenter studies are planned to initiate in 4Q, 2013

- Model development for the prediction of toxicity and prognosis in Korean elderly cancer patients receiving chemotherapy: a multicenter prospective study (PI: Jee Hyun Kim)

- Combination vs single agent chemotherapy as 1st line chemotherapy in patients with metastatic and/or recurrent gastric cancer 70 years and older (PI: Insil Choi)

4. Seoul National University Bundang Hospital Designated as “Global Center of Excellence in Clinical Trials for older patients” by Korean Government, November 2013 ~ March 2017, which will work as the hub for education of medical professionals on geriatric oncology/clinical trials for older patients with cancer. Commemorative symposium was held in SNUBH during IAGG 2013 period, and symposium agenda was as below; Multidisciplinary approach towards better care and clinical trials in older patients with cancer – held in Seoul National University Bundang Hospital, 24th June 2013.

During IAGG 2013, Presidential symposium “Integrating geriatric into oncology care: (convener Dr. Martine Extermann)” and Submitted symposium “Bridging the Gap Between Geriatrics and Oncology - Global Efforts Towards Better Care of Older Adults (convener Dr Stuart Lichtman) was held successfully with active discussions among geriatricians and geriatric oncologists. SIOG promotion was shown everywhere in the slides.

MALAYSIA NR: Beena Devi For the year 2013, the following activities are:

- Research: The Study on the feasibility of using Groningen Frailty Index in a busy Oncology clinic is on going.

- The role of IMRT for treating older patients with nasopharyngeal cancer is still recruiting patients. The preliminary results were presented at the Annual Malaysian Oncology Conference in September 2012.

- The role of TKIs in older patients with Lung cancer has been analysed and will be presented at the Annual Malaysian Oncology Conference in November 2013.

- Quantitative study addressing “end of life issues in the older patients” was carried out in collaboration with Lisa Deng who had a Fulbright scholarship from North Carolina University in January to March 2013.

- Educational: Topics related to Geriatric patients are presented at all major conferences in Sarawak. The topic on the care of the elderly is still in infancy stage in Malaysia though there are now more on going educational programmes to increase greater awareness in both professional as well at the community level.

MEXICO NR: Luis Argote Greene The epidemiologic trend is showing a steep increase in the number of malignancy related procedures along with the age in the population. There are more and older surgical patients being operated for diagnostic and curative intent. This year was busy regarding the Early Lung Cancer diagnostic awareness to achieve curative treatment in Mexico. Our goal is to increase the resection rate to 1% per year. At this time it is trending to zero but no adequate data is available. Implementation of multidisciplinary treatment and early referral to curative surgical treatment was implemented for early stage lung cancer. Communication pathways were created and continued work with Geriatric Service was implemented, to accomplish comm pathways. Symposium for GP´s regarding lung cancer screening and treatment (50 attendees) Lung Cancer symposium supported by the National Surgery Academy (300 attendees). Participated in the National Lung Cancer Consensus and implemented guidelines for the treatment of NSCLC in the elderly. Conference “Mesothelioma, the National Experience” with special focus in the elderly population at the Iberoamerican Association for Thoracic Surgery International Meeting, (100 attendees from LATAM and Europe). Web-based Database creation and funding (LMAG), with implementation at a National quaternary referral center (National Institute of Medical Sciences and Nutrition “Salvador Zubirán”.) An early mobilization program was implemented by the thoracic surgery team in 5 private hospitals in two most populated cities in Mexico. Two Thoracic RoWalkers (Handicare) were bought and placed in these cities in Mexico. Early Mobilization training was taken at the Pennsylvania, USA HandiCare headquarthers. A specialized Geriatric Oncologist was trained and now is back in Mexico. Future approaches with her will allow the team approach that will enable better outcomes guided by outcomes research with the new database.

Next year Project will be to strengthen communication lines and multidisciplinary treatment with the Geriatric medical community, as well as increase the awareness of curative and palliative management for the elderly population, with adequate QOL. Efforts to involve the Geriatric Medical Community will be increased and to participate actively in the SIOG. The goal will be to enrol 50 members for next year. NETHERLANDS NR: Johanna Portielje Geriatric Oncology in the Netherlands 2012-2013 Research and Care KWF (Koningin Wilhelmina Fonds= Largest cancer research funding partner in the Netherlands ) has declared "cancer in the elderly" a priority and has started an awareness campaign. In cooperation with Gerionne a Geriatric Oncology Program has been developed. Components of the program in 2013: -Invitational conference on tailored care for elderly patients with cancer (May 2013) -Specific funding of tailored care programs (project call Oktober 2013) -Invitational conference for researchers to discuss future directions and priorities (Oktober 2013) -Foundation of a working party on cancer in the elderly within KWF(March 2013) -Foundation of a clinical research group of hospitals with "onco-geriatric teams" Through these initiatives research on the subject increased: Large number of publications on elderly cancer patients generated from national cancer registration data. Large prospective cohort study on breast cancer has been initiated and on colorectal cancer will be initiated this year. Several groups are prospectively studying the value of GA or screening to predict outcome of different cancer treatments. Several Dutch presentations on ESMO Several theses on Geriatric Oncology have been defended in 2013 Education November2013: 5th National Symposium Geriatric Oncology Cancer in the Elderly is becoming a popular topic on educational conferences. NEW ZEALAND NR: Cristian Hartopeanu Here is an update about the domain of Geriatric Oncology in New Zealand. Myself as a NR and a Geriatrician I work with visited the Adelaide Ger Onc Unit in the beginning of the year to learn from their experience. On return we had a meeting with nurses involved with various MDT's and proposed to them to use a screening geriatric assessment tool for all patients over 75 prior to the discussion through the meetings. The idea being that when such a patient is presented all specialists (surgeons,MO's ,RO's etc.) know who's fit-vulnerable-frail and consider that in the overall decision making process. At the moment we pilot the concept through the Head&Neck MDT given the magnitude of treatments required for those cancers. We have a Registrar showing interest in possibly going for a fellowship in Ger Onc if such thing exist in the English speaking world so he has proper expertise in both Oncology/Geriatrics.

Once returned from the meeting in Copenhagen I intend to prepare a document for the Ministry of Health -through one of its advisory groups- regarding the topic of Ger Onc modelled on the children/youth cancer pathway. While might not sound like much I feel the concept is gaining ground/interest/support. NORWAY NR: Siri Rostoft Kristjansson Activity report from Norway General: Geriatric oncology remains a small field, and we do not have a dedicated organization for geriatric oncology. There are very few examples of organized clinical activity. Educational (MDs): We arranged the first national meeting of geriatric oncology in Gardermoen in March 2012 with support from Amgen. The next meeting is planned in January 2014. Research: We have one ongoing study (RCT studying the effect of GA and intervention in older patients electively operated for colorectal cancer). In 2013 another study looking at GA in chemotherapy patients was initiated. Four centers are recruiting patients. In 2013 a research group based at Oslo University Hospital was initiated. Eight doctors are part of the research group. We will have our first seminar in November 2013. Organized clinical activity: At Diakonhjemmet hospital in Oslo all older patients with newly diagnosed colorectal cancer are referred to a geriatrician for GA and intervention preoperatively. The surgical department organizes this, and they are collaborating with the dep of internal medicine (geriatrics). There has been no activity on the political level/health authorities.

POLAND NR: Agnieszka Jagiello-Gruszfeld From 11.2012 to 10.2013 we implemented in Poland following activities 1. We undertook an effort into involving geriatrics oncology training courses into education and fellowship of internal medicine, geriatric and courses for oncologic nurses. 2. We entered into education of geriatrics oncology for medical students (so far in two medical schools). 3. We implement CGA scale for all the inpatients over 65 qualified into operations in four leading oncological centres in Poland. 4. We started implementing CGA scale for the patients over 70 qualified into chemotherapy treatment. 5. We entered into working on compiling Polish abridgement of the survey involving geriatrics survey of the oncological patients qualified into chemotherapy treatment. 6. We started works on the particular treatment for the elderly patients in emergent program of National Cancer Institute. PORTUGAL

NR: Francisco Luis Pimentel Report from initiatives that can be significant for geriatric oncology promotion Past Activities (2009-2012): 1. Diffusion of SIOG 10 priorities monograph. Between 2011 September and November, a letter was send to

health politic makers (Health ministry, and two co-chairs; directors of 5 sub health Portuguese regions; CEO and Clinical Directors of 3 Portuguese Oncology Institutes. To others Hospitals where there are oncology activity (about 30), a e-mail was send with the same text of the letter, and a pdf of “SIOG 10 priorities monograph”, I ask to the monograph be diffused in the institutions Intranet. To National Medical organizations significant to the practice of oncology the same procedure was done. Unfortunately, only one letter, that was circumstantial and politically correct was received from Health Ministry.

2. Papers in Geriatric Oncology: a. Oliveira A, Ferreira PL, Antunes B, Pimentel FL. OnQol: Electronic device to capture QoL data in

oncology: Difference between patients 65years or older and patients younger than 65years of age. Journal of Geriatric Oncology [Internet]. 2011;2(4):253-8.

b. Silveira AP, Goncalves J, Sequeira T, Ribeiro C, Lopes C, Monteiro E, Pimentel FL. Geriatric oncology: comparing health related quality of lifein head and neack cancer patients. Head Neck Oncol. 2011 Jan 3:3. http://www.headandneckoncology.org/content/3/1/3

3. Conferences concerning geriatric oncology;. a. [Palliative care in the elderly ] (conference) Pimentel F.L. (2011) “Cuidados Paliativos no idoso”.

Apresentado na mesa redonda “Temas actuais de Geriatria”, IX Curso Pós-graduado sobre envelhecimento. HUC Coimbra, 15-16 de Setembro de 2011

4. Congress organizations a. [7th National Congress of Oncology Units - "Geriatric Oncology State of the Art] (Chairman). 7o

Congresso Nacional de Unidades Oncologia – “Oncologia Geriátrica Estado da Arte”, 5 a 7 Novembro, Aveiro. (Presidente), este congresso foi realizado sob os auspícios de sociedades científicas e instituições como a, Societé Européene pour la Oncologie Geriatrique, Sociedade Portuguesa de Oncologia e Universidade de Aveiro. Moderador da Mesa “Terapêuticas de Suporte” no 7o Congresso Nacional de Unidades Oncologia – “Oncologia Geriátrica Estado da Arte”, 5 a 7 Novembro, 2009, Aveiro.

2012 activities: 1. In the syllabus of medicine was made seminars about geriatric oncology, and palliative care in geriatrics, under

training in geriatrics. 2. Conferences / Poster presentation concerning geriatric oncology;

a. [Palliative care in the elderly ] (conference). Pimentel F.L. (2012) “Cuidados paliativos no idoso”, curso pré-congresso Bases Clínicas Geriátricas 22 de Maio de 2012, Vilamoura, no âmbito do 18º Nacional de Medicina Interna e 3º Congresso Ibérico de Medicina Interna.

b. Ana Catarina Pinto, F. Ferreira-Santos, L. Dal Lago, E. de Azambuja, M. Piccart- Gebhart, D. Razavi, F.L. Pimentel. Effects of demographic and clinical factors on the information level of cancer patients attending the day hospital in a cancer centre. MASCC 2012, New York, Abstarct 839. Support Care Cancer (2012) 20 (Suppl 1): S201

2013/14 activities done/planed: 1. Publications planed

a. I had an invitation to write a chapter in a book of Geriatrics, aimed at health professionals Portuguese, and I will do it with the affiliation of national representative of SIOG. The chapter on "Palliative Care in Geriatrics." This chapter shall be sent for editing in June 2013, planed publication 2014. This book also has a chapter about Geriatric Oncology. Publication language: Portuguese.

b. The magazine of the Portuguese Society of Oncology, Seasons specific planned in issue No. 3 of 2013 which is published an article I am writing about Geriatric Oncology (Title: Oncologia geriátrica, uma realidade esquecida. [Geriatric oncology, a forgotten reality.]). The main objective of this paper, among others, is to disclose the 10 recommendations of SIOG. This paper is accepted for publication.

2. Conferences / divulgation

a. The most important Oncology Congress which takes place in Portugal called "Spring Meetings" with the organization got the commitment to be a main session lasting two hours on " Geriatric Oncology ", this will occur in April , 2014. Waiting for confirmation.

b. The Oncology Department of “Barreiros Hospital”, yearly promote the realization of two thematic meetings concerning CCR and Breast cancer. For the next meeting in breast cancer, February 2014, that will be a session concerning breast cancer in elderly women (2 hours, overview from surgery, radiotherapy and medical oncology)

c. In a post graduate course concerning Gerontology, I introduce in the syllabus “Geriatric Oncology for non doctors“, in parallel for general population will be several conferences and this them will be one of that. The organization is made by Portuguese Catholic University. Waiting to schedule the dates.

3. There is no organized service or consultation addressed to the elderly patient oncological in Portugal. In this sense I launched a challenge to three other institutions (through medical oncologists who work there) for us to promote the evaluation of Oncologic geriatric patient. The implement of the project is delayed. Planed to be done another starting in 2014.

ROMANIA NR: Alexandru Calin Grigorescu The first observation that I have to mention in this report is that in Romania the geriatric oncology specialty or sub-specialty does not exist. For that reason all senior adults are treated in the same place with other patients. Medical oncologists don’t collaborate with specialists in geriatrics that sporadically. Like National representative in SIOG for Romania I contacted “Ana Aslan” Institute for Geriatric to establish a collaboration. Thus since 2013 we established the lecturer Gabriel Prada, medical director of geriatric institute, to attend the Annual Conference of the Society for Medical Oncology in Romania (SNOMR), and a representative of SNOMR to attend the Geriatrics National Conference. This collaboration aims to promote the use of specific tests in the assessment of geriatric oncology treatment indication. In addition every SNOMR National Conference will have a presentation on treatment for senior adults. This presentation in 2012 addressed the issue of the treatment of lung cancer in elderly patients. This initiative was adopted and by Regional Institute of Oncology from Iasi (another university center in Romania).

SINGAPORE NR: Ravindran Kanesvaran Geriatric Oncology (GO) Clinical Service and Research at the National Cancer Centre Singapore (NCCS) There is an on-going centralised IRB approved study titled “Development of a clinical-genomic model using Comprehensive Geriatric Assessment (CGA) and identification of genetic factors in elderly cancer patients in Singapore” being conducted at NCCS. Three abstracts were accepted for presentation this year. They are as follow: Poster Presentations 1) Identification of comprehensive geriatric assessment based risk factors for malnutrition in elderly Asian patients with cancer. T Tan, WS Ong, KN Koo, IB Tan, D Poon, R Kanesvaran. ASCO 2013, Chicago. 2) CGA based risk factors for caregiver burden amongst elderly Asian cancer patients. T Rajasekaran, WS Ong, T Tan, KN Koo, D Poon, R Kanesvaran. ESMO 2013, Amsterdam. Oral presentation

1) Do elderly patients benefit from enrolment into phase 1 trials? Tai WM, Lim C, Ahmad A, Ong WS, Choo SP, Lim WT, Tan EH, Kanesvaran R, Tan DS. Scientific Symposium, ASCO 2013, Chicago. The Society of Geriatric Oncology Singapore The Society of Geriatric Oncology Singapore had its annual general meeting on the 15th of May 2013. It was held at the National Cancer Centre Singapore. History of the inception of the society and its objectives were delineated. A new committee was elected. Society activities for the upcoming year were planned. These include organizing a regional GO educational conference in 2014, building up funds, and organizing public service projects. There are plans to engage more geriatricians as well as specialists in other fields who have a special interest in the elderly. Possible collaborations with SIOG and mutual benefit were discussed as well. The financial report and money from the previous year was handed over to the elected treasurer.

SLOVAKIA NR: Maria Wagnerova Educational activities

- Lectures on the most important oncological conferences • Oncological conference, Oct. 2012 and Oct. 2013, Bratislava, Slovak Republic • Oncological conference Dec. 2012 Košice, Slovak Republic • Mediforum Oncological Conference march 2013

- Local educational postgraduate courses (geriatric oncology) • Jun 2012, Jun 2013, Bratislava, Slovak republic

Publications

- Contribution to Slovak Clinical Oncology Comprehensive Book about diagnosis and treatment strategy in LUNG Cancer (chapter about geriatric oncology)

- Textbook about Cardiooncology (chapter about geriatric oncology) - Comprehensive review on geriatric oncology in local medicine journal „Onkologia“ Vol. 5, 2012 in

Slovak language ,Farmakoterapia 2/2013 - Organization Activities - Section of geriatric oncology as part of Slovak oncological society is working continuously - Current number of members 53, unfortunately it has not increased - Preparing the first independent Slovak conference in geriatric oncology (cancelled for low interest of

oncologists and society). - Information from SIOG was introduced to national government and especially to ministry of health (but

the most important information about geriatric oncology personally to ministry of health and for public via media again, however it did not draw the interest).

- We are preparing recommendations for treatment of elderly patients in to national oncology guidelines (according to our plan)

- Education on geriatric oncology we introduce in the curricula for medical education in the years 2009 up to now based on experience from Oncology Institute in Košice and we now as well organize education activity on the postgraduate level too

- We have mentioned the shortage of specialist oncologists/geriatricians to ministry of health once again

Plans

- Incorporate recommendations for treatment of elderly patients into national oncology guidelines - Strengthen cooperation between Czech and Slovak Republic in the field of geriatric oncology. - Organize postgraduate educational course on geriatric oncology with SIOG speakers - Induce the specific position of geriatric oncology in the health care system in our country - Spread geriatric oncology in the curricula for medical and nursing education, both during studies and

post-graduate education for all national institutions again - Recruit our patients into international clinical studies for elderly

Problems

- Public media are not interesting about this topic (geriatric oncology) henceforward - Gathering support for scientific activities from EU and other organizations is very complicated or

impossible - Barriers exists concerning SIOG plan set up Geriatric Oncology Units - Acquisition of new SIOG members is difficult, affected by economic and political instability and this

situation was worse in 2013 worse than before. ----------------------------------------------- Model for organization of geriatric oncology care in Slovakia Background of our National Organization on the field of geriatric oncology in my opinion is possibility and stability of our political and economic situation. It is the head stone our successfully work. We collect by section of geriatric oncology some information about organization of the care of oncology seniors. The situation is not satisfying. So for establishment the future models are necessary: Increase public awareness to the worldwide cancer in the elderly and in our country too.

- -Political (Health ministries, international organizations) - -Medical societies - -Advocacy networks, media, to develop a more positive image of older cancer patients

For this activity health ministry help is needed. Integration of geriatric oncology in the curricula for medical and nursing education, both during studies and post-graduate education. In Slovak Oncology Institute in Bratislava and Košice we integrate geriatric oncology in the curricula for medical education both during studies and post-graduate education.

- Address the shortage of specialist oncologists/geriatricians, - -Develop/support specific training programs - -Increase/develop funding to foster academically oriented specialists able to address the populations not

targeted by traditional oncology studies Specific geriatric-oncology program is only under preparation because we haven’t oncology-geriatric specialist. We propagate the US geriatric-oncology models. Develop interdisciplinary geriatric oncology clinics, especially in academic institutions and comprehensive cancer centres At this time it is in our country impossible. Integrate geriatric evaluation (comorbidity included) into oncology decision-making and guidelines. It is under preparation. We founded a section of geriatric-oncology as part of Slovak Oncological Society with the cooperation of the Slovak Geriatric Society. We currently have 53 members. The Multidimensional Geriatric Evaluation (MGE) is generally recommended but not in use in all department where oncological patients are treated. Performed almost in all Departments, but not in all consecutive cases. Developing multidisciplinary clinics or integrated approaches between oncologists and geriatricians. Cooperation between oncologists and geriatrics in our country is on the developed level.

I think the current score system for vulnerable and frailty patients is possible to use for the evaluation of vulnerability of oncology patients. Increasing the relevance of clinical trials for older patients:

- Requiring large phase III trials to oversample older cancer patients in order reach a meaningful percentage of their cohorts, and to build their analyses to provide results specific and pertinent to this population.

- To recruit some new patients to clinical trials with evaluation of high level of comorbidity or functional impairments is very important, but for as no possible.

- Promoting multidisciplinary basic/translational research on the interface of aging and cancer For this is necessary to receive support for scientific activities from EÚ and other organization The basic points to send me in the description of one or more national or continental models are for as acceptable. USA NR: Vicki Morrison Continued active participation as a member of the Alliance Cancer in the Elderly committee Initiated a sub-project on this committee examining the impact of weight-based dosing on outcome in a CALGB trial of adjuvant chemotherapy in women older than 70 yrs Local and national projects on the impact of Agent Orange exposure on the prognosis of patients with CLL (a disease with a median age approx 70 yrs) - poster on this at the SIOG mtg Grand Rounds and Research Conference at our local site (VAMC, Mpls MN) on topics in cancer in elderly patients Continued communications with VA Central Office on care of elderly patients in the VA medical system