October 15, 2020


Geriatric oncology is gaining increasing momentum as a subspecialty ensuring comprehensive care for older adults with cancer. A number of factors need to be considered while managing their unique needs, such as physical and psychological ageing, underlying comorbidities, social and family support, polypharmacy, nutritional problems and cognitive impairment and their life expectancy. These principles play a crucial role in the oncological therapeutic decision-making process. Ideally, a thorough initial evaluation of older patients with cancer should involve a Comprehensive Geriatric Assessment (CGA) i.e., a multi-dimensional diagnostic and therapeutic process evaluating the functional, psychological and nutritional status, comorbidities, medications used, and social support, of the patient. This process has several benefits, including predicting toxicities on anticancer treatments, aiding therapeutic decisions, estimating prognosis, improving quality of life & well-being, reducing the rate of hospital admissions due to treatment side effects and reducing the risk of complications on systemic therapeutic approaches.

Nonetheless, there are several challenges to the implementation of integrated oncogeriatric care in routine practice, mainly owing to the shortage of geriatricians, the lack of training of cancer specialists in the principles of geriatrics, the fact that these assessments are frequently deemed to be time consuming and the prevalence of cancer in the older age group. In most countries there is a significant lack of opportunities for geriatric oncology training. In an online survey conducted amongst 69 medical oncology trainees in the United Kingdom, almost two-thirds of the respondents had not received formal training in geriatric oncology, with only about one-third of them being confident in treating older cancer patients. On the other hand, in the United States dual training in hematology/oncology and geriatrics can be pursued in multiple institutions across the country.

Personal Experience by Dr. Nicolò Matteo Luca Battisti

I completed my medical oncology training in Milan, Italy. Training there was an incredible opportunity as a number of centres of excellence are available and world-renowned experts work in Milan in several disciplines related to cancer and ranging from basic and translational science to clinical research. The National Cancer Institute of Milan is the headquarters of the medical oncology training program there and has an illustrious past, featuring faculty members such as Umberto Veronesi and Gianni Bonadonna, who have significantly contributed to the shaping of medical oncology as a specialty on its own. Nonetheless, opportunities to train in geriatric oncology are still lacking there.

I became interested in the field of geriatric oncology as a medical student while working on a research project included in my medical degree thesis under the supervision of my first mentors Professor Paolo Foa and Dr Andrea Luciani at San Paolo Hospital. They offered me the chance to work on a research project investigating the impact of chemotherapy related fatigue on functional status for older patients with cancer. This experience made me  understand what is meaningful for older individuals with cancer may not always align with standard trial endpoints and realize that there is a large unmet need for this population of patients.

Dr Andrea Luciani has a specialist geriatric oncology clinic at San Paolo Hospital. During my specialist training, I had the opportunity to work with him and to learn the challenges of treating cancer in this specific population and how to adapt their management to their unique needs. In 2014, Professor Foa and Dr Luciani suggested that I could spend the last year of training abroad to get further training in geriatric oncology.

An internship in geriatric oncology can give you the chance to conduct research and improve the care of patients in a highly unmet need area, such as the management of older individuals with cancer. Therefore, this can be an incredibly rewarding experience as you can be confident that you will make a difference and your contribution will count and be meaningful for older adults with cancer. At the same time, I also believe that the value of pursuing an internship is not only to do with your professional career, but most importantly also aids with your personal growth.

In 2013 I attended my first SIOG (International Society of Geriatric Oncology) conference in Copenhagen, Denmark, that I consider as a turning point in my career. I was amazed to find out about SIOG and its role as a leading advocate for older patients with cancer worldwide since 2000. I clearly remember how deeply the meeting scientific program resonated with what I was hoping to learn. There, I also had the opportunity to meet Dr Martine Extermann and Dr Lodovico Balducci, who welcomed me as a Research Visiting Scholar at the Senior Adult Oncology Program (SAOP) of Moffitt Cancer Centre of Tampa, US the following year. Moffitt is one of the first and largest dedicated programs providing excellent and comprehensive care to older adults with cancer in Florida and leading a research program that has shaped the field of geriatric oncology.

Under the supervision of Dr Extermann, I worked on a research project evaluating the external validity of the NCCN and ESMO guidelines for the management of non-small cell lung cancer in older adults, which completely changed how I look at clinical trials design now. I also authored my first book chapter and contributed to other research projects with other scholars. At Moffitt I found a fantastic mentor, Dr Extermann, and an incredibly friendly and compassionate team of physicians, nurses, pharmacists and allied healthcare professionals that have also become dear friends. This is very important when you spend 8 months almost 8,000 km far from home.

When I was training in Milan, I thought I would have never left Italy as I thought I would not have been “brave enough” to leave my home country. However, this opinion changed quickly as soon as my plane landed at Tampa International Airport. Now that I left my country to work in London, UK, this still remains true and I think that I would not be here if it was not for this unique opportunity and the awesome mentors that I met during my training.


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