Society Of Geriatric Oncology Research Articles

Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology

A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology (SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.

The assessment and management of older cancer patients: A SIOG surgical task force survey on surgeons' attitudes

AimThe Surgical Task Force at SIOG (International Society of Geriatric Oncology) designed this survey to explore the surgical oncologists' approach toward elderly cancer patients. MethodsA web-based survey was sent to all members of ESSO (European Society of Surgical Oncology) and SSO (Society of Surgical Oncology). ResultsTwo hundred and fifty-one surgeons responded (11% response rate) with a main interest on breast (62.1%), colorectal (43%) and hepatobiliary (27.4%) surgery. Almost all surgeons (>90%) offer surgery regardless the patient's age; only 48% consider mandatory a preoperative frailty assessment. The American Society of Anesthesiologists (ASA) score, nutritional and performance status are most frequently used as screening tools; only 6.4% surgeons use Comprehensive Geriatric Assessment (CGA) in daily practice and collaboration with geriatricians is low (36.3%).If proven to be effective, the majority of surgeons (71%) is prepared to pre-habilitate patients for up to 4 weeks before surgery. One in two surgeons would not offer an operation to patients with impaired cognitive status; conversely, one in three would proceed to surgery regardless of the patient's cognitive status, if functional capacity is conserved. Quality of life and functional recovery are regarded as the most important endpoints in onco-geriatric surgery. Large “real life” prospective observational studies and randomized controlled trials are demanded. ConclusionAge is not perceived as a limitation to surgery. Screening for frailty is limited. A thorough CGA is seldom used and collaboration with geriatricians is rather uncommon. There is a need for clinical investigations focusing on pre-habilitation and other strategies to achieve better functional recovery.

Integrating Geriatric Assessment into Decision-Making after Prostatectomy: Adjuvant Radiotherapy, Salvage Radiotherapy, or None?

Despite current advancements in the field, management of older prostate cancer patients still remains a big challenge for Geriatric Oncology. The International Society of Geriatric Oncology (ISGO) has recently updated its recommendations in this area, and these have been widely adopted, notably by the European Association of Urology. This article outlines the principles that should be observed in the management of elderly patients who have recently undergone prostatectomy for malignancy or with a biochemical relapse following prostatectomy. Further therapeutic intervention should not be considered in those patients who are classified as frail in the geriatric assessment. In patients presenting better health conditions, salvage radiotherapy is to be preferred to adjuvant radiotherapy, which is only indicated in certain exceptional cases. Radiotherapy of the operative bed presents a higher risk to the elderly. Additionally, hormone therapy clearly shows higher side effects in older patients and therefore it should not be administered to asymptomatic patients. We propose a decision tree based on the ISGO recommendations, with specific modifications for patients in biochemical relapse.

Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013

Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Europe and worldwide, with the peak incidence in patients >70 years of age. However, as the treatment algorithms for the treatment of patients with CRC become ever more complex, it is clear that a significant percentage of older CRC patients (>70 years) are being less than optimally treated. This document provides a summary of an International Society of Geriatric Oncology (SIOG) task force meeting convened in Paris in 2013 to update the existing expert recommendations for the treatment of older (geriatric) CRC patients published in 2009 and includes overviews of the recent data on epidemiology, geriatric assessment as it relates to surgery and oncology, and the ability of older CRC patients to tolerate surgery, adjuvant chemotherapy, treatment of their metastatic disease including palliative chemotherapy with and without the use of the biologics, and finally the use of adjuvant and palliative radiotherapy in the treatment of older rectal cancer patients. An overview of each area was presented by one of the task force experts and comments invited from other task force members.

Report on the 14th Conference of the International Society of Geriatric Oncology.

14th Conference of the International Society of Geriatric Oncology, Lisbon, Portugal, 23-25 October 2014 The annual international conference of the International Society of Geriatric Oncology gathered about 400 scientists in Lisbon in October 2014. Arti Hurria, President of the Society, opened the meeting and presented recent Globocan data on the development of the number of people newly diagnosed with cancer. From 2012 to the expected figures of 2035 the number of people aged 65 years and older diagnosed with cancer will increase by 108%. All areas of the world are concerned, not only the so called western Countries. Five major tracts covered important areas in the field of Geriatric Oncology: solid tumors; hematological malignancies; new therapies and basic science; nursing, supportive care and geriatric assessment; advocacy and social-economical issues.

WS2-6 - The Role of Siog, International Society of Geriatric Oncology

The International Society of Geriatric Oncology (SIOG) is a multidisciplinary society, including physicians in the fields of oncology and geriatrics, and allied health professionals and has over 1000 members in more than 40 countries around the whole world.MISSION and VISION: The goal of SIOG is to foster the development of health professionals in the field of geriatric oncology, in order to optimize treatment of older adults with cancer.THE SIOG 10 PRIORITIES INITIATIVE: The world population is aging. In developed countries, half of the cancers already occur in patients aged 70 and older, so geriatric oncology is rapidly coming to the foreground of oncology practice. In booming Asian nations, such as South Korea or Japan, the aging trend is particularly striking. In fact, by 2050 the majority of older persons will live in developing countries. As older patients have a very variable health status, the need for proper integration of an oncologic and a geriatric approach has become increasingly important. Incorporating geriatric principles into routine oncology care will serve to optimize the treatment and reduce the functional impairment of older cancer patients and its associated social and personal costs. Given the size of the problem, governmental health agencies, international and local organizations, academic institutions, and the medical community at large will need to identify and primarily target the most pressing issues. Expert input is invaluable in this process, and therefore SIOG decided to build an expert consensus on top priorities within the field of geriatric oncology, based on the input from experts from each world continent.SIOG GUIDELINES (TASK FORCES): Recent areas reviewed are radiation therapy and lung cancer, both published in Annals of Oncology in 2014. Forthcoming publications will be in lymphoma and colorectal cancer.NEXT EDUCATIONAL ACTIVITIES: 14th SIOG Annual Conference in Lisbon, Portugal, October 23-25, 2014.

THE ROLE OF ADJUVANT THERAPY IN OLDER ADULTS WITH LUNG CANCER: CONTROVERSIES AND CHALLENGES

Adjuvant treatment decisions are challenging since benefit for the individual patient cannot be measured immediately, and the decision process is actually a risk calculation. In 2007, the International Society of Geriatric Oncology (SIOG) established evidence-based recommendations for the management of breast cancer in elderly individuals and updated this guideline in 2012. Whole breast radiotherapy after breast conserving surgery, with a boost to the tumor bed, should be considered in all elderly patients since it decreases risk of local relapse. There is no subgroup of fit older patients in whom post-BCS WBRT can be systematically omitted but benefit in terms of overall survival can be very limited in low risk or frail patients. Hypofractionated radiation schedules offer similar local-regional control and adverse effects as standard fractionation regimens. The evidence for partial breast irradiation in older patients is not sufficiently robust to recommend it as standard therapy. Concerning adjuvant hormonal therapy, there is no age-dependent efficacy of tamoxifen or aromatase inhibitors. Efficacy is slightly greater with aromatase inhibitors; however, elderly patients are more vulnerable to toxicity and safety is important in choice of agent. Omission of endocrine therapy is an option for patients with a very low-risk tumour (pT1aN0) or life-threatening comorbidities. The decision to treat with adjuvant chemotherapy should not be age-based. Older patients with node-positive, hormone-negative disease potentially derive the largest benefit. Four cycles of an anthracycline-containing regimen are usually preferred over CMF. Standard AC and CMF chemotherapy are better than single-agent capecitabine. Taxanes are associated with increased toxicity compared with younger women, but can be added to anthracyclines in high-risk healthy elderly patients, or replace anthracyclines to reduce the cardiac risk. Patients with HER2-positive breast cancer, without cardiac disease, should be offered trastuzumab in combination with chemotherapy. Tumor extent, general health status assessed by geriatric evaluation, tumor biology, and patient preference are critically important parameters to include for optimal adjuvant treatment decisions. Disclosure of interest: None declared

Geriatric interventions in older cancer patients: International society of geriatric oncology (siog) recommendations

in geriatrics and oncology. For elderly patients with cancer, its impact is significant in terms of quality of life, morbidity and mortality, nevertheless, it is under-diagnosed and under-treated. Our hypothesis is that certain socio-demographic, clinical and treatmentrelated characteristics are associated with depression during chemotherapy and identification would allow early detection of patients needing specific treatment. Objectives: To identify prognostic factors associated with depressive symptoms among cancer patients aged 70 years and older, during chemotherapy. To assess whether the efficacy and safety of chemotherapy are associated with depression. Methods: A regional prospective multicentre cohort, of cancer patients aged 70 years and older, receiving first-line chemotherapy and a comprehensive geriatric assessment at baseline and before the fourth treatment cycle. Depressive symptoms were measured by the Geriatric Depression Scale (GDS). Prognostic and associated factors were sought using a logistic regression model. The complete case analysis was compared with an analysis after multiple imputation, due to missing data. Results:Among the 344 patientswithGDS at the start of chemotherapy, 260 had a second assessment before the fourth treatment cycle. The prevalence of depressive symptoms at fourth cycle was 45%. Independent predictors of depression were malnutrition (OR =5.1, p=0.014), risk of malnutrition (OR= 1.6, p=0.014) and depressive symptoms at baseline (OR = 6.7, p b0.001). Parameter estimates were similar after multiple imputation. Patients who lived alone had a higher risk of depressive symptoms, but this result was not confirmed after multiple imputation. Effective chemotherapy was associated with a lower risk of depression especially after multiple imputation (OR =0.42, p=0.018). Conclusion: We highlight the prognostic role of depressive symptoms and nutritional status at baseline on the occurrence of subsequent depression during chemotherapy, which has not been identified previously. This can be usefull to identify cancer patients at risk for depression and to start as early as possible specific treatments with demonstrated benefits. The role of chemotherapy on depressive symptoms requires further study.

How we treat early systemic prostate cancer in older men.

With the aging of our population, the prevalence of prostate cancer is anticipated to rise dramatically. Consequently, physicians will be confronted with the challenges of managing prostate cancer and treatment side effects in older men. The maintenance of mobility and functional independence, which are fundamental goals of the aging patient with cancer, should not be overlooked when choosing treatments and their toxicities focused on cancer control. Consistent with the SIOG (International Society of Geriatric Oncology) guidelines, we recommend standard approaches for older patients with prostate cancer who are fit. Vulnerable patients should also receive standard treatment, provided their health status can be maintained with appropriate interventions. Treatment for frail patients should be adapted to their health status and supportive care interventions should be considered. Individualized treatment plans should take into account patient's remaining life-expectancy from coexisting comorbidities and disability, aggressiveness of the prostate cancer, treatment preferences as well as potential adverse effects of treatment.

IS9.12: Updated guidelines of the SIOG (International Society of Geriatric Oncology) for prostate cancer management in senior adult patients

IS9.12: Updated guidelines of the SIOG (International Society of Geriatric Oncology) for prostate cancer management in senior adult patients

International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer.

To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.

Cancer and ageism.

The number of cancer cases being diagnosed is increasing. The single most important risk factor for the development of cancer is ageing. Improvements in cancer care over recent decades are substantial, however improvements in five year survival rates are less pronounced in elderly patients [1]. Do the association of cancer and ageing and the care for elderly cancer patients receive the attention they deserve? In 1999 Laura Hutschins et al. published an analysis of the relative frequency of patients aged 65 years and older included into trials of the South-West-Oncology-Group (SWOG) and compared the data to the relative frequency of persons aged 65 years and older in the general US population. All in all elderly cancer patients are often excluded from clinical trials [2, 3]. Barriers are the in- and exclusion criteria, the referral of elderly patient to centres offering trials compared to younger patients is poorer, and participation offered less frequently, even if a trial is available [4]. Elderly specific trials improve the recruitment of elderly patients [5]. Together with the European Organization for Research and Treatment of Cancer (EORTC) and the America Study Alliance, the International Society of Geriatric Oncology (SIOG) recently suggested strategies to overcome the deficits of clinical research for elderly patients [6]. Clinical research to improve the care of elderly patients is more difficult than for younger ones. Elderly patients suffer more often from multimorbidity with the cancer diagnosis being just one disease among others, they more often face limitations in functional status as well as experiencing a greater incidence of depression, cognitive impairment and social isolation. In addition the aging process is very heterogeneous. Whereas some elderly patients are very fit, others are compromised or frail [7]. This heterogeneous process of aging is well known in geriatric medicine and led to the establishing of a geriatric assessment to describe the patient`s deficits and resources and to develop an individual treatment plan. So far the transfer of geriatric assessment into oncological care could demonstrate that it identifies deficits of patients missed before and that these restrictions are associated with toxicity and reduced quality of life and clinical outcome. Integration of geriatric assessment can result in a modification of the treatment plan [8]. All in all elderly cancer patients deserve a personalized approach to medicine, reflecting the overall health and social situation, to define the individual aims of treatment. Why do they remain so poorly addressed in clinical cancer research? One reason is that clinical research in this group of patients is more difficult than in younger ones, however, should we not address topics just because they are difficult? Another reason is the poor image of geriatric care in general. A Norwegian study asked medical students, general practitioners, and consultants for the image of 26 different specialities of medicine - geriatric medicine was at the bottom line in all three groups. Thus the image of the care for older patients is poor, irrespective of the setting of care (general practice vs. hospital) and the amount of experience in the field (students vs. general practitioners and consultants) [9]. The first step to overcome ageism in cancer care is to accept that the topic has been neglected in the past for many different reasons. The second step is to develop strategies to address the specialised needs of elderly cancer patients and to overcome ageism. The patients deserve these steps. SIOG (http://www.siog.org/) addresses the special situation of elderly cancer patients within its yearly conferences, this years conference will be held in Lisbon October 2014 (http://www.siog.org/index.php?option=com_content&view=article&id=278&Itemid=177), in several publications covering important topics (http://www.siog.org/index.php?option=com_content&view=article&id=246&Itemid=92), in the monthly edition of the Journal of Geriatric Oncology (http://www.geriatriconcology.net/) and among others in videos talks (http://ecancer.org/advanced-search/video.php?_limit=15).

Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology.

Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment.

Development of a simple discriminator for the health status groups proposed by the International Society of Geriatric Oncology and its validation study in elderly Japanese patients with castration-resistant prostate cancer.

e20525 Background: SIOG recommendation is particular to allow various treatment regimens which covers wide range of comorbidities. However, the classifying system of patient comorbidity status is c...

Feasibility of docetaxel-prednisone (DP) in frail elderly (age 75 and older) patients with castration-resistant metastatic prostate cancer (CRMPC): GERICO10-GETUG P03 trial led by Unicancer.

152 Background: Chemotherapy with docetaxel-prednisone (DP) is one of the standard treatment of castration-resistant metastatic prostate cancer (CRMPC). However little is known about feasibility of DP in frail elderly patients seen in daily practice. Methods: Randomized phase II study evaluating prospectively the feasibility of DP administered either q3w (Arm A: 60 mg/m² cycle one then 70 mg/m²) or weekly (Arm B: 35 mg/m² D1 D8 q3w) in patients age 75 or older, assessed through comprehensive geriatric assessment (CGA) and classified according to the International Society of Geriatric Oncology (SIOG) as vulnerable (SIOG group 2) or frail (SIOG group 3). Failure was defined as: (1) stop or delay of chemotherapy more than 2 weeks, (2) need for dose reduction more than 25%, (3) febrile neutropenia or NCI CTC grade 3 non-haematological toxicity (excluding alopecia), and (4) decrease of activities of daily living (ADL) scoring two or more points. The study was based on a Simon’s optimum two-stage design for each group (α = 5%, 1-β = 90 %, p0 = 0.70 and p1 = 0.90). An interim analysis was planned after enrolment of 15 patients per arm, with continuation of the program if at least 12 patients met the feasibility criteria. Results: From December 2010 to August 2012, 21 centers have included 66 CRMPC patients, 45 and 21 in SIOG groups 2 and 3 respectively, based on investigators evaluation. The planned interim analysis primary endpoint is based on group allocation by a steering committee (per-protocol [PP] population). The enrolment in group 3 was prematurely closed on October 2012 after inclusion of 19 PP patients (Arm A/B, n=9/10) on recommendation of a safety committee due to an excess of toxic deaths. In this group, only four patients completed six cycles of DP in each arm. In group 2, the planned interim analysis was performed after inclusion of 30 PP patients (Arm A/B n=15/15): 11 and 10 patients in Arm A and B did not meet the predefined criteria for feasibility (73.3%; 95%CI=[44.9; 92.2] and 66.6%; 95%CI=[38.4; 88.2], respectively, and only nine and seven respectively completed six cycles of DP. Conclusions: Chemotherapy with DP given q3w or weekly is not feasible in CRMPC patients age 75 and older classified in SIOG group 2 and 3, according to our study criteria. Patients age 75 and older shouldn’t be offered DP without a CGA. Clinical trial information: NCT01254513.

Policy statement on multidisciplinary cancer care

BackgroundCancer care is undergoing an important paradigm shift from a disease-focused management to a patient-centred approach, in which increasingly more attention is paid to psychosocial aspects, quality of life, patients’ rights and empowerment and survivorship. In this context, multidisciplinary teams emerge as a practical necessity for optimal coordination among health professionals and clear communication with patients. The European Partnership for Action Against Cancer (EPAAC), an initiative launched by the European Commission in 2009, addressed the multidisciplinary care from a policy perspective in order to define the core elements that all tumour-based multidisciplinary teams (MDTs) should include. To that effect, a working group conference was held in January 2013 within the EPAAC Work Package 7 (on Healthcare) framework. MethodsThe consensus group consisted of high-level representatives from the following European scientific societies, patient associations and stakeholders: European CanCer Organisation (ECCO), European SocieTy for Radiology & Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS),European Cancer Patient Coalition (ECPC), EuropaColon, Europa Donna - The European Breast Cancer Coalition, Association of European Cancer Leagues (ECL), Organisation of European Cancer Institutes (OECI), EUSOMA - European Society of Breast Cancer Specialists, European Hospital and Healthcare Federation (HOPE) and EPAAC Work Packages 5 (Health promotion and prevention), 7, 8 (Research), 9 (Information systems) and 10 (Cancer plans). A background document with a list of 26 core issues drawn from a systematic review of the literature was used to guide the discussion. Five areas related to MDTs were covered: care objectives, organisation, clinical assessment, patients’ rights and empowerment and policy support. Preliminary drafts of the document were widely circulated for consultation and amendments by the working group before final approval. ResultsThe working group unanimously formulated a Policy Statement on Multidisciplinary Cancer Care to define the core elements that should be implemented by all tumour-based MDTs. This document identifies MDTs as the core component in cancer care organisation and sets down the key elements to guide changes across all European health systems. ConclusionMDTs are an essential instrument of effective cancer care policy, and their continued development crucial to providing patients the care they need and deserve. While implementation must remain in local hands, European health systems can still benefit from having a basis for an effective multidisciplinary model of cooperation. This policy statement is intended to serve as a reference for policymakers and healthcare providers who wish to improve the services currently provided to the cancer patients whose lives and well-being depend on their action.

Screening tools for geriatric impairments in older cancer patients: International Society of Geriatric Oncology (SIOG) recommendations

Screening tools for geriatric impairments in older cancer patients: International Society of Geriatric Oncology (SIOG) recommendations

Metastatic castration-resistant prostate cancer. Part 2: helping patients make informed choices and managing treatment side effects

Nursing patients with mCRPC presents considerable challenges to nurses. They need to draw upon a variety of skills to support and care for patients throughout the disease journey. As the majority of patients with mCRPC are elderly, they tend to have co-morbidities and possibly side effects from previous treatment that need consideration. Some patients will present at around 50 years of age and will also have specific, different needs. The majority of patients with mCRPC will have bone metastases that may cause disability and pain. The International Society of Geriatric Oncology (SIOG) has recommended that older men are treated according to health status and not chronological age. So nurses need to understand how to assess patients' status effectively, regardless of their age. This will enable nurses to provide appropriate and effective intervention and to support their patients during treatment for advancing disease. This article reviews the main methods of assessment and the nursing interventions for the common side effects associated with treatment for mCRPC.

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For the past 25 years Stuart M. Lichtman has been actively involved in the treatment of older patients with cancer. He has been an active participant in a number of research organizations, including the Cancer and Leukemia Group B (CALGB) Committee on Pharmacology & Experimental Therapeutics and their Committee on Cancer in the Elderly; the Scientific Advisory Board of the Geriatric Oncology Consortium; the International Society of Geriatric Oncology (SIOG) and its Taskforces on Geriatric Assessment, Renal Dysfunction, Chemotherapy and Gynecologic Oncology and currently on the Board of Directors; and the Elderly Taskforce of the Gynecologic Oncology Group. He was on the Program Committee for the 2005 and 2006 meetings of American Society of Clinical Oncology (ASCO) and led the Patient Care Tract and have been reappointed for 2012-2014 as well as the ASCO Special Interest Group in Geriatric Oncology. In 2008 and 2010 he was a faculty member of the ASCO Educational Session devoted to the pharmacology of chemotherapy and assessment in older patients. He has been a faculty member for the Vail ASCO/AACR Clinical Trials Workshop (2004-2009) and was the Scientific Chair of the 11th International Society of Geriatric Oncology (SIOG) meeting in 2011.

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B.L. van Leeuwen, MD, PhD is a surgeon with the elderly patient as main interest. She was employed by the Dutch Cancer Foundation 2007–2009 as a clinical and research fellow in “cancer in the elderly”. As such she gained valuable working and research experience in Uppsala University Hospital, Sweden, Whiston Hospital in Liverpool and the MD Anderson Cancer Center in Houston, USA. She started work in the University Medical Center Groningen on September 2008 and was rewarded a tenure track fellowship by the University. Since then she has been the primary investigator in several clinical and preclinical studies. Her main research focal points are preoperative screening tools for frailty in elderly patients and the etiology and sequelae of postoperative cognitive dysfunction in elderly patients. She is a member of the board and research taskforce of Gerionne (Geriatric Oncology in the Netherlands) and the surgical taskforce of the International Society of Geriatric Oncology (SIOG). Together with Professor R.A. Audisio (University of Liverpool) she is a co-investigator of an international study investigating the predictive value of several preoperative screening instruments in frail elderly patients.