Abstract
Simple SummaryThis position paper aims to provide practitioners a proposal for multidisciplinary care planning for older patients with ovarian cancer from the time of suspected diagnosis. The first-line treatment of advanced ovarian cancer involves several interdependent sequences: cytoreductive surgery, (neo)adjuvant chemotherapy and maintenance targeted treatments. In older patients, care planning must be adapted to their geriatric parameters and consider the geriatric impact of each treatment sequence to allow treatment completion. Care planning should be centered on patient motivation and imply multidisciplinarity. Each step of treatment plan should be reconsidered in light of a geriatric assessment and follow-up. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes.In this position paper the Société Francophone d’OncoGériatrie (SOFOG; French-speaking oncogeriatric society), the Société Française de Pharmacie Oncologique (SFPO, French society for oncology pharmacy), the Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO, National Investigators’ Group for Studies in Ovarian and Breast Cancer) and the Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN) propose a multi-disciplinary care planning of ovarian cancer in older patients. The treatment pathway is based on four successive decisional nodes (diagnosis, resectability assessment, operability assessment, adjuvant, and maintenance treatment decision) implying multidisciplinarity and adaptation of the treatment plan according to the patient’s geriatric covariates and her motivation towards treatment. Specific attention must be paid to geriatric intervention, supportive care and pharmaceutical conciliation. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes.
Highlights
Management of advanced ovarian cancer has been progressively standardized over recent decades to the association of an extensive cytoreductive surgery and adjuvant chemotherapy; this allowed overall survival rates to improve, and the median survival exceeds 40 months [1]
Chemotherapy needs to be associated with current standards of supportive care developed in the younger populations and completed with geriatric interventions proposed during the comprehensive geriatric assessment, especially nutritional care, fall prevention and management of social isolation [38]
An additional level of complexity in the treatment discussion has come from the OVHIPEC study that found that hyperthermic intraperitoneal chemotherapy (HIPEC) with thiosulfate for nephroprotection improved survival in first-line initially non-resectable ovarian cancer; surgery-related morbidity and mortality at 30 days were comparable in
Summary
Management of advanced ovarian cancer has been progressively standardized over recent decades to the association of an extensive cytoreductive surgery and adjuvant chemotherapy; this allowed overall survival rates to improve, and the median survival exceeds 40 months [1]. Data for the treatment of older patients are derived from retrospective studies of selected populations [12], subgroup analyses of pivotal randomized trials [13,14], real-life unselected population-based studies [5] and specific clinical trials conducted in older patients, but these seldomly integrate assessment of geriatric covariates These are often small and non-comparative phase II studies, and there is heterogeneity in the geriatric covariates explored. The geriatric oncology community aims to share the objectives of geriatricians that are to avoid under-treatment, over-treatment and bad practices; an additional challenge is to provide older patients with access to therapeutic innovation This position paper aims, in this context of a relatively low level of evidence, to provide practitioners a proposal for multidisciplinary care planning for older patients with ovarian cancer from the time of suspected diagnosis. The patient’s care course is hereafter conceptualized as the succession of several decisional nodes in which the classical risk/benefit ratio is enriched by the adjunct of geriatric assessment and, when data are available, the way such geriatric assessment may modify patients’ treatment schedule
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