Dr. Matti S. Aapro: Geriatric Oncology is Complex, Requires Multidisciplinary Vision to Advance
Patients with cancer benefit signifi cantly from surgery, radiation, and chemotherapy, yet many senior adults have been traditionally viewed as too frail to cope with these treatment options. Since the late 1980s, Matti S. Aapro, MD, of the Multidisciplinary Oncology Institute, Clinique De Genolier, Switzerland, has been involved in the design and implementation of clinical trials in older patients to address such realities.
He has dedicated his career to confronting the challenges faced every day by those in the geriatric oncology field—heterogeneity of the senior adult population and determination of the best treatment decisions possible, on a case-by-case basis.
For his leadership and dedication to the field, ASCO is pleased to honor Dr. Aapro as the 2012 recipient of the B. J. Kennedy Award and Lecture for Scientifi c Excellence in Geriatric Oncology, which honors individuals who have demonstrated outstanding leadership or who have contributed outstanding scientifi c work of major importance to the field of geriatric oncology. Dr. Aapro will present his lecture, “Geriatric Oncology: Realities and Hopes Around a Patient’s History,” tomorrow, 9:45 AM-11:00 AM, S100bc.
“The reality is that geriatric oncology is a wider and much more complex field, compared with the well-established specialty of pediatric oncology, and will need many more years before reaching maturity,” he wrote in an introductory Journal of Geriatric Oncology (JGO) editorial. 1
“With the global demographic shift towards a more elderly population and continuing advances in cancer treatment, it is imperative that chronologic age alone does not prevent senior adult patients from receiving adequate surgical, radio-oncological, and medical therapy and supportive care in line with best practice.”
To treat older patients with the best possible care, Dr. Aapro hopes for lecture attendees to recognize there are certain obstacles to overcome. He will address the “many prejudices and sad realities of patients with geriatric cancer by following a slightly modified true patient history,” he said in an interview with ASCO Daily News. He will also “remind everyone that evidence is accumulating for treatment tailored to the real status of the patient and to the true nature of the cancer.”
In addition to his current position as dean at the Multidisciplinary Oncology Institute, Switzerland, Dr. Aapro is executive director of the International Society of Geriatric Oncology. He is the founding editor of JGO, has edited several journals focused on the care of older patients with cancer, and is a former member of the Journal of Clinical Oncology Editorial Board.
Dr. Aapro’s current work includes the use of perioperative radiation therapy for breast cancer. “This technique allows us to deliver all the needed radiation to the tumor bed during surgery and decrease the risks of local recurrence to the same extent as classic or modified techniques, which cause the patient to return to the cancer center for several weeks,” he said.
The institute is also continuing its work in supportive care, presently with an observational protocol on the use of biosimilar granulocyte-colony stimulating factor (G-CSF). “Recommendations of several organizations indicate that patients older than 65 are at high risk of febrile neutropenia, and a more liberal preventative use of G-CSF is justified in these patients,” he said.
A Message to Tomorrow’s Geriatric Oncologists
For those entering the field of geriatric oncology, Dr. Aapro’s lecture will offer insight on how the multimodality specialty could be improved. Although many cancer centers throughout the world do have geriatric oncology programs, not all of them address specific issues. According to Dr. Aapro, the main question for radiation therapists is probably related to the socioeconomic constraints found in many countries that make long-term treatments involving daily travel difficult for the elderly. He recommends investigation of potential solutions in this area.
Dr. Aapro encourages surgeons interested in specializing in geriatric oncology with design of better instruments for patient assessment.
“Surgeons must understand—with support from anesthesiologists—what the limits are for older patients, especially in terms of postoperative complications,” he told ASCO Daily News.
For those entering the field of medical oncology, Dr. Aapro suggests examination of “programs with an interest in validating tools that help to use safe, presently available drugs for patients with comorbidities, as well as those that highlight many medications with potential interactions.”
Geriatric oncology is a complex specialty, and since its inception, those in the field have made great strides in learning and discovery. Nevertheless, Dr. Aapro has a clear vision for its future: “We must increase the pace of this learning as the number of elderly patients worldwide is increasing quickly, and these patients deserve the best possible care based on facts, not on extrapolation of data from studies in younger people.”
1. Aapro M. Launching the Journal of Geriatric Oncology: A historical milestone. J Geriatric Oncol. 2010;1:2-3.