Oncogériatrie : quelle réalité aujourd'hui ?

Oncogeriatrics was born when both ageing and cancer authorities noted difficulties arising from cancer management in the elderly: under-treatment, under-representation in cancer-treatment trials, excess of toxicities. These specificities led both to the acquisition by some oncologists of specific competences and to a privileged relationship between cancer specialists and geriatricians. Though some research fields, like geriatric assessment and elderly specicific trials, made considerable improvements, some other remain little explored and unsolved. Among those, an improved medical policy, particularly in the relationships between hospital and home care services, has to be developed, since treatments of cancer are more and more ambulatory and use increasingly oral drugs. Oncogeriatrics' reality includes a majority of patients at home, vulnerable because of their cancer, their age and sometimes of the defects of family support. If this vulnerability can be revealed thanks to the geriatric assessment and, when necessary, a geriatric follow-up, it requires thereafter an adaptation of care units' offer, for example through a partnership with home care services and more reactivity when facing emergencies. Lastly, every treatment decision should respect the four fundamental ethical principles: benevolence, non-maleficence, equity and autonomy. The fragile balance of this decision must take into account both the toxicities of oncologic treatments and the frequent age-associated cognitive disorders that should not exempt of a communication of quality.