beam radiotherapy necessary. So far, this combination has mainly beengiven with contact X-rays and only sporadically with intraluminalbrachytherapy. In this presentation, an overview of different optionsand possible selection criteria for specific treatments will be given.Disclosure of Interest: None Declared.

Keywords: None

doi:10.1016/j.jgo.2013.09.217

S15Colorectal cancer - pre-habilitation before colorectal surgery

P. Somasundar⁎. Roger Williams Medical Center, East Greenwich,United States

Abstract: There have been several advances in early detection,diagnosis, surgical management, anesthesia and perioperative care.These advance have made surgery a lot safer. However there is a groupof patients especially the elderly whowith multiple co-morbidities andseveral other factors are not good candidates for surgery as theirperioperative recovery is compromised in certain situations. In mostsituations efforts are mainly made to intervene at the postoperativeperiod and it may not be the most opportune moment to do so. Thepreoperative period may be a more emotionally and physically salienttime to intervene with regards to factors that contribute to betterrecovery. This talk will reiterate the factors that have been applied toimprove the postoperative outcomes with preoperative interventions.Disclosure of Interest: None Declared.

Keywords: None

doi:10.1016/j.jgo.2013.09.218

S16Geriatric oncology: A case of medical complexity/Clinical Aspectsof Complexity

L. Balducci⁎. Geriatric Oncology, Moffitt Cancer Center, Tampa, UnitedStates

Abstract: A 76 year old woman with single brain metastases frombreast cancer, present with high risk myelodysplasia. The managementof this case exemplifies the complexity of geriatric oncology. Complex-ity is derived from the Latin cum plexere which means “to weavetogether.” In older individuals examples of medical complexity includepolymorbidity, polypharmacy, the relation of the patient with thesupport system, and the ability of the patient tomakemedical decisionsand follow a treatment program. Personalized cancer care, the hallmarkof geriatric oncology, involves the understanding of medical complex-ity. This is best studied through the development of dynamic caremodels, rather than randomized clinical trials.Disclosure of Interest: None Declared.

Keywords: None

doi:10.1016/j.jgo.2013.09.219

S17Spiritual aspects of complexity

B. Devi⁎. Sarawak General Hospital, Kuching, Sarawak, Malaysia

Abstract: Spirituality is a complex and weakly understood matter.Often spirituality is mistaken for religious needs. Life is viewed

differently by people in various parts of the world. The issue ofspirituality becomes complex with illness especially when the timeto live is short. While it is important to recognise and meet the needsof those from all cultures and creeds, to see spiritual care only asreligious care trivialises and diminishes its true nature.The concept of spirituality is broader than religion. Religion refers tothe spiritual doctrine and practices that exist in formal religiousinstitutions. Spirituality, however, also encompasses beliefs andneeds unrelated to organised religion that can be expressed outsidea religious context,. However due to the illusive nature of spiritualityoutside organised religion and the lack of clarity in defining it, moreattention has been given to the religious aspects in clinical care.In my presentation I will discuss the aspects of spirituality as what iscommonly understood. With case studies as examples I will try toillustrate the difficulties that face professionals when dealing withpeople from various cultures. These difficult issues form the barriersto better care of the dying patient.Disclosure of Interest: None Declared.

Keywords: None

doi:10.1016/j.jgo.2013.09.220

S18Anemia in the elderly: Clinical relevance, differential diagnosis(ICUS, IDUS, MDS) and therapy

L. Balducci⁎. Geriatric Oncology, Moffitt Cancer Center, Tampa, UnitedStates

Abstract: The incidence and prevalence of anemia increase with age.Though age may be associated with a progressive reduction inerythropoiesis and drop in hemoglobin levels, aging may not beconsidered at present a cause of anemia, at least until age 90. Anemiain older individuals is associated with a number of healthcomplications that include death, functional dependence, dementia,falls, and increased risk of therapeutic complications. In cancerpatients anemia may be associated with increased risk of complica-tions of cytotoxic chemotherapy. It is not clear at present whetherreversal of anemia may prevent these adverse outcomes.In approximately 50% of cases the causes of anemia are reversible andinclude iron deficiency, nutritional deficiency, hypothyroidism, hyp-ogonadism, and chronic renal insufficiency. Anemia of inflammation isthe most common cause of anemia in cancer patients and may respondto erythropoiesis stimulating agents, whose use is controversial.In approximately 30% of cases the cause of anemia is unknown andin some cases it may represent early form of myelodysplasia.The important diagnostic issue of anemia of aging include: definitionof anemia in older women, diagnosis of anemia from multiple causes,and detection of iron deficiency in the presence of inflammationDisclosure of Interest: None Declared.

Keywords: None

doi:10.1016/j.jgo.2013.09.221

S19Relevance of age and comorbidities in risk scoring and decisionmaking in MDS in the elderly

R. Stauder⁎. Internal Medicine V (Haematology, and Oncology),Innsbruck Medical University, Innsbruck, Austria

Abstract: Myelodysplastic syndromes (MDS) represent a broad spec-trum of clonal hematological disorders characterized by dysplastic

2013 SIOG Speaker AbstractsS12

changes and ineffective production of hematopoietic cells, resulting incytopenias and symptoms thereof. Thus,MDS represent one of themostfrequent and serious hematologic diseases of the elderly. MDS arecommonly classified based on World Health Organization (WHO)categories. These categories are typically based on blast cell counts,signs of dysplasia in peripheral blood or bone marrow cells as wellas evaluation of karyotype. Significant differences in survival amongthese groups, as well as varying likelihood of developing secondaryacute myeloid leukemia (sAML) have been described. Due to highlyindividual courses of MDS and in order to individualize therapeuticdecisions, prognostic scores are needed. Actually, several scoringsystems are applied in clinical practice. The gold standard inprognostication in MDS remains the International Prognostic ScoringSystem (IPSS), which has been updated recently (IPSS-R). Based on thenumber and degree of cytopenias, blast counts, cytogenetic risk groupsand age the IPSS-R defines different risk groups for overall survival andleukemic evolution. The transfusionneed of patientswas integrated as arelevant parameter in the WHO classification-based prognostic scoringsystem (WPSS). Patient-associated parameters like age or performancestatus have been introduced and established as prognostic parametersin MDS recently. Thus, the impact of distinct comorbidities or possiblecumulative effects on clinical outcome of MDS has been described byseveral groups. Scores applied in MDS so far were the CharlsonComorbidity Index (CCI), the hematopoietic cell transplantation-comorbidity index (HCT-CI) as well as the Adult ComorbidityEvaluation-27 (ACE-27). Based on HCT-CI scoring a MDS-specificcomorbidity index (MDS-CI) was developed. This presentation willgive an overview on the relevance of the integration of age andcomorbidities in clinical risk scoring and in prediction of toxicities andcompletion of chemotherapy in MDS-patients. In addition, options forfuture developments will be highlighted.Disclosure of Interest: None Declared.

Keywords: None

doi:10.1016/j.jgo.2013.09.222

S20Francilian oncogeriatric group (FROG)'s focus on management ofelderly patients with bladder cancer

D. Ghebriou⁎. Medical Oncology, Centre Hospitalier Argenteuil, Argenteuil,France

Abstract: Bladder cancer is diagnosed more often in the elderly. Themost effective treatment strategies are mostly very aggressive andare not applicable to all patients in a very heterogeneous population.However, effective options exist to treat themost vulnerable subjects. Amultidisciplinary approach including a geriatric assessment is essentialfor optimal adaptation of treatment. The FRancilian OncogeriatricGroup (FROG) conducted a comprehensive literature search in orderto review the applicable therapeutic options according to oncologicaland geriatric settings. International recommendations are essential toharmonize the management of elderly patients with bladder cancer.Disclosure of Interest: None Declared.

Keywords: None

doi:10.1016/j.jgo.2013.09.223

S21National organization of geriatric oncology care: The french model

Pierre Soubeyran⁎. Medical Oncology, Institut Bergonié, Bordeaux, France

Abstract: As life expectancy increases, the number and proportion ofelderly patients with cancer are rising. Consequences in terms ofPublic Health are major and the national health systems should dealwith it, including both patient care and research.To organize geriatric oncology care, the French National CancerInstitute (INCa) decided in 2006 to create a regional network ofgeriatric oncology units in France. The first step occurred in 2006/2007 with the accreditation of 15 pilot UCOG (Geriatric OncologyCoordination Unit). Each of them have been evaluated annually andaudited by an international advisory board before a new call fortender was launched in 2011/2012. Currently, the full territorycoverage is ensured by 24 regional UCOGs, including five with inter-regional duties. All are coordinated by both an oncologist and ageriatrician. They have to deal with cancer care in their territory withthe objective to ensure that geriatric oncology management isstructured and feasible in all community hospitals. They have alsoto train physicians to older patient cancer care, to inform patientsand public and to promote geriatric oncology research with theobjective to include more than 5% of elderly with cancer in clinicaltrials. All UCOG are grouped and coordinated in the FédérationFrançaise des UCOG and with the INCa.To support geriatric oncology on a supranational basis, a society hasbeen launched recently, name SoFOG (Société Francophoned’OncologieGériatrique), French division of SIOG. It is linked to a periodical (Journald’Oncogériatrie) and an annual meeting to disseminate good clinicalpractice in France with 200 to 300 participants per year. Among itsobjectives, it will develop guidelines in cooperation with other Frenchspecific cancer societies.Besides that, clinical research is active based on active research networks:the GERICO supported by the UNICANCER group of cancer centers, mostFrench oncology cooperative groups and on the UCOGs which performtransversal, geriatry-based, clinical trials such as ONCODAGE.Overall, thanks to strong government incitation and support, organizationof geriatric oncology in France is clear and functional. Currents efforts aimat consolidating this organization andmake it able to better participate tothe development of geriatric oncology on an international basis.Disclosure of Interest: None Declared.

Keywords: None

doi:10.1016/j.jgo.2013.09.224

S22How to integrate geriatrics into oncology care: Nursing perspectives

B.A. Esbensen⁎. Research Unit, Glostrup Hospital, Glostrup, Denmark

Abstract:Over the coming decades, the numbers of elderly will increase, andthrough improved lifestyles and better treatment longevity hasincreased, and with it, the risk of contracting cancer. How elderlypeople live with cancer has until now attracted limited research. Theoverall aim of this presentation is to focus on available researchwithin the field. Furthermore, to discuss how it is possible tointegrate geriatrics into oncology care from a nursing perspective.The presentation will be based on existing research focusing onfactors with significant meaning to elderly with cancer, such asquality of life, dependency, hope, social network, financial issues,dominating complaints (fatigue and pain), and considerations aboutend of life. Health care professionals need to take time to listen to andcounsel the elderly regarding their concerns as both an elderly personand as a personwith cancer. Inwhichway health care professionalswillbe able to be conscious about elderly with cancer as a heterogeneousgroup will be discussed. For that reason it is significant to identify thespecific meaning that the cancer has for the individual elderly, and to

2013 SIOG Speaker Abstracts S13