emanuele galante

Emanuele Galante......

Curriculum

On the threshold of the year 2000 the population over 65 is more than 20% of the whole population in the western countries and life expectation for those being already 70 years old is further 15 years for women and

from eight to ten years for men.
The more population gets older the more the incidence of cancer increases, both as regard to the age bands and to monitoring years. Indeed in Italy and starting from 1978 the incidence of cancers has increased 0,9% for males and 1,5% for females over 65 years (the age arbitrary taken to set a threshold age for old people). Under 65 years the increase of the incidence has been 0,2% in males and 1,4% for females.
On the opposite, mortality for cancer that represents the main cause for old people death has increased 1,7% for males and 0,7% for females. Under 65 years old mortality decreases: -0,6% for males and -0,5% for females. Providing that the evaluation of the results of an oncology treatment is done over a five-years period, the decisional tree, mainly for a patient over 65, must lie over age (expressed as residual expectation of life and as “intrinsic fragility “), over quality and quantity of diseases the subject shows at the neoplasia diagnosis (side morbidity) and over the subject's ability as regards to physical, psychical and social interaction (entire functional state).
Age brings to a difference in the conditions of the physiological reserves in terms of readjustment of the functions of the different systems, more pathologies coexistence and rise of symptomatology. Nevertheless age is often overvalued since, cancer development stage being equal and so excision conditions being equal, results achieved with old people are superimposable with those achieved with adults. Side morbidity represents the whole of the psychophysical diseases existing before cancer and estimated by the means of measuring, reproducible and corroborating systems lying on mortality data within a year for the neoplastic pathology examined (Charlson scale). The seriousness of the pathology is measured according to a scale from 0 to 4 (CIRS-G or Geriatric Cumulative Illness Rating Scale).
43% patients that have been evaluated employing CIRS-G show a 3°-4° side morbidity degree while the evaluation according to the Charlson scale points out a side morbidity in 36% of patients. An attentive evaluation of side morbidity is basic in order to reckon with it and to prevent effects of pharmacological and radiotherapy treatments as regard to the survival, quality of life and patient's conditions improvement, in order to define the impact of therapy not on the subject's cancer but on the patient himself, since successful treatments on adults show the same result in elderly people.Then quality of life is the factor that plays the most important rôle.
The entire functioning condition of which quality of life is expression, provides the ability and the individual predisposition to interact with environment and society, but opposite to the performance scales employed for adults in working age, it frames the elderly person by the means of a multidisciplinary analysis lying over the different importance the old subject gives to the several acts of life and so estimating the real “fragility” of the elderly persons.
The balance could be that more than age it's important what age can give in terms of relationships, socialization and interaction, even if attitude of society, which does not discover itself as old yet, keeps on being somehow ambiguous as regards to the elderly people, managing the matter by wavering between resignation and rationality.

Emanuele Galante
Divisione Oncologia
A. O. San Giovanni - Addolorata
Roma