Prof. Riccardo Audisio, MD: Breast Cancer and the Elderly

Professor Audisio discusses his research involving breast cancer and the elderly. Prof Audisio is the president of the International Society of Geriatric Oncology and he was presented on Sept. 25 with the 2011 ESSO Award for his achievements in geriatric oncology.

The Group Room at the 2011 European Multidisciplinary Cancer Conference was made possible, in part, by:

 

VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International:

This Selma Schimmel at the Multidisciplinary Cancer Congress 2011 at Stockholm. Professor Audisio, this morning here in Stockholm you gave a teaching lecture on breast cancer and the elderly, and the different treatment modalities. So let’s start by asking what age group is actually considered “the elderly” when you’re talking about breast cancer?

Riccardo A. Audisio, MD, FRCS, International Society of Geriatric Oncology, President:

These very much varies according to geographical distribution, and cultural background. I think that 80s is kind of obsolete to revolve around a clear, anagraphic age. I think we need today, we need to accept the idea that we definitely need to talk frailty. Frail individuals not fit for standard treatment entails a careful screening for frailty, and we shall just move one step forward from the 70, 75 years which is the standard age cut that the literature puts.

Selma Schimmel:

There’s this perception that after a certain age you’re too old for cancer treatment. That’s really not so, is it?

Riccardo A. Audisio:

It definitely is not. Again this is a misconception that we have by far past and left behind. There are evidence that older individuals can and should be offered a standard treatment, and tailored treatment is even better option in view of better understanding of their common mobility, associated with medical condition, frailty, in order to optimize the treatment planning.

Selma Schimmel:

Would you be able to give us an example of the significant treatment differences between the elderly and the younger breast cancer patient?

Riccardo A. Audisio:

You need to consider their quality of life that every single individual is facing. Lack of mobility, bound in a wheelchair, would possibly discourage from Tamoxifen and would possibly aromatase inhibitors. On the other hand patient with severe arthritis of the generative bone condition would probably benefit of Tamoxifen rather than aromatase inhibitor. So it’s very much a careful balancing of side effects and advantages.

Selma Schimmel:

So Professor Audisio, we’ve just talked about arthritis. I would imagine patients with issues related to cardiovascular concerns, in that area, that could impact breast cancer treatment.

Riccardo A. Audisio:

For sure, medication that are often utilized might be a risk, and particularly I would like to draw your attention to the fact that as a surgical oncologist myself, surgery is the best treatment option. And surgery sometimes neglected in view of cardiac failure. So it is important to better understand what the cardiac performance is in order to avoid neglecting surgery.

Selma Schimmel:

Do you ever have issues with the children of their elderly parents that are resistant saying ‘no, no, no. I don’t want my mother to go through anything like that’?

Riccardo A. Audisio:

Yes, we do have these situation. I must say that it’s an interesting one because sometimes it’s more difficult to reassure the relatives of the beloved ones rather than the patient themselves. Most of the time you would be surprised to know that elderly women are quite brave, they have seen their friends, next door neighbors sailing through surgical procedure, they had their lump taken and they’re quite adamant in having active treatment.

Selma Schimmel:

Well speaking of active treatment, chemotherapy is hard on a young person. How do the elderly handle chemotherapy, and is the dosing different when a patient gets older?

Riccardo A. Audisio:

Chemotherapy is by far less administered in the older group of patients for a number of reasons, but certainly it is interesting to consider active medical treatment and include chemotherapy in the older age group. The Association of Chemotherapeutic Compound says it is probably better than a single drug, receptive in HER2 positive lady with no major cardiovascular toxicity is also an option, and there are several new compounds that are worth taking into consideration. Slight increase in head and foot seizure, slight increase in hypertension according to the drugs that have been utilized but definitely not to neglect active treatment just for an anagraphical age.

Selma Schimmel:

A curious question if you would look up a patient is a young adult and gets diagnosed with breast cancer you may wonder ‘oh perhaps they’re BRCA positive,’ would you test in older women who may have children to be concerned about or because they’re diagnosed when they’re much older it would be irrelevant?

Riccardo A. Audisio:

An older lady senior patient with diacetate breast cancer you would like to know whether her profile fits with the one that is passed over to the sibling, so it’s just double checking and cross matching.

Selma Schimmel:

So as a surgical oncologist what are the recommendations that you would have for a newly diagnosed older breast cancer patient?

Riccardo A. Audisio:

First of all, inform the patient in a positive way. There is a problem but the problem can be fixed most of the time, it’s fixable. Surgery is the best option, remove it. Not necessarily with an aggressive surgical treatment, mastectomy is not necessarily required. Breast conservation is advisable. We are now starting to talk reconstruction because other people might often require a decent cosmetic reconstruction. They have an excellent quality of life, life expectancy for a 70-year-old lady in the UK and in the US, averages 15 to 18 years, so there are these ladies that they go swimming, they have an active life and they deserve the most appropriate.

Selma Schimmel:

I’m so glad you said that because one of the issues I’ve heard from older breast cancer patients is a doctor saying to them ‘you know what, you don’t need your breasts anyway at your age’ and that is so devastating and hurtful. So to hear you reinforce the fact that how one feel about themselves, how one looks that that is an important aspect of quality of life.

Riccardo A. Audisio:

I have more than one patient in their 80s they go dancing they go swimming, they got new boyfriends, and they are interested in having a very decent cosmetic results.

Selma Schimmel:

See, that’s your Italian roots. All right, I’m curious to know what prompted you to study in particular, breast cancer in the elderly patient population.

Riccardo A. Audisio:

It’s a long story but to cut it short, I felt that we can improve cancer survivor looking high dose, low dose, mutant medications, but the real bulk of the survivor gain that we can easily offer to our population is by looking at badly neglected subsetting and these are older patients. So breast is what I’m dealing with but in my career I went through colorectal and liver and there is large evidence that these group of patient is neglected and we can do much better. It’s really rewarding.

Selma Schimmel:

I think what you’re doing is so significant, and we’re all going to get older – hopefully we live so long, and the fact that you’re reaching out and focusing attention on an area that mainly physicians may take less of an interest in, I think really distinguishes you. So let me ask, how does it feel, tomorrow you’re receiving the 2011 ESMO Award from the European Society of Surgical Oncologists, and what does it feel like for you to receive this honor?

Riccardo A. Audisio:

I’m really, really honored. I never thought I never expected anything like this. I take it not as a personal gift but as a sign of… a significant sign of gratitude towards the medical community has been contributing in the right track, and it’s a team work as medical oncology surgeons and geriatricians, research, nurses – so it’s really an interesting area of research.

Selma Schimmel:

So for some of the younger oncologists that may be viewing you right now, and hearing you speak, what message do you want to give to them? What can you give us a teachable moment?

Riccardo A. Audisio:

It is important to master guidelines and standards of care, but you need to move one step forward and understand patients’ needs, targets and offer tailored treatment. The vulnerable individual requires special attention, special empathy, just make sure that you get it right and you deliver what these patients are asking for.

Selma Schimmel:

Well I wish to thank you for what you are doing. I think that it shows sensitivity, compassion  and you used a very important word, empathy.

Riccardo A. Audisio:

Thank you so much. Thank you for having me.

Selma Schimmel:

Professor Doctor Riccardo Audisio.

Riccardo A. Audisio:

Thank you.

Selma Schimmel:

Thank you.

END OF VIDEO