1

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?

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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

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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

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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

18

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

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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

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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

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«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

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MERCIaux patient(e)s

et à leurs médecins et soignants( professionnels et proches )

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MERCI!

BON MAO!