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LE MÉDECIN TRAITANT, LE PHARMACIEN
ET
LE CANCÉROLOGUE
Matti S. Aapro
Genolier
Suisse
Quelques idées
pour
NOTRE MAO
Matti S. Aapro
Genolier
Suisse
Conflict of interest
Dr Aapro is/was a consultant for:
•Accord,Amgen, BMS, Celgene, Clinigen, Eisai, Genomic Health, G1,
GSK, Helsinn, Hospira, JnJ, Novartis, Merck, Merck Serono, Pfizer,
Pierre Fabre, Roche, Sandoz, Tesaro, Teva, Vifor
and has received honoraria for lectures at symposia for:
•Accord, Amgen, Bayer Schering, Biocon, Cephalon, Chugai, DRL,
Eisai, Genomic Health, GSK, Helsinn, Hospira, Ipsen, JnJ
OrthoBiotech, Kyowa Hakko Kirin, Merck, Merck Serono, Novartis, Ono
Pharmaceuticals, Pfizer, Pierre Fabre, Roche, Sandoz, Sanofi, Tesaro,
Taiho, Teva, Vifor
Conflict of Interest
for this talk
WWW.SIOG.ORG
No responsibility accepted for
involuntary errors or omissions.
The list may be incomplete, and does not reflect consultancy for
Pharma and Diagnostic Industry, NGOs, Universities, Governmental agencies, and others
RingrazioLaura Biganzoli
Etienne Brain
Robert Coleman
Diana Crivellari
Arti Hurria
Ian Kunkler
Juan Morote
Hans Wildiers
Et tant d’autres
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«Idées«
> Faut-il le dire?…
> Faire, ne pas faire?
> Quelques idées
8
«IDÉES«
> Faut-il le dire?…
> Faire, ne pas faire?
> Quelques idées
9
Pourquoi est-on
administrativement
âgé à 65 ans?
10
Ach, encore les allemands…• Was first put forward, at Bismarck's
behest, in 1881 by Germany's Emperor, Wilhelm I, in a ground-breaking letter to the German Parliament.
• He wrote: ". . .those who are disabled from work by age and invalidity have a well-grounded claim to care from the state."
• Germany initially set age 70 as the retirement age (and Bismarck himself was 74 at the time) and it was not until 1916 that the age was lowered to 65.
• Presently governments worldwide are increasing the age at which one can claim pension benefits…
◼old-age social insurance program in 1889,
◼designed by Germany's Chancellor Otto von Bismarck
Les “vieux” c’est ailleurs...
Figure taken from: United Nations World Population Prospects at http://esa.un.org/unpp/index.asp?panel=2
55
50
45
40
35
30
25
20
15
Year
United States
South Korea
JapanChina
India
Mexico
Pakistan
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Med
ian
ag
e (
years
)
Based on slides Courtesy Prof Lokiec at
FoRoMe 3 mars 2016 Lausanne
Mais les « vieux »
ne le sont pas toujours…
Ursula Andress at age 26 (1962)
Ursula Andress aged 74 (2010)
Based on slides Courtesy Prof Lokiec at
FoRoMe 3 mars 2016 Lausanne
Mais les « vieux »
ne le sont pas toujours…
The challenge? An ageing population,
a decreasing workforce
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Heavy burden on the younger generations to
pay for the welfare system and find ways to care for
elderly
20602010
4 people working for every person over 65
2 people working for every person over 65
Hedberg.A, Hines.P. 2016. Addressing the crisis of tomorrow: the sustainability of European health systems. European Policy Centre. Available at: http://www.epc.eu/documents/uploads/pub_6951_sustainabilityeuropeanhealthsystems.pdf. [Last Accessed: 6.10.2016]
A challenge? Really?:An ageing population,
a decreasing workforce
15
Heavy burden on the younger generations to
pay for the welfare system and find ways to care for
elderly
20602010
4 people working for every person over 65
2 people working for every person over 65
Hedberg.A, Hines.P. 2016. Addressing the crisis of tomorrow: the sustainability of European health systems. European Policy Centre. Available at: http://www.epc.eu/documents/uploads/pub_6951_sustainabilityeuropeanhealthsystems.pdf. [Last Accessed: 6.10.2016]
? ?
La population vieillissante,…grand souci économique
16
Mais en fait,que représente cette courbe?
17
Succès des croisières!
18
19
«Idées«
> Faut-il le dire?…
> Faire, ne pas faire?
> Quelques idées
CET APRÈS MIDI
20
M’enfin, voooooous
voulez tuer MA patiente avec
votre s…ie de chimio??
Elle a 80 ans…
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Life expectancy in senior adults: a large variability reflecting health status variability
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1
4.3
5.8
7.9
10.8
14.2
2.33.2
4.7
6.7
12.4
9.3
1.52.2
3.3
6.7
4.9
0
5
10
15
20
25
70 years 75 years 80 years 85 years 90 years 95 years
Life
exp
ecta
ncy,
yea
rs
Top 25th percentile (FIT seniors)
Lowest 25th percentile (FRAIL seniors)
50th percentile (MEDIAN life expectancy)
Walter LC et al. JAMA 2001, 285, 2750-2756
Domains
Cognition
Comorbidity
Emotional conditions
Function
Geriatric syndromes
Nutrition
Pharmacy
Socioeconomic
conditions
Health status
groups
Ma patiente
a besoin de plusieurs
médicaments
23
Et vous n’allez quand même pas
arrêter ses statines
Images and content are courtesy of Dr. Martine Extermann, Moffitt Cancer Center, 2015.
Number of medications
Copyrig
ht ©
Dave C
overly
TOUJOURS ce JEUDI
25
Le malentendu:
elle est “en forme”, donc tout ira bien
• Fitness does not
mean you can all
do the same
exercise, does
it?
Shown by Audisio, SIOG 2003
27
«Idées«
> Faut-il le dire?…
> Faire, ne pas faire?
> Quelques idées
Some final reflections• Decisions on treatment have to take into consideration the patient’s
quality of life
• Decisions on treatment have to take into consideration her decision
to live longer or to have a better quality of life, perhaps dying earlier
• Chronological age should not be the basis for treatment decisions
• Decisions on treatment never should never be made for economic
reasons
• Individual assessment of each patient is necessary; patient /doctor
communication is key to making the right decision for each patient.
From Roswitha Britz at ECCO 2015
29
MERCIaux patient(e)s
et à leurs médecins et soignants( professionnels et proches )
31
MERCI!
BON MAO!
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