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Nov. 15, 2018 - News from the Surgical Taskforce

What is the role of the SIOG-surgical task force (STF)?

The surgical task force (STF) is an integral part of the SIOG as is surgery an integral part of treatment of elderly cancer patients with solid malignancies.  The times we are living in will be remembered by healthcare providers for the significant ‘contradictions’ in the medical and surgical care of elderly cancer patients. On one hand it has been documented how chronological age per se does not contraindicate surgical management at any time in life; on the other hand the vast majority of senior cancer patients are routinely undertreated as a consequence of unproven assumptions. This group of cancer patients is likely to receive suboptimal treatment, either under-treatment as well as over-treatment.  The function of the STF is to eliminate the myth that the elderly are not candidates for surgery and this is to be done within the society and to the rest of the world per se. 

The role of the STF inside the International Society of Geriatric Oncology is mainly to establish evidence that could help clinicians in being more aware and proactive about several issues.

There is a poor understanding of cancer in the elderly.  Solid tumors are detrimental at any age as shown for colorectal, breast and pancreatic cancer while surgery is still the number one option to treat solid cancer, above all in senor adults.  When appropriately chosen it could be curative or good palliative procedure. 

A prejudice about life expectancy is usually preventing cancer specialists whether it be medical, surgical, radiation oncologists or geriatricians to offer the best possible treatment. In the USA a 75-year old male in good health has 18 more years in front of him and 10 years at the age of 82[1]. The presence of severe comorbidities shrinks life expectancy to 6 and 2 years respectively, which is still a far longer period when compared to the average overall survival of untreated cancer subtypes.

Even though there is significant education going on among the surgeons there are several among the community who are hesitant to operate on the elderly just because of the chronological age.   Education is the key and there needs to be a valiant effort on the part of the society to show that there is vast available data demonstrating how fit older individuals can successfully undergo most complex invasive procedures with good quality of life outcomes.

The work of the STF began about a decade ago when the PACE study[2] proved that the assessment of frailty in every elderly patients undergoing surgery accurately predicts the operative mortality, morbidity and costs. This was achieved by means of a non-cancer-specific tool (Comprehensive Geriatric Assessment - CGA). In 2014, another STF effort, the PREOP study[3], showed that the complex and time consuming CGA, could be replaced by quick and surgeon-friendly tools like the “Timed Up-and-Go” test and how nutrition has to be optimized to minimize complications. Lately, the STF together with the European Society of Surgical Oncology (ESSO), developed the GOSAFE study[4]. The research was recently opened to serve the purpose of recording data about quality of life and functional recovery of elderly patients undergoing major oncological surgery. The ambitious endpoint of this international prospective registry is to take a real-time-picture of the ultimate outcomes achieved when delivering personalized care to fit, vulnerable and frail cancer patients (including cognitive impairment).

The role of the SIOG-STF is precisely to promote an individualized surgical standard. We realize that personalized treatment does not stand on targeting molecular biomarkers but on putting real-life patients needs as the ultimate goal of our care.

What the SIOG-STF could be in future?

The way the STF is preparing for the future is primarily to implement the network of clinicians that has been proficiently developed during the process of the PACE, the PREOP and the GOSAFE studies. This group of motivated surgeons with a common goal is open to the challenges that older adults with cancer face and focused on organ-specific malignancies.

The STF members are ambassadors not only in the oncological field in general, but in the organ-specific Scientific Societies. Their role is to promote a more rational and personalized treatment of solid cancer in the elderly by collaborating on scientific sessions, guidelines, research studies with the main Scientific Societies (i.e. ESSO, ASCRS, ESCP, SSO). By doing so, the STF members may function as vectors for the knowledge developed by the experience in the SIOG into other scientific groups.

Further research projects by the SIOG-STF, following the GOSAFE, will focus on cancer surgery prehabilitation, biological age predictors, cancer biology in the elderly as few of the fields which requires immediate attention. 

[1] Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making JAMA 2001 Jun;285(21):2750-6

[2]Audisio RA, Pope D, Ramesh HS, Gennari R, van Leeuwen BL, West C, Corsini G, Maffezzini M, Hoekstra HJ, Mobarak D, Bozzetti F, Colledan M, Wildiers H, Stotter A, Capewell A, Marshall E, PACE participants. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study.  Crit Rev OncolHematol. 2008 Feb;65(2):156-6.

[3]Huisman MG, van Leeuwen BL, Ugolini G, Montroni I, Spiliotis J, Stabilini C, de'Liguori Carino N, Farinella E, de Bock GH, Audisio RA. "Timed Up & Go": a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study. PLoS One. 2014 Jan 24;9(1):e86863.

[4]http://www.essoweb.org/news/gosafe-project/ last time checked on 7/18/2018.