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Mailly-Giacchetti L, Lopez-Trabada D, Feldman J, André T, Cohen R. [Safety and efficacy of immune checkpoint inhibitors in elderly patients]. Bull Cancer 2023; 110:1204-1214. [PMID: 37679205 DOI: 10.1016/j.bulcan.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 09/09/2023]
Abstract
Immune checkpoint inhibitors (ICI) are the standard of care for many solid tumors with specific physiopathology mechanisms and adverse events. While the percentage of elderly patients increase from years to years, these patients are underrepresented in clinical trials. Immunosenescence and inflammaging, two main components of the aging of our immune system, and their consequences on the safety and the efficacy are today major focus of clinical research. However, there are still no risk assessment score specific to ICI in elderly patients. In this review we showed the global reassuring data on safety from several retrospective and subgroup analysis, in elderly patients. In summary, impairment of the general state is an independent factor of occurrence of adverse events treatment related whatever the age. Here, we highlight the necessity to use of geriatric evaluation screening test in clinic, the need of specific risk score ICI use in the erdely population and mostly the inclusion of elderly patients in clinical trial to generate specific data.
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Affiliation(s)
| | | | - Judith Feldman
- Department of Geriatry, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Thierry André
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP; SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France
| | - Romain Cohen
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP; SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France.
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2
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Messaoud M, Vercherin P, Chanelière AF, Mottet N. [Geriatric assessment and treatment of nonmetastatic muscle-invasive bladder cancer in patients over 75 years of age. Retrospective and multicentric study of 121 cases]. Prog Urol 2022; 32:419-425. [PMID: 34998681 DOI: 10.1016/j.purol.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 11/04/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of our study was to assess prevalence of geriatric assessment (GA) in patients over 75years with nonmetastatic invasive bladder cancer (MIBC). MATERIAL AND METHODS We performed a retrospective study between 2000 and 2015. We assessed comobidity by Charlson score and ASA score, geriatric assessement (GA) and treatments. RESULTS One hundred and twenty one patients were inclued. Median age was 81 (73-95) at diagnosis. Thirty nine patients (32%) were evaluated by GA, G8 screening tool was performed in 16% of patients. Patients without GA were older (82 vs. 81years) and had less comorbidities (Charlson≥2 à 61% vs. 69%). Seventy-four percent of patients received a curarive therapy: 60% were treated by RC, 9% by chemoradiotherapy, 26% received palliative therapy and 15% were only in observation. CONCLUSION Patients with MIBC over 75years were less evaluated and less treated. Patients in pallative care received mostly observation. Although practices have improved, GA was underused. Care of these patients needs standardization in order to adapt therapeutic to their comorbidities and to treat them with curative intent. LEVEL OF PROOF 4.
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Affiliation(s)
- M Messaoud
- Service d'urologie, hôpital Nord, Centre hospitalo-universitaire de Saint-Étienne, Hôpital Nord, Saint-Priest en Jarez, France.
| | - P Vercherin
- Service de santé publique et information médicale, Hôpital Nord, centre hospitalo-universitaire de Saint-Étienne, hôpital Nord, Saint-Priest en Jarez, France
| | - A-F Chanelière
- Service de gériatrie et gérontologie clinique, Hôpital de la Charité, Centre hospitalo-universitaire de Saint-Étienne, Saint-Étienne, France
| | - N Mottet
- Service d'urologie, hôpital Nord, Centre hospitalo-universitaire de Saint-Étienne, Hôpital Nord, Saint-Priest en Jarez, France
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3
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Helissey C, Geiss R, Baldini C, Noret A, Frelaut M, Rodrigues M, Bringuier M. [Why and how to assess older people with cancer?]. Bull Cancer 2021; 108:513-520. [PMID: 33836861 DOI: 10.1016/j.bulcan.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/22/2020] [Accepted: 01/03/2021] [Indexed: 11/15/2022]
Abstract
The older population accounts for almost 60% of new cancers. Their management is a public health problem and is complex. It raises different questions: Is the patient's prognosis linked to cancer or another pathology? The heterogeneity of this population emphasises the importance of the overall condition assessment, in particular to avoid over-treatment (or under-treatment), and to be able to identify frail or vulnerable elderly patients who are at risk of having more treatment toxicities. Through this article, we will recall the importance of geriatric in-depth evaluation (EGA) by detailing the different factors that impact the therapeutic decision, tolerance to treatments… This EGA is however time-consuming and not all patients can be evaluated. In order to identify the subjects covered by this EGA, screening scales have been developed. Finally, we will develop the place of research in oncogeriatric management.
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Affiliation(s)
- Carole Helissey
- Hôpital militaire Begin, unité de recherche clinique, Saint-69 avenue de Paris, 94160 Saint-Mandé, France.
| | - Romain Geiss
- Hôpital européen Georges-Pompidou, unité d'oncogériatrie, service de gériatrie, 20, rue Leblanc, Paris, France
| | - Capucine Baldini
- Saclay University of Paris, Drug Development Department (DITEP), Gustave Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Aurélien Noret
- Institut Curie, université PSL, département d'Oncologie médicale, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - Maxime Frelaut
- Saclay University of Paris, Drug Development Department (DITEP), Gustave Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Manuel Rodrigues
- Institut Curie, université PSL, département d'Oncologie médicale, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - Michael Bringuier
- Institut Curie, université PSL, département interdisciplinaire de soins de support pour le patient en oncologie (DISSPO) et département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France
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4
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Falandry C, Gouy S. [Epithelial ovarian cancer and elderly patients. Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:238-49. [PMID: 30712964 DOI: 10.1016/j.gofs.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 11/24/2022]
Abstract
In ovarian, tubal and primary peritoneal cancers, older adults have an over-mortality due to more aggressive disease (NP4), surgical and chemotherapy under treatment (NP4) and co-morbidities (NP4). Older age is at higher risk for postoperative morbidity and mortality (NP4). Surgery is more often incomplete in this elderly population (NP4). Older age is a risk factor for lower dose intensity in adjuvant chemotherapy (NP4) and incomplete chemotherapy (NP4). Nevertheless, the benefit of a complete surgery remains identical to that of the younger population (NP2). Preoperative functional assessment identifies patients at risk for postoperative complications (NP4). The perioperative risk depends on three variables, the ASA score, the age and the complexity score of the surgery (NP4). It is recommended to perform cytoreduction surgery in an expert centre (grade C) and on the basis of geriatric expertise analysing functional and physical performance (grade C). The benefit/risk balance of surgery should be assessed on a case-by-case basis for the most at-risk (NP4) populations defined by: (i) age≥80 years, especially if albuminemia≤37g/L; (ii) age≥75 years and FIGO stage IV; (iii) age≥75 years, stage FIGO III and≥1 comorbidity. A comprehensive geriatric assessment is recommended prior to the management of an elderly person with primary ovarian, tubal or peritoneal cancer (grade C). The GVS (Geriatric Vulnerability Score) is used to identify vulnerable elderly patients (NP2). In fit elderly patients, it is recommended to perform intravenous chemotherapy identical to that of younger patients (ie platinum-based dual therapy) (grade B). In vulnerable elderly patients, various adapted chemotherapy regimens have been prospectively evaluated in non-comparative trials, and seem feasible considering specific and nonspecific toxicities: carboplatin monotherapy (NP2), carboplatin AUC2+paclitaxel 60mg/m2 3 weeks/4 (NP2), carboplatin AUC 4-5+paclitaxel 135mg/m2/3 weeks (NP2), carboplatin AUC5/3 weeks+paclitaxel 60mg/m2/week (NP3). In the absence of comparative data, no recommendation can be made in this population. Primary chemotherapy decreases the complexity of the surgical procedure and perioperative morbidity and mortality during interval surgery (NP1). It should be considered after 70 years in cases of comorbidities and/or peritoneal carcinomatosis sufficient for complex initial surgery (NP4).
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Antoine V, Courtial M, de Wazieres B, Di Castri A, Duvjnak S, Geronimi L, Labarias C, Le Guillou C, Martin-Allier A, Matelot D, Moitrelle C, Santoni F, Solinas G, Viala M. [Cognitive decline in geriatric oncology: Trends, evaluation and treatment]. Bull Cancer 2018; 105:720-734. [PMID: 29773225 DOI: 10.1016/j.bulcan.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/13/2018] [Accepted: 04/05/2018] [Indexed: 12/19/2022]
Abstract
Cancer prevalence increases with aging. Prevalent or incident neurocognitive disorders are frequent in geriatric oncology. Cognitive decline associated with cancer increases the risk of under or over-cancer treatment and makes therapeutic decisions complex. In this context, we present tools to optimize cognitive impairment screening, identification of underlying mechanisms and specific treatments. Geriatric specialists intervention can help global care, social services utilization and patient's orientation when ambulatory cares become difficult.
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Affiliation(s)
- V Antoine
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France.
| | - M Courtial
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - B de Wazieres
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - A Di Castri
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - S Duvjnak
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - L Geronimi
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - C Labarias
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - C Le Guillou
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - A Martin-Allier
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - D Matelot
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - C Moitrelle
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - F Santoni
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - G Solinas
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - M Viala
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
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Cholley I, Correas JM, Masson-Lecomte A, Sanchez S, Champy C, Le Guilchet T, Ariane M, Hurel S, Audenet F, Thiounn N, Fontaine E, Mejean A, Timsit MO. [Comparison of operative and oncologic results between partial nephrectomy and radiofrequency ablation for treatment of renal tumors in patients older than 75]. Prog Urol 2018; 28:55-61. [PMID: 29174691 DOI: 10.1016/j.purol.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/14/2017] [Accepted: 10/19/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Elderly patients represent a growing part of our society for who treatment strategy for localized renal tumors has to be chosen knowing iatrogen effects and renal function morbidity. The aim was to analyze oncological and functional results of nephron sparing surgery (PN) versus radiofrequency ablation (RFA). MATERIALS AND METHODS All patients aged more than 75 treated by partial nephrectomy or radiofrequency ablation between 2007 and 2014 in our centre were included. Patient and tumors data were compared and these criteria were analyzed: survival (overall and without recurrence) and loss of renal function (pre- and postoperative MDRD). RESULTS In total, 100 patients were included (26 partial nephrectomies, group 1 and 74 radiofrequency ablation, group 2) with a 32-months medium follow-up. Medium age and tumor size were significantly different (respectively, 78 versus 81 years old, P=0.001, 38mm versus 29mm, P=0.003). Perioperative results showed no differences in complications. Transfusion rate and duration of hospital stay were significantly higher in the PN group. Median overall survival were 45 vs. 27 months (P=0.23) for PN and RFA and median recurrence-free survival were 28 vs. 10 months (P=0.34). On a multivariate analysis, operative technique (PN or RFA) were not significantly linked to survival (HR 2.37 [95% CI: 0.66-8.5]), P=0.19. Loss of renal function were 1.5±14mL/min/1.73m2 for PN and 3±14mL/min/1.73m2 for RFA (P=0.69). CONCLUSION Our study showed better perioperative results for RFA than for PN, without significant different survival. Loss of renal function were little and similar. LEVEL OF EVIDENCE 4.
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Sabbagh C, Cosse C, Fournier R, Carola E, Chauffert B, Dumesnil R, Regimbeau JM. [The use of the G8 score for the patient of more than 75years old in digestive surgery for cancer]. Bull Cancer 2016; 103:896-897. [PMID: 27712831 DOI: 10.1016/j.bulcan.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Charles Sabbagh
- CHU d'Amiens-Picardie, service de chirurgie digestive, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, chemin du Thil, 80000 Amiens, France; UPJV, unité Inserm U 1088, chemin du Thil, 80000 Amiens, France; Unité de recherche clinique Ikebana, 80054 Amiens, France
| | - Cyril Cosse
- CHU d'Amiens-Picardie, service de chirurgie digestive, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; UPJV, unité Inserm U 1088, chemin du Thil, 80000 Amiens, France; Unité de recherche clinique Ikebana, 80054 Amiens, France
| | - Roxana Fournier
- CHU d'Amiens-Picardie, service de gériatrie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France
| | - Elisabeth Carola
- Groupe hospitalier public du Sud-de-L'Oise, 4, avenue Paul-Rouge, 60300 Senlis, France
| | - Bruno Chauffert
- CHU d'Amiens-Picardie, service d'oncologie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France
| | - Romain Dumesnil
- CHU d'Amiens-Picardie, service de chirurgie digestive, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France
| | - Jean-Marc Regimbeau
- CHU d'Amiens-Picardie, service de chirurgie digestive, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, chemin du Thil, 80000 Amiens, France; Unité de recherche clinique Ikebana, 80054 Amiens, France; UPJV, unité Inserm EA 4294, chemin du Thil, 80000 Amiens, France.
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8
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Liuu E, Caillet P, Curé H, Anfasi N, De Decker L, Pamoukdjian F, Canouï-Poitrine F, Soubeyran P, Paillaud E. [Comprehensive geriatric assessment (CGA) in elderly with cancer: For whom?]. Rev Med Interne 2016; 37:480-8. [PMID: 26997159 DOI: 10.1016/j.revmed.2016.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/17/2015] [Accepted: 02/20/2016] [Indexed: 12/27/2022]
Abstract
Scientific societies recommend the implementation of a comprehensive geriatric assessment (CGA) in cancer patients aged 70 and older. The EGA is an interdisciplinary multidimensional diagnostic process seeking to assess the frail older person in order to develop a coordinated plan of treatment and long-term follow-up. Identification of comorbidities and age-induced physiological changes that may increase the risk of anticancer treatment toxicities is essential to better assess the risk-benefit ratio in elderly cancer patients. The systematic implementation of a CGA for each patient is difficult to perform in daily practice. Therefore, it is recommended to screen vulnerable patients who will benefit from a complete CGA. Our work presents the vulnerability screening tools validated by at least two independent studies in a cancer elderly population setting. Among seven screening tools, the G8 and the VES13 are the most effective, and have been validated specifically in older population with cancer. The G8 is recommended by scientific societies and the French National Cancer Institute (INCa) because of its easy implementation in daily clinical practice, its high sensitivity and fair specificity. Although studies are underway to improve its performance, the G8 is currently the simplest tool to routinely identify older cancer patients who should have a complete assessment in geriatric oncology.
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Affiliation(s)
- E Liuu
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France
| | - P Caillet
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France
| | - H Curé
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Medical oncology department, Grenoble university hospital, CS 10127 Grenoble, France
| | - N Anfasi
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - L De Decker
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Department of internal medicine and geriatrics, Nantes university hospital, 44093 Nantes, France
| | - F Pamoukdjian
- Unité de coordination en oncogériatrie, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - F Canouï-Poitrine
- CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Service de santé publique, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - P Soubeyran
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Institut Bergonié, université de Bordeaux, CS 61283 Bordeaux, France
| | - E Paillaud
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France.
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Abstract
Ageing is an individual process. Chronological age does not reflect life expectancy or functional capacity. That is why, in geriatric oncology, the estimation of this capacity is a determining factor. An inter-disciplinary approach is necessary in order to coordinate the different players in the care and optimise the hospitalisation of elderly patients with multiple pathologies, all the more so when they are suffering from cancer.
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Antoine V, de Wazières B, Houédé N. Attentes des professionnels hospitaliers impliqués dans la prise en charge globale en oncogériatrie. Bull Cancer 2015; 102:150-61. [DOI: 10.1016/j.bulcan.2014.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/10/2014] [Indexed: 12/13/2022]
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