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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Taking care of older patients with cancer in the context of COVID-19 pandemic</title>
<author><name sortKey="Mourey, Loic" sort="Mourey, Loic" uniqKey="Mourey L" first="Loïc" last="Mourey">Loïc Mourey</name>
<affiliation><nlm:aff id="aff1">Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse – Oncopole, Toulouse, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Falandry, Claire" sort="Falandry, Claire" uniqKey="Falandry C" first="Claire" last="Falandry">Claire Falandry</name>
<affiliation><nlm:aff id="aff2">Geriatrics Unit, Lyon Sud University Hospital, Hospices Civils de Lyon and Lyon University, Pierre-Bénite, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="De Decker, Laure" sort="De Decker, Laure" uniqKey="De Decker L" first="Laure" last="De Decker">Laure De Decker</name>
<affiliation><nlm:aff id="aff3">Médecine Aiguë Gériatrique, Université de Nantes, Vice-Présidente de la Société Francophone d'Oncogériatrie, CHU Nantes, Saint Herblain, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Boulahssass, Rabia" sort="Boulahssass, Rabia" uniqKey="Boulahssass R" first="Rabia" last="Boulahssass">Rabia Boulahssass</name>
<affiliation><nlm:aff id="aff4">Geriatric Coordination Unit for Geriatric Oncology, Centre Hospitalier Universitaire de Nice, Nice, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Carola, Elisabeth" sort="Carola, Elisabeth" uniqKey="Carola E" first="Elisabeth" last="Carola">Elisabeth Carola</name>
<affiliation><nlm:aff id="aff5">Pôle d'Oncologie Médicale, Groupe Hospitalier Public du Sud de l'Oise, Creil, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bengrine Lefevre, Leila" sort="Bengrine Lefevre, Leila" uniqKey="Bengrine Lefevre L" first="Leila" last="Bengrine Lefevre">Leila Bengrine Lefevre</name>
<affiliation><nlm:aff id="aff6">Department of Medical Oncology, Centre Georges-Francois Leclerc, Dijon, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cudennec, Tristan" sort="Cudennec, Tristan" uniqKey="Cudennec T" first="Tristan" last="Cudennec">Tristan Cudennec</name>
<affiliation><nlm:aff id="aff7">Service de Médecine Gériatrique du Pr Teillet AP-HP, Université Paris Saclay Hôpitaux Antoine-Béclère, Boulogne-Billancourt, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Brain, Etienne" sort="Brain, Etienne" uniqKey="Brain E" first="Etienne" last="Brain">Etienne Brain</name>
<affiliation><nlm:aff id="aff8">Department of Medical Oncology, Institut Curie, Saint-Cloud, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Paillaud, Elena" sort="Paillaud, Elena" uniqKey="Paillaud E" first="Eléna" last="Paillaud">Eléna Paillaud</name>
<affiliation><nlm:aff id="aff9">Geriatric Oncology Unit, APHP, Hôpital Européen Georges Pompidou, Paris, France</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff10">Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Soubeyran, Pierre" sort="Soubeyran, Pierre" uniqKey="Soubeyran P" first="Pierre" last="Soubeyran">Pierre Soubeyran</name>
<affiliation><nlm:aff id="aff11">Department of Medical Oncology, Institut Bergonié, Université de Bordeaux, Inserm U1218, 33076 Bordeaux Cedex, France</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">32302533</idno>
<idno type="pmc">7156244</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156244</idno>
<idno type="RBID">PMC:7156244</idno>
<idno type="doi">10.1016/S1470-2045(20)30229-1</idno>
<date when="2020">2020</date>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Taking care of older patients with cancer in the context of COVID-19 pandemic</title>
<author><name sortKey="Mourey, Loic" sort="Mourey, Loic" uniqKey="Mourey L" first="Loïc" last="Mourey">Loïc Mourey</name>
<affiliation><nlm:aff id="aff1">Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse – Oncopole, Toulouse, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Falandry, Claire" sort="Falandry, Claire" uniqKey="Falandry C" first="Claire" last="Falandry">Claire Falandry</name>
<affiliation><nlm:aff id="aff2">Geriatrics Unit, Lyon Sud University Hospital, Hospices Civils de Lyon and Lyon University, Pierre-Bénite, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="De Decker, Laure" sort="De Decker, Laure" uniqKey="De Decker L" first="Laure" last="De Decker">Laure De Decker</name>
<affiliation><nlm:aff id="aff3">Médecine Aiguë Gériatrique, Université de Nantes, Vice-Présidente de la Société Francophone d'Oncogériatrie, CHU Nantes, Saint Herblain, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Boulahssass, Rabia" sort="Boulahssass, Rabia" uniqKey="Boulahssass R" first="Rabia" last="Boulahssass">Rabia Boulahssass</name>
<affiliation><nlm:aff id="aff4">Geriatric Coordination Unit for Geriatric Oncology, Centre Hospitalier Universitaire de Nice, Nice, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Carola, Elisabeth" sort="Carola, Elisabeth" uniqKey="Carola E" first="Elisabeth" last="Carola">Elisabeth Carola</name>
<affiliation><nlm:aff id="aff5">Pôle d'Oncologie Médicale, Groupe Hospitalier Public du Sud de l'Oise, Creil, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bengrine Lefevre, Leila" sort="Bengrine Lefevre, Leila" uniqKey="Bengrine Lefevre L" first="Leila" last="Bengrine Lefevre">Leila Bengrine Lefevre</name>
<affiliation><nlm:aff id="aff6">Department of Medical Oncology, Centre Georges-Francois Leclerc, Dijon, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cudennec, Tristan" sort="Cudennec, Tristan" uniqKey="Cudennec T" first="Tristan" last="Cudennec">Tristan Cudennec</name>
<affiliation><nlm:aff id="aff7">Service de Médecine Gériatrique du Pr Teillet AP-HP, Université Paris Saclay Hôpitaux Antoine-Béclère, Boulogne-Billancourt, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Brain, Etienne" sort="Brain, Etienne" uniqKey="Brain E" first="Etienne" last="Brain">Etienne Brain</name>
<affiliation><nlm:aff id="aff8">Department of Medical Oncology, Institut Curie, Saint-Cloud, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Paillaud, Elena" sort="Paillaud, Elena" uniqKey="Paillaud E" first="Eléna" last="Paillaud">Eléna Paillaud</name>
<affiliation><nlm:aff id="aff9">Geriatric Oncology Unit, APHP, Hôpital Européen Georges Pompidou, Paris, France</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff10">Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Soubeyran, Pierre" sort="Soubeyran, Pierre" uniqKey="Soubeyran P" first="Pierre" last="Soubeyran">Pierre Soubeyran</name>
<affiliation><nlm:aff id="aff11">Department of Medical Oncology, Institut Bergonié, Université de Bordeaux, Inserm U1218, 33076 Bordeaux Cedex, France</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">The Lancet. Oncology</title>
<idno type="ISSN">1470-2045</idno>
<idno type="eISSN">1474-5488</idno>
<imprint><date when="2020">2020</date>
</imprint>
</series>
</biblStruct>
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<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="You, B" uniqKey="You B">B You</name>
</author>
<author><name sortKey="Ravaud, A" uniqKey="Ravaud A">A Ravaud</name>
</author>
<author><name sortKey="Canivet, A" uniqKey="Canivet A">A Canivet</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Falandry, C" uniqKey="Falandry C">C Falandry</name>
</author>
<author><name sortKey="Filteau, C" uniqKey="Filteau C">C Filteau</name>
</author>
<author><name sortKey="Ravot, C" uniqKey="Ravot C">C Ravot</name>
</author>
<author><name sortKey="Le Saux, O" uniqKey="Le Saux O">O Le Saux</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet Oncol</journal-id>
<journal-id journal-id-type="iso-abbrev">Lancet Oncol</journal-id>
<journal-title-group><journal-title>The Lancet. Oncology</journal-title>
</journal-title-group>
<issn pub-type="ppub">1470-2045</issn>
<issn pub-type="epub">1474-5488</issn>
<publisher><publisher-name>Elsevier Ltd.</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">32302533</article-id>
<article-id pub-id-type="pmc">7156244</article-id>
<article-id pub-id-type="publisher-id">S1470-2045(20)30229-1</article-id>
<article-id pub-id-type="doi">10.1016/S1470-2045(20)30229-1</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Taking care of older patients with cancer in the context of COVID-19 pandemic</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" id="au10"><name><surname>Mourey</surname>
<given-names>Loïc</given-names>
</name>
<xref rid="aff1" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author" id="au20"><name><surname>Falandry</surname>
<given-names>Claire</given-names>
</name>
<xref rid="aff2" ref-type="aff">b</xref>
</contrib>
<contrib contrib-type="author" id="au30"><name><surname>de Decker</surname>
<given-names>Laure</given-names>
</name>
<xref rid="aff3" ref-type="aff">c</xref>
</contrib>
<contrib contrib-type="author" id="au40"><name><surname>Boulahssass</surname>
<given-names>Rabia</given-names>
</name>
<xref rid="aff4" ref-type="aff">d</xref>
</contrib>
<contrib contrib-type="author" id="au50"><name><surname>Carola</surname>
<given-names>Elisabeth</given-names>
</name>
<xref rid="aff5" ref-type="aff">e</xref>
</contrib>
<contrib contrib-type="author" id="au60"><name><surname>Bengrine Lefevre</surname>
<given-names>Leila</given-names>
</name>
<xref rid="aff6" ref-type="aff">f</xref>
</contrib>
<contrib contrib-type="author" id="au70"><name><surname>Cudennec</surname>
<given-names>Tristan</given-names>
</name>
<xref rid="aff7" ref-type="aff">g</xref>
</contrib>
<contrib contrib-type="author" id="au80"><name><surname>Brain</surname>
<given-names>Etienne</given-names>
</name>
<xref rid="aff8" ref-type="aff">h</xref>
</contrib>
<contrib contrib-type="author" id="au90"><name><surname>Paillaud</surname>
<given-names>Eléna</given-names>
</name>
<xref rid="aff9" ref-type="aff">i</xref>
<xref rid="aff10" ref-type="aff">j</xref>
</contrib>
<contrib contrib-type="author" id="au100"><name><surname>Soubeyran</surname>
<given-names>Pierre</given-names>
</name>
<email>p.soubeyran@bordeaux.unicancer.fr</email>
<xref rid="aff11" ref-type="aff">k</xref>
</contrib>
</contrib-group>
<aff id="aff1"><label>a</label>
Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse – Oncopole, Toulouse, France</aff>
<aff id="aff2"><label>b</label>
Geriatrics Unit, Lyon Sud University Hospital, Hospices Civils de Lyon and Lyon University, Pierre-Bénite, France</aff>
<aff id="aff3"><label>c</label>
Médecine Aiguë Gériatrique, Université de Nantes, Vice-Présidente de la Société Francophone d'Oncogériatrie, CHU Nantes, Saint Herblain, France</aff>
<aff id="aff4"><label>d</label>
Geriatric Coordination Unit for Geriatric Oncology, Centre Hospitalier Universitaire de Nice, Nice, France</aff>
<aff id="aff5"><label>e</label>
Pôle d'Oncologie Médicale, Groupe Hospitalier Public du Sud de l'Oise, Creil, France</aff>
<aff id="aff6"><label>f</label>
Department of Medical Oncology, Centre Georges-Francois Leclerc, Dijon, France</aff>
<aff id="aff7"><label>g</label>
Service de Médecine Gériatrique du Pr Teillet AP-HP, Université Paris Saclay Hôpitaux Antoine-Béclère, Boulogne-Billancourt, France</aff>
<aff id="aff8"><label>h</label>
Department of Medical Oncology, Institut Curie, Saint-Cloud, France</aff>
<aff id="aff9"><label>i</label>
Geriatric Oncology Unit, APHP, Hôpital Européen Georges Pompidou, Paris, France</aff>
<aff id="aff10"><label>j</label>
Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France</aff>
<aff id="aff11"><label>k</label>
Department of Medical Oncology, Institut Bergonié, Université de Bordeaux, Inserm U1218, 33076 Bordeaux Cedex, France</aff>
<pub-date pub-type="pmc-release"><day>14</day>
<month>4</month>
<year>2020</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>14</day>
<month>4</month>
<year>2020</year>
</pub-date>
<permissions><copyright-statement>© 2020 Elsevier Ltd. All rights reserved.</copyright-statement>
<copyright-year>2020</copyright-year>
<copyright-holder>Elsevier Ltd</copyright-holder>
<license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p>
</license>
</permissions>
<related-article related-article-type="article-reference" id="d32e156" ext-link-type="doi" xlink:href="10.1016/S1470-2045(20)30204-7"></related-article>
</article-meta>
</front>
<body><p id="para10">In their Comment in <italic>The Lancet Oncology</italic>
, Benoit You and colleagues<xref rid="bib1" ref-type="bibr"><sup>1</sup>
</xref>
recommend prevention of coronavirus disease 2019 (COVID-19) in patients with cancer through barrier measures and limitation of hospital admissions by all means, and caution before initiating or continuing treatment because of excess risk of COVID-19-related death in patients with cancer. We, the Société Francophone d'Onco-Gériatrie (SoFOG) and the French cooperative group for clinical research in geriatric oncology DIALOG (GERICO-UCOG), would like to endorse these guidelines and stress further important points for older patients with cancer.</p>
<p id="para20">Indeed, older patients (ie, >70 years) have cumulative excess risks related to both cancer and ageing. Prevention with intensified barrier measures is required; however, facing an unprecedented health crisis, the choice between pursuing the standard treatments for these patients (often based on little data in the literature) and a cautious so-called <italic>primum non nocere</italic>
approach, raises many concerns and ethical questions.<xref rid="bib2" ref-type="bibr"><sup>2</sup>
</xref>
Highly committed to an individualised health-care approach, we think highlighting the following points is essential. First, in light of the potential for patients with cancer to be infected with SARS-CoV-2 during this pandemic treatment decision making should take into account cancer type, disease extent, prognosis, and treatment opportunities irrespective of a patient's age, but acknowledge the excess risks associated with viral infection in older patients. Second, evaluation of life expectancy should be part of treatment decision making. Finally, as much as possible, alternatives to standard therapy that have few side-effects on the immune system (eg, endocrine therapy <italic>vs</italic>
chemotherapy) should be favoured, and are preferred to no treatment, which might lead ultimately, long after the epidemic, to excess cancer-related deaths.</p>
<p id="para30">Barrier measures and confinement, supportive care, and adjustment of treatment schedules (eg, increased intervals between treatments, dose reductions, and alternative radiotherapy fractionation) should be widely used, as in younger patients when appropriate.</p>
<p id="para40">In our community, stressing these points seems to be essential because older patients with cancer might be exposed to excess risk from both COVID-19 and under-treatment of cancer. To avoid serious ethical issues and preserve the highest standards of care and treatment for older patients with cancer, sharing treatment decision making with a geriatrician team remains the best strategy, whenever possible. Through this process, we can indeed avoid under-treatment, often and wrongly influenced by a patient's age alone, and hopefully reach the balanced and appropriate decisions our patients deserve.</p>
<p id="para50">Of course, in critical situations related to COVID-19, referral physicians remain at the forefront to prioritise patients and treatments, relying on their own clinical judgment. When possible, practitioners should have institutional support from ethics committees to help them find a balance between unreasonable obstinacy and the principle of beneficence.</p>
</body>
<back><ref-list id="bibl10"><title>References</title>
<ref id="bib1"><label>1</label>
<element-citation publication-type="journal" id="sbref10"><person-group person-group-type="author"><name><surname>You</surname>
<given-names>B</given-names>
</name>
<name><surname>Ravaud</surname>
<given-names>A</given-names>
</name>
<name><surname>Canivet</surname>
<given-names>A</given-names>
</name>
</person-group>
<article-title>The official French guidelines to protect patients with cancer against SARS-CoV-2 infection</article-title>
<source>Lancet Oncol</source>
<year>2020</year>
<comment>published online March 25.</comment>
<pub-id pub-id-type="doi">10.1016/S1470-2045(20)30204-7</pub-id>
</element-citation>
</ref>
<ref id="bib2"><label>2</label>
<element-citation publication-type="journal" id="sbref20"><person-group person-group-type="author"><name><surname>Falandry</surname>
<given-names>C</given-names>
</name>
<name><surname>Filteau</surname>
<given-names>C</given-names>
</name>
<name><surname>Ravot</surname>
<given-names>C</given-names>
</name>
<name><surname>Le Saux</surname>
<given-names>O</given-names>
</name>
</person-group>
<article-title>Challenges managing older patients with cancer during the COVID-19 pandemic</article-title>
<source>J Ger Oncol</source>
<year>2020</year>
<comment>published online April 2.</comment>
<pub-id pub-id-type="doi">10.1016/j.jgo.2020.03.020</pub-id>
</element-citation>
</ref>
</ref-list>
<ack><p>RB is on the consulting board of Bristol-Myers Squibb and Teva and as received honoraria from Roche, Pierre Fabre, Ipsen, Teva, Eli Lilly, and Amgen. EC is on the consulting board of Teva, Pfizer, Bristol-Myers Squibb, and Sanofi and has received honoraria from Amgen, Roche, and Pierre Fabre Oncology. EB reports personal fees, travel support, and accommodation from Pfizer, Roche; travel support and accommodation from Pierre Fabre, Novartis, and AstraZeneca; grants, personal fees, travel support, and accommodation from Bristol-Myers Squibb; and personal fees from Samsung, TLC PharmaChem, Clinigen, Mylan, and G1 Therapeutics. PS reports personal fees from Celgene, Bristol-Myers Squibb, TEVA, and Sandoz and travel support from AstraZeneca. All other authors declare no competing interests.</p>
</ack>
</back>
</pmc>
</record>
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