Dr. Jean-Pierre Droz
The B.J. Kennedy Award honors ASCO members who have made outstanding contributions to the research, diagnosis, and treatment of cancer in elderly patients and who have brought an understanding of geriatric oncology to fellows and junior faculty. It is named for B.J. Kennedy, MD, one of the leaders in both medical and geriatric oncology in the United States.
Dr. Droz will deliver the lecture and receive the award on June 5. His lecture will focus on the question “Has the Time Come to Develop the Concept of Global Geriatric Oncology?” The ASCO Daily News recently spoke with Dr. Droz about the current and future state of geriatric oncology.
ASCO Daily News: How do you define geriatric oncology? How does the care of older patients differ from younger patients?
Dr. Droz: The official definition of geriatric oncology usually includes all patients older than age 70, but that is not the true reason to define these patients as different. Younger patients tend to be a homogeneous population. They are generally in good health, working, and more or less doing well. Older patients are heterogeneous. They have different comorbidities, progressive dependency, and other variations in health status such as malnutrition, cognitive impairment, or depression.
Daily News: Why is the field of geriatric oncology growing in importance?
Dr. Droz: Cancer is a disease of the elderly, and half of new cancers develop in people age 60 to 70. In Western countries, geriatric oncology is increasing in importance because life expectancy is increasing, and we have a growing population of baby boomers. This is why the International Society of Geriatric Oncology (SIOG) was created 17 years ago, to raise awareness about the need for geriatric oncology expertise, educated health professionals with geriatric oncology principles, and geriatric oncology multidisciplinary teams to treat older patients with cancer. In the future, we will have an increase in elderly patients not only in countries with the highest incomes, but also in countries with the lowest. That is why interest in the cancer burden in elderly patients is growing worldwide.
ASCO Daily News: Why are geriatric assessments important in cancer care?
Dr. Droz: Health status is heterogeneous in elderly patients, and physicians must know each patient’s health status before treatment decisions are made. There are three types of geriatric assessments to measure health status.
First, there is a general, short screening test. In the United States, the Vulnerable Elders Survey (VES-13) is largely the most useful. In Europe, we typically use the G8 questionnaire. These tests can be performed by trained nurses and take less than 5 minutes to complete. The second type is a minimum health status assessment, which looks at a patient’s dependency, daily activities, malnutrition, and comorbidities. The third type is a comprehensive geriatric assessment. These are time-consuming and can take between 2 hours and a day to complete, depending on the different health professionals involved. These assessments may identify geriatric interventions that can help a patient outside of their cancer treatment. For example, you can treat uncontrolled diabetes or enroll the patient on a nutritional program.
ASCO Daily News: How can clinical research be more inclusive of older populations?
Dr. Droz: It has been said for 20 to 25 years that the proportion of elderly patients who are included in clinical trials is very low, between 5% and 10%. The question remains if clinical trial results obtained in younger adults are relevant for the treatment of elderly patients. Therefore, there are two kinds of solutions. The first is to include more elderly patients in clinical trials, while also including younger patients; although, that may render conclusions more difficult to obtain. The other solution is to have specific clinical trials for older patients, but researchers must include some information about health status and geriatric assessments in these trials.
ASCO Daily News: Can you give us some of the highlights of your research in geriatric oncology?
Dr. Droz: My interest in geriatric oncology began in 1995 when I was practicing and researching urologic oncology. That year, I began to develop a geriatric oncology program at my institution and, later, at the French National Cancer Institute and SIOG. My interest lay mainly with the different geriatric assessments, particularly the comprehensive assessments and screening tools such as the G8 questionnaire.
Since then, I have maintained my interest in genitourinary tumors and I have worked on the development of guidelines to treat elderly patients with prostate cancer. I have been involved with the development of three sets of guidelines within SIOG. The most recent set was published this year in European Urology. These guidelines reflect the fact that prostate cancer treatment finally seems to be the same in elderly patients as it is in younger patients. The most important aspect is to screen for health status and to select adapted treatment based on the health status of each patient.
Now that I am retired, I have also been spending time working in Guinea. I have begun to introduce geriatric screening there, particularly the G8 questionnaire. It is interesting to see if these screening tools can be applied in these tropical and low- and middle-income countries. The elderly population in these countries is increasing, and many of these patients have important comorbidities such as hypertension, diabetes, cardiovascular disease, malnutrition, and tropical diseases. They also often have advanced cancers and cancers that are different than in Western countries. The culture in these countries is a bit different and may impair the validity of the health status screening tools we use. That is an interesting aspect of applying geriatric assessments that I am working on at this time.
ASCO Daily News: What additional improvements need to be made in the field of geriatric oncology?
Dr. Droz: The principles of cancer management are the use of different tools, diagnostic approaches, and treatment approaches based on evidence-based medicine. With geriatric oncology, is it possible to apply these rules of disease management considering the heterogeneity of elderly patients? For example, we have published guidelines for prostate cancer in elderly patients, but we have never proven that applying these guidelines is better than not applying them.
Therefore, we do not know exactly the clinical and outcome value of health status screenings and geriatric interventions for elderly patients with cancer. There is a lot of work to do to develop more and better information on evidence-based medicine in geriatric oncology.