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The 2019 edition of the SIOG Annual Conference took place in Geneva, Switzerland from November 14-16. We would like to thank all participants, faculty members and industry partners for their participation which contributed to the huge success of our conference.

The SIOG 2019 Annual Conference in numbers

  • 420 delegates from 40 countries
  • 15 scientific sessions with a total of 62 talks
  • 61 faculty members from 19 countries
  • 230 abstracts submissions
  • 3’273 tweets from 326 people, 5 671 000 impressions* mentioning #SIOG19 & #SIOG2019.

* Impressions : number of times that users have seen posts containing your hashtag, keyword, url and/or @mention. A single user can deliver multiple impressions.

SIOG 2019 Awards

The SIOG 2019 awards were announced at the SIOG Presidential Session in Geneva. Delegates met to congratulate the winners.
The SIOG 2019 Paul Calabresi award: Marije Hamaker (NL).  Read More
The 2019 BJ Kennedy award for best poster: Ruth Mary Parks (GB) -  The role of the androgen receptor in primary breast cancer in older women. Read her abstract
The SIOG 2019 Nursing & Allied Health investigator award: Rei Ono (JP) - The high impact of preoperative social frailty on overall survival in elderly gastrointestinal cancer patients. Read his abstract
The SIOG 2019 Young investigator award: Isacco Montroni (IT) - Patient-reported outcomes measures (PROMs) in geriatric patients undergoing major surgery for solid cancer: 90-day preliminary report on 643 patients from the geriatric oncology surgical assessment and functional recovery after surgery (GOSAFE) study. Read his abstract

SIOG 2019 Session slides

The session presentations will be available for SIOG members and SIOG 2019 participants. SIOG members will be able to access them by logging in their MySIOG acccount (the presentations will be located under the member news section). SIOG 2019 participants can contact the SIOG Head Office at info@siog.org to obtain the link for the slides.

SIOG 2019 Photos

Selected photos taken during the conference are available here. (Dropbox)

Download

SIOG 2019 Final Programme (pdf)

SIOG 2019 in the media

  is the leading oncology channel committed to improving cancer communication and education with the goal of optimising patient care and outcomes. ecancer's programmes offer the healthcare community a wealth of free resources to support continued professional development. ecancer and SIOG have delivered a series of interviews of SIOG key opinion leaders and conference speakers in Geneva. These interviews will be available shortly.
This service has been kindly supported by unrestricted grants from Janssen Oncology and Sanofi Genzyme.

 

  All abstracts of the 19th Annual Conference of the International Society of Geriatric Oncology were published in a supplement of the Journal of Geriatric Oncology (JGO) - the official journal of SIOG.
  To access the online book, simply click here.


Regional experts, leaders in SDG3 call for action to address cancer in the ageing population.

Aligned with the United Nations’ Sustainable Development Goals, the World Health Organization’s strategic policy goals, and the forthcoming Decade of Healthy Ageing starting in October 2020, International Federation on Ageing (IFA) and the International Society of Geriatric Oncology (SIOG) jointly hosted a meeting at the United Nations in Geneva. The objective was to perform a  multi-stakeholder review on the progress towards achieving UHC 2030 focusing mainly on the development and preparation of health workers for the ageing population with cancer.
Leaders and experts engaged in high-level discussions around cancer control, non-communicable and lifestyle disease programmess and policies that address the elderly or aging population, including the role of research.


Integrating geriatric assessment improves care satisfaction
Giving community oncologists a tailored GA summary with recommendations for each patient - a move aimed at enhancing discussion - significantly increases patient satisfaction with communication about age-related concerns. It also significantly improves satisfaction with overall care when compared with the standard practice of alerting physicians only when patients show depression or cognitive impairment (Supriya Mohile et al. JAMA Oncology, 2019).

Older patients increasingly shut out of trials
In a study which looked at more than three hundred phase 3 trials, Ethan Ludmir et al (JAMA Oncology 2019) found that the age discrepancy between patients enrolled in RCTs and the wider population of cancer patients with common solid tumours is pervasive and has increased over recent years.
The bias towards enrolling younger patients is more evident in trials of targeted agents, in trials in lung cancer, and in studies funded by industry. But previous work has shown major age discrepancies are also present in cooperative group trials.

Study participation brings survival benefit
Lack of generalisability in results is one major problem when trials enroll patients who are appreciably younger than most people with the cancer in question. Another problem is that this practice is unfair on older patients since participation in trials per se is clearly associated with improved survival (Nicholas Zaorsky et al, JNCCN 2019).
This study found that enrolled patients were younger (median 59 vs 65 years) and also more likely to be white and have fewer comorbidities than non-enrolled patients. But analysis that took these baseline differences into account still showed a clear survival advantage from being included in a trial: OS at 5 years was 95.0% vs 90.2%; p<.0001.

Geriatric referral reduces post-op deaths
Elective oncologic surgery patients aged 75 years and older who are co-managed by a geriatric service have significantly lower 90-day post-operative mortality than patients not referred (4.3% vs 9.2%, p < 0.0001), according to a single-institution study reported by Armin Shahrokni et al at ASCO 2019 (abstract 11512).
Referred patients had a pre-op geriatric evaluation and were jointly managed while inpatients. A greater proportion of co-managed patients had physical therapy (80% vs. 64%) and occupational therapy (37% vs. 25%). Co-managed patients stayed a day longer in hospital (7 vs 6 days).
The findings come from a retrospective review of a prospectively maintained database of patients operated on at Memorial Sloan Kettering Cancer Center between 2015 and 2018.

GOSAFE data on function
Many older patients value good functioning as much as they value increased survival. The Geneva conference was told of interim data about functional status after major surgery derived from the multicentre, prospective Geriatric Oncology Surgical Assessment and Functional Recovery (GOSAFE) study.
At ASCO (abstract 11151), Isacco Montroni reported decreased functional capacity at 90 days in 23% of 471 patients (a third of whom were frail at baseline, with a G8 greater than 14). Function was assessed by Activities of Daily Living, Timed Up and Go (TUG) and the MiniCog. On a positive note, though, 29% had improved or maintained function at 90 days; and average quality of life on the EQ-5D index was higher following surgery.

Phone for cognitive status
The Sydney Memory and Aging Study has validated a Telephone Interview for Cognitive Status (TICS) approach to the cost-effective screening of older adults in the community (Adam Bentveltzen et al. J Am Geriatr Soc, 2019). The modified TICS they used performed well in relation to the Mini-Mental State Exam and other neuropsychological measures and could predict development of dementia over the next year.

Reducing the burden of care
Aligning care with patients' priorities is feasible and effective in older adults with multiple chronic conditions, according to a non-randomised trial conducted in primary care practices in Connecticut, USA (Tinetti ME et al. JAMA Intern Med, 2019).  Compared with usual care, care aligned to the health outcome goals and care preferences of patients resulted in a 25% lower score on a treatment burden questionnaire and significantly less use of medication.

The above papers were among those selected by Ravindran Kanesvaran (National Cancer Centre, Singapore) and Marije Hamaker (Utrecht, The Netherlands) in their review of the year.

Expanding horizons
2019 has seen some helpful advances in our understanding of geriatric oncology. It has also seen some important changes at SIOG. The organisation has decided to devote more energy to influencing public policy affecting care of the elderly cancer patient. As Board member Ravindran Kanesvaran put it: it is all very well talking to ourselves, but we also have to convince others.
Secondly, SIOG is enhancing its global engagement.
Both these trends were evident in the regional stakeholders’ consultation held in Manila (the Philippines) in May, in other consultations involving global opinion leaders, and in November’s ground-breaking day of dialogue jointly organized with the International Federation on Ageing (IFA) and hosted at the United Nations in Geneva.

Quick-fire presentations
An innovation at SIOG 2019 was the decision to present more original research but allow each speaker less time in which to do it. Conveying complicated ideas in just three minutes is a big ask, but speakers rose to the challenge.  Among them:

  • Nicole Marie Saur (University of Pennsylvania, USA) reported data on function from a subgroup analysis of 440 older patients having surgery for colorectal cancer who are included in the GOSAFE study. A third of patients had a severe functional decline at 90 days. But two-thirds of patients return to independent living, with partial or complete functional recovery. And surgery improves quality of life, largely due to reductions in pain, anxiety and depression.
  • Penny Mackenzie (University of New South Wales, Australia) has been using registry data to investigate the relationship between age and radiotherapy. While 28% of patients aged under 80 years had at least one course of radiotherapy within a year of diagnosis, the proportion fell to 14% in those aged 80 and over.
  • Gabriele Ribeiro Sena (Recife, Brazil) is developing machine learning algorithms to improve the power of comprehensive geriatric assessment to estimate the risk of early death in elderly cancer patients.
  • Kristian Kirkelund Bentsen (Odense, Denmark) and colleagues have found that combining hand grip strength with the G8 tool increases the power of the latter to predict overall survival in elderly non-small cell lung cancer patients undergoing stereotactic body radiotherapy. Three year OS was 80% in fit patients (G8 and hand grip both normal), 61% in the vulnerable (abnormal on G8 or hand grip), and 38% in the frail (both G8 and hand grip abnormal).

Among other highlights, the many delegates attending Day 2 of the Geneva meeting heard encouraging results on the health economic benefits of geriatric assessment, surprising data on difficulties in predicting chemotherapy toxicity, a lively debate on screening, and an intriguing insight into the survival implications of the androgen receptor.

Oncologists overestimate life expectancy
The value of many interventions depends on patients living long enough to benefit. So it is important to take into account new data reinforcing the evidence that oncologists substantially overestimate the life expectancy of older people with advanced cancer.
In a study presented by Jennifer Lund (University of North Carolina, USA) of 105 patients who actually survived less than six months, oncologists predicted that half would survive for a year. They correctly predicted survival of less than six months in only 10%.
Of 84 patients who survived for 7-12 months, they predicted survival of over a year in almost 70%.
Dr Lund’s data are from a study of 435 patients with a median age of 75 years, half of whom had GI or lung cancers. Stage IV disease was present in 89%.
Oncologists estimated less than six months survival in only 5% and survival of over a year in 72%. In fact, 44% died within 12 months.
Evidence from the study suggests that oncologists’ estimations of life expectancy can be better calibrated through access to information from a geriatric assessment – particularly in relation to impairment on the Mini Nutritional Assessment and the Instrumental Activities of Daily Living.

Geriatric assessment cuts overall costs
A geriatric oncology clinic offering comprehensive assessment is highly cost-effective according to a financial analysis conducted at a university hospital in Toronto. The study covers 91 patients aged 65 or more attending the Princess Margaret Cancer Center in the years 2016-2018.
Almost half a million Canadian dollars were saved by having patients seen by the specialist geriatric oncology service offered by the Older Adults with Cancer Clinic. And that is around 375,000 US dollars.
In a world in which the bottom line is many healthcare administrators’ top concern, these data can be used to build a strong business case for GA screening.
Comprehensive geriatric assessment led to treatment plans being modified in 38% of patients, and in almost all cases the decision was to reduce the intensity of cancer treatment. This resulted in an overall saving of $CAN 860,000.
But geriatric assessments – and any interventions that follow – also involve cost. In total, this amounted to $CAN 390,000.
Hence the overall net saving of around $CAN 470,000. This is more than $CAN 5000 per patient entered into the study.

The bottom line
One example makes the case. A 77 year old man was originally scheduled to have a sigmoid colectomy (at $CAN 33,600) and neoadjuvant radiation ($CAN 11,000). Following GA, it was agreed that he should have palliative radiation only ($CAN 6,000). The cost of him being seen, assessed and followed up by the clinic amounted to $CAN 500.
Savings seen in the Canadian context – where healthcare is essentially universal and government is the single payer -- may not be not necessarily apply to other settings, cautioned Zuhair Alam.
Though the study was conducted during his time in Toronto, Dr Alam is now at the Good Samaritan Hospital, Cincinnati, USA.   

Inflammation informs decisions
Routinely measured inflammatory markers are good independent predictors of all-cause one-year mortality, add to the information provided by clinical factors, and could help decide the most appropriate treatment for individual older patients with cancer.
The markers – CRP and albumin – have prognostic value even in fit elderly patients with a normal G8  who would not routinely be referred to a geriatrician, Nadia Oubaya (Université Paris-Est, Créteil, France) told the meeting.
Dr Oubaya and colleagues applied a number of models to their data. The baseline predictive model included age, sex, tumour site, metastasis, ECOG PS and G8. Adding the Glasgow Prognostic Score, or the modified Glasgow score, or CRP level, or albumin all increased the number of patients who were correctly classified as at risk of death.
But the best performance – which correctly reclassified 14% of patients – was when the CRP/albumin ratio was added to the basic model.
Data derived from three prospective French cohorts of patients with solid tumors. Mean patient age was 78.5; metastatic disease was present in 38%, and 71% had an abnormal G8.
It is thought that the adverse effects of inflammation derive from an abundance of cytokines which increase neovascularisation and so promote tumour growth.

To screen or not to screen: an issue debated
We should not screen people over the age of 70 for breast or colorectal cancer, Shabbir Alibhai (University of Toronto, Canada) told the SIOG annual meeting, in the context of a debate. His case was clear. 

  • There is no randomised controlled trial evidence supporting screening for either tumour in this age group.
  • Retrospective cohort studies used to support screening are confounded by many variables. Most important is the fact that people who choose screening in older age are more health conscious than those who do not and so are inherently likely to fare better.
  • The benefits of screening decrease with age, because of competing causes of death, and the risks increase. With repeated mammography, the likelihood of experiencing a recall due to false positive results – and hence the need for biopsy – accumulates. With colonoscopy, the risk of perforation increases with age.
  • Linking screening to estimated life expectancy is logical but impossibly complex to achieve.

The case in favour
Shabbir Alibhai’s arguments were in response to the case in favour of screening the elderly put forward by Lodovico Balducci (Moffitt Cancer Center, Florida, USA).
He had proposed screening people with at least 5-10 years life expectancy. In the case of colorectal cancer, faecal DNA every 2-3 years was likely to prove the most appropriate technique, with colonoscopy every ten years a reasonable alternative, he suggested. One big plus to extending screening beyond 70 is the reduced rate of non-elective bowel surgery, which is high-risk in older people.
In the case of breast cancer, SEER data from the US showed screening to be associated with a reduced risk of breast cancer and all-cause mortality in women aged 65-85. Two-yearly mammography would be the gold standard. But, since older people see their physician or nurse practitioner fairly regularly, an annual professional physical examination of the breast would also be appropriate, and practical.  

Predicting chemo toxicity: not there yet?
This was also a controversial issue, particularly in the light of a recent study from Sydney, Australia, which showed – contrary to the expectations of many -- that the proportion of chemotherapy patients aged 65 and over actually experiencing severe toxicity did not relate to that predicted by the CARG Toxicity Score (Erin Moth et al. Predicting chemotherapy toxicity in older adults. JGO 2019).
In the CARG low-risk group, 58% of patients experienced severe toxicity. The proportion in the high-risk group was also 58%; and 47% in those with intermediate CARG scores. CARG was no worse – but also no better – than oncologists’ clinical judgment in predicting who among their 126 solid tumour patients would experience toxicity. Essentially, both the CARG tool and oncologists themselves were operating at the level of chance.

Are Australians different?
These results are in stark contrast to those from the development and validation studies of CARG conducted in the USA.
One possibility is that Australians are simply different! Another is that the case mix of patients studied in Sydney and the kind of chemotherapy they received were not the same as in the US studies. Also, the toxicities experienced may not be comparable: as Erin Moth pointed out, if the toxicities are different, so too will be their predictors.
A further question – independent of CARG’s predictive value – is whether patients themselves are interested in the likelihood of grade 3-5 toxicity per se, or more concerned about factors such as whether they will remain capable of living independently.
A positive view of the data from Australia is that we should embrace uncertainty and be prepared to extend supportive care to all our chemotherapy patients, Dr Moth said.

Androgen receptor has prognostic potential
Irrespective of age, women with androgen-receptor positive breast cancer have significantly better breast-cancer specific mortality than those whose tumours are androgen-receptor negative. Regardless of age, AR positivity is significantly associated with smaller tumour size, and lower grade.
Ruth Parks (Nottingham Breast Cancer Research Centre, UK) presented these findings in a poster which won the SIOG 2019 best poster award.  
Nottingham has a large and unique series of 1758 primary breast cancers from women aged 70 and older treated at a single institution and with follow-up extending to 37 years. It was possible to construct good quality tissue microarrays in 509 cases which had already had 24 biomarkers measured. These arrays were stained for the AR.
Data were compared to a similar group of women aged less than 70. There was no difference in AR expression between older and younger women: positivity was seen in 59% of cancers from older women and 63% of tumours from the younger cohort (p=0.065).

Accreditation Statement
The 19th Conference of the International Society of Geriatric Oncology (SIOG 2019), Geneva, Switzerland, 14/11/2019 - 16/11/2019 has abeen accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) with 12 European CME credits (ECMEC®s). Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity.

Through an agreement between the Union Européenne des Médecins Spécialistes and the American Medical Association, physicians may convert EACCME® credits to an equivalent number of AMA PRA Category 1 CreditsTM. Information on the process to convert EACCME® credit to AMA credit can be found at www.ama-assn.org/education/earn-credit-participation-international-activ....

Live educational activities, occurring outside of Canada, recognised by the UEMS-EACCME® for ECMEC®s are deemed to be Accredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.

EACCME® credits
Each participant can only receive the number of credits he/she is entitled to according to his/her actual participation at the event once he/she has completed the feedback form. Cf. criteria 9 and 23 of UEMS 2016.20.

In order to help you issue individual certificates to each participants, please find below the breakdown of ECMEC®s per day:

15.11.2019 - 4.00
16.11.2019 - 8.00

The EACCME® awards ECMEC®s on the basis of 1 ECMEC® for one hour of CME with a maximum of 6 ECMEC®s per day. Cf. Chapter X of UEMS 2016.20.

CME Certificates will be provided after completing the post-event survey. The survey will be sent by e-mail after the conference.

Europe
The EACCME® has signed agreements with the majority of European countries. For a full and updated list of signed agreements in Europe please visit www.eaccme.eu. The countries with which the EACCME® has signed agreements will recognise EACCME® credits. All the other countries may recognise EACCME® credits on a voluntary basis. For these countries you will also need to apply to the central or relevant regional accreditation authority.

USA
The UEMS-EACCME® has had an agreement of mutual recognition of credits with the American Medical Association (AMA) for live educational events and for e-learning materials since the year 2000. The agreement was renewed in 2014 for another 4 years. The issue of territoriality is very important; both organisations are fully responsible for the activities taking place or organised within their remit. The UEMS-EACCME® is the central body for accrediting events in Europe and the AMA is the central body for recognition of CME credits in the USA. E-learning activities need to be certified for credit by the process in place where the CME provider is based, i.e. AMA PRA Category 1 Credit™ for U.S. CME providers and ECMEC® credit for organisations in countries that are represented by the UEMS.

Canada
The UEMS-EACCME® has an agreement of mutual recognition of credits with the Royal College of Physicians and Surgeons of Canada (RCPSC) for live educational events since the year 2011. The issue of territoriality is very important; both organisations are fully responsible for the activities taking place or organised within their remit. The UEMS-EACCME® is the central body for accrediting events in Europe and the RCPSC is the central body for accrediting events in Canada through its accredited providers.

The International Society of Geriatric Oncology would like to thank all sponsors and supporters for their support towards the SIOG 2019 Annual Conference.

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