Abstract
Purpose of the study: No information is presently available on cancer incidence and management in the nursing homes in Italy as well as in the other European countries. The aim of this analysis was to provide information on the characteristic of neoplasia and therapeutic approach in 5 nursing homes Methods: The charts of all neoplastic patients admitted in five nursing homes of the Don Carlo Gnocchi Foundation in the Lombardy Region (Palazzolo, Malnate, Girola, Salice, Pessano) from January 2009 to December 2011 were analyzed for tumor type, age, previous antineoplastic treatment, and associated diseases (CIRS) Results: In these Foundation's nursing homes (total 1074 beds), in the Lombardy region, we observed 136 histologically proven cancer cases. The median age was 86.9 years (range 76–101), 23 (17%) were males and 113 (83%) females. Of 136 evaluable cases 104 were frail (77.6%), 11 vulnerable (8.2%) and 19 fit (14.2%). Breast cancer was observed in 31 pts, of whom 5 with metastatic disease and 4 with locally advanced disease. Hormone therapy was administered in all, but none of these cases was treated with chemotherapy. In 24 cases, a colo-rectal cancer had been diagnosed but only 1 had metastatic disease. Prostatic cancer was observed in 19 cases, 6 of whom handled with hormone therapy. Eleven cases of lung cancer were observed, 2 of whommetatastatic. A genito-urinary cancer was observed in 16 cases: 6 with bladder cancer; 2 ureteral cancer, 2 cervical cancer, 3 endometrial, 1 vulvar, 1 ovarian and 1 kidney. Seven skin tumors were noticed: 4 were melanoma and the other squamous skin cancer.We also noticed 4 cases of lymphoma and 3 cases of chronic leukemia, but only one could receive chemotherapy while being in the nursing home. The remaining 23 cases were distributed among gastroesophageal, pancreatic and head and neck cancer. As a whole, 19 cases were in an advanced stage, but for none, with the exception of a case of malignant lymphoma, chemotherapy was considered while being in the nursing home. Concerning the medical approach to the neoplasia in these patients our impression is that chemotherapy was not considered to be feasible because of frailty, while the endocrine therapy with aromatase inhibitors was administered in all cases with locally advanced and metastatic breast cancer and used in cases with prostatic carcinoma, both for the relative easiness in prescription and administration. Conclusion: The majority of elderly pts in these nursing homes were frail, with a female predominance, cancer being quite often only one of the multiple heavy problems. In these pts, a complete diagnostic assessment may not be possible in all instances .Chemotherapy should be planned all the time in cases with chemosensitive neoplasia such as malignant lymphomas, while in the majority of the other cases should not be excluded a priori. Our preliminary experience in treating with chemotherapy in our division of Geriatric Oncology patients coming from the nursing home within the same institution and replacing them again there after chemotherapy is positive.
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