MONFARDINI Italia longeva...Si tratta di una soluzione inaccettabile che condanna il paziente a un...
Transcript of MONFARDINI Italia longeva...Si tratta di una soluzione inaccettabile che condanna il paziente a un...
LONG-TERM CARE THREEStati Generali dell’Assistenza a lungo termine
Roma, 11 e 12 luglio 2018 Ministero della Salute
Silvio MonfardiniProgramma Oncologia GeriatricaIstituto Palazzolo,Fondazione Don Gnocchi,Milano
IL PAZIENTE ONCOLOGICO E I “LONG SURVIVORS”: BISOGNI INEVASI PER UNA CORRETTA PRESA IN CARICO
Disclosure
Session Chairman at a Meeting sponsored by Cellgene
Giotto. Evil exorcism in Arezzo
Quanti sono gli italiani che vivono dopo una diagnosi di tumore?
*Nel 2017, oltre 3 milioni e trecentomila (3.304.648) gli italiani
che vivono dopouna diagnosi di tumore ( 5,4% della popolazione italiana ,1/19 italiani)
*I NUMERI DEL CANCRO IN ITALIA 2017 AIOM-AIRTUM
Survivorship by Age
• Survivorship includes not just patients in remission but where cancer is a chronic disease
46% of cancer survivors are 70 years and older
Survivorship includes not just patients in remission but where cancer is a chronic disease
Estimated number of personswith a history of cancer from 1971 to 2008, by age group, projected through to the year 2030.
Rowland J. H., and Bellizzi K. M. JCO 2014; 32:2662-2668
©2014 by American Society of Clinical Oncology
2014 prevalence by age, sex, and durationamong cancer survivors age ≥ 65 years
1)Focus on screening for physical impairments (from mild to severe) as they need to be identified and treated
2)refer cancer survivors who have problems amenable to rehabilitation interventions to the appropriate health care
How to improve survivors' physical and psychological outcome?
From Giuseppe Colloca 2018,Treviso advancedcourse of Geriatric Oncology
General Physical Impairments
•Difficulty returning to premorbid activities•Joint pain, diffuse (e.g., arthralgias)•Musculoskeletal pain (e.g., myalgias)•Neuropathic pain•Somatic pain•Visceral pain•Weakness•Fatigue•Deconditioning
And Specific (organ or treatment related in each neoplasia)Physical Impairments
Common amenable Impairments
“medical care that should be integrated throughout the oncology carecontinuum and delivered by trained rehabilitation professionals
to diagnose and treat patients’ physical, psychological and cognitive impairments
to maintain or restore function,in a multidisciplinary approach reduce symptomburden, maximize independence and improve quality of life
Whatis then CancerRehabilitation?
From Giuseppe Colloca 2018,Treviso advanced course of GeriatricOncology
Arco temporale di attuazione della riabilitazione in oncologia
“La riabilitazione deve occuparsi del paziente oncologico per tutto
l’iter della malattia, dalla diagnosi all’intero percorso terapeutico, fino alla fase
ultima della vita “Progetto finanziato dal Ministero Salute -Riabilitazione in oncologia-: dalla diagnosi alle cure palliative,2006. Istituto Nazionale TumoriMilano-FAVO
M.P. Schieroni, M.R. Strada, P. Varese in Libro Bianco sulla
riabilitazioneoncologica
La Riabilitazione Oncologica non è purtroppo stata inclusa nei Lea
“la riabilitazione oncologica continuerà a essere inclusa in modo frammentato all’interno di diverse tipologie riabilitative riferite ad altri gruppi di patologie
Si tratta di una soluzione inaccettabile che condanna il paziente a un percorso riabilitativo discontinuo, frammentato, ma soprattutto parziale,
perché focalizzato esclusivamente sul recupero della funzione fisica lesa dalla malattia e non
sul completo recupero cognitivo, psicologico, sessuale, nutrizionale e sociale
FAVO .Quotidiano Sanita’ 2016
Ministero della salute Quaderno n. 8 del 2011
“La centralità della Persona in riabilitazione: nuovi modelli organizzativi e gestionali”
“un’efficace terapia antitumorale non può prescindere da una precoce presa in carico riabilitativa globale che prevede una completa integrazione con chi si occupa
del piano terapeutico strettamente oncologico e chi si occupa della terapia di supporto e delle cure di
sostegno”
Rehabilitation in older cancerpatients
The rehabilitative program should be tailored to single-out elderly patients after an attentive
evaluation of their needs and the assessment of clinical(impairments for each type of cancer and
comorbidities), psychological and social conditions through a Comprehensive Geriatric Assessment
E Morello,G Giordano,C Falci,S Monfardini. Aging Health 2009
● In elderly cancer survivors an assessment of persistentand coexisting health problems should be carried out
● In this field issues are still open concerning deliveringoptimal post-treatment care
● Dialogue between oncology and geriatric specialistsother than cross-training of clinical researchersshould be encouraged
Rowland J. and Bellizzi K., J ClinOncol.20142014
Unmet needs of old cancer survivors
Follow-up of elderly patients with urogenitalcancers: Evaluation of geriatric care needs and related actions (Supported by the Italian Ministry of Health (RF -2009-1502045 )
(Comparison of a modeled geriatric management to usual care in elderly patients firstly treated urogenital neoplasms )
S.Monfardini1, S.Morlino2, R.Valdagni2, M.Catanzaro3, A.Tafa4, B.Bortolato5, G.Petralia6, E.Bonetto7, E.Villa8, S.Picozzi9, M.C. Locatelli10, G.Galetti1, E.Bianchi11,A.Millul11, Y.Albanese11, C.Panzarino1, F.Gerardi1 and E.Beghi11
Journal of Geriatric Oncology,2017
S.Monfardini1, S.Morlino2, R.Valdagni2, M.Catanzaro3, A.Tafa4, B.Bortolato5, G.Petralia6, E.Bonetto7, E.Villa8, S.Picozzi9, M.C. Locatelli10, G.Galetti1, E.Bianchi11,A.Millul11, Y.Albanese11, C.Panzarino1, F.Gerardi1and E.Beghi11
Results
CGA was performed in 459 pts, >70 years
Prostate cancer : 291 pts (median age 75 y)Bladder cancer :126 (median age 77 y) Kidney cancer :37 (median age 77 y).
Clinical care patterns
• Home & follow-up• Home & caregiver• Home & general
practitioner• Integrated home assistance• Specialist consultation
• Integrated home assistancefor rehabilitation
• Geriatric rehabilitation• General & focused
rehabilitation• Nursing home
Distribution of Fit,Frail,Vulnerable Pts
•prostate ca:40% Fit, 47% Vulner, 13% Frail.
• bladder ca: 21% Fit, 42% Vulner, 37% Frail.
•renal ca: 22% Fit, 43% Vulner, 35% Frail.
Conclusions of this Study•Vulnerable and Frail were over 75% of both renal and bladder cancer pts, and 60% of prostate cancer pts. •During the follow up only a minority of pts was seen by a specialist in case of severe comorbidities. Only few pts with functional deficits received rehabilitation. •A Geriatric consultation was almost unexistent.
An integrated approach also duringthe follow up has to be considered
The U13 conference series of Cancer and Aging Research Group NCI,NIA and the Alliance Clinical Trials in Oncology (2010-2014):
Areas of highest research priorities in Geriatric Oncology
The 3rdrd U13 Conference in 2016 focused on improving the quality of life
and survivorship of older and frail adults with cancer(S.G. Mohile et al,
Cancer 2016)
We need this Orchestra also for older cancersurvivors
GERIATRICONCOLOGY
Primary care
Clinical Oncol. (Surgical,Medical
Oncology, RT)
Epidemiology. Clinical and LaboratoryResearch
Geriatrics, Gerontology
Palliative careSupportive therapy
Rehabilitation, pharmacy, nutrition,
social services
Clinical Oncologists, Geriatricians and other partners
How difficult is it to transfer such specificapproach in the real
world throughout the entire Patient’s Disease
Trajectory?
Bosch, Hieronymus the Ship of Fools
We need to develope dedicated Geriatric OncologyProgrammes (GOP)
• A comprehensive care through a multidisciplinary approach (age-associatedconditions and cancer management) should be provided
• These programmes should take care of the initial diagnostic and therapeuticapproach
• But also provide Survivorship assistance through the management of General and Specific Physical Impairments related to cancer and its treatment as well as of the geriatric-related conditions,
during all the disease trajectory
• S Monfardini et al: Report of a SIOG task force.Crit Rev Oncol/Hematol,2006
CONCLUSIONI• I pazienti oncologici anziani sono la maggior parte dei 3 milioni di
italiani che vivono dopo una diagnosi di tumore ed il loro numero è in aumento
• Le menomazioni legate al cancro ed alla terapia oncologica,comeanche quelle connesse alla eta’dovrebbero essere oggetto dellaRiabilitazione Oncologica e di quella Geriatrica durante tutto l’arcodella malattia( dalla fase iniziale a quella della malattia avanzata)
• E’ necessario pensare per il futuro ad una Valutazione GeriatricaMultidimensionale ed un approccio integrato(Oncologo,Geriatra,Fisiatra,Psicologo,Medico di MedicinaGenerale,ecc)
• Ad oggi molte di queste necessita’ sono inevase ,la prima sfida e’ di ordine culturale:occorre pensare anche per gli Oncologi che ilprocesso di geriatrizzazione della Medicina richiede nuovi tipi di organizzazione :Programmi di Oncologia Geriatrica