Tailored approach of the older person with a haematological malignancy

A significant increase has been seen in the number of older patients with cancer due to population ageing. Ageing however is a highly individualized and very heterogeneous process with a broad spectrum ranging from older persons who are functionally independent to those who are at high risk of functional decline and mortality and all the others in between. Fit older patients should logically receive the same treatment as their younger counterparts. The main problem however is the group of frail patients at increased risk for treatment complications. The main aim of this doctoral thesis was to explore whether in older patients with haematological malignancies a geriatric approach, and in particular a comprehensive geriatric assessment (CGA), might be worthwhile in the selection of patients with a geriatric profile, in the detection of geriatric syndromes and in the prediction of patient outcomes. In this thesis, we demonstrated that, also in patients with a haematological malignancy, a CGA can identify previously unknown geriatric problems in an individual. Through nutritional screening a large majority of patients was identified with potential nutritional problems. Given the negative impact of malnutrition on an anticancer treatment, regular follow-up and implementation of specific interventions, in collaboration with a dietician, are essential, even though efficacy of these interventions has not yet been adequately proven. Moreover, geriatric evaluation in this thesis has clearly proven that chemotherapy, and inherent use of supportive medication, leads to polypharmacy and frequent changes in medication regimen. Because of this, more than half of the patients are no longer able to manage their medication independently. As most older patients are living alone or are taken care of by a partner of the same age, their current care pathway should include a structured and repeated evaluation of functional autonomy with regard to medication management. This thesis did focus not only on the detection of geriatric syndromes, but also on a correct selection of patients with a geriatric profile, as the administration of a CGA is time and staff-consuming. Therefore a two-step approach is proposed with the use of a screening tool to identify those patients that subsequently would benefit most from a CGA. During the conduct of our study we tested the performance of two different screening tools. G8 (with a cut-off of ≤14) could be validated for use in older patients with haematological malignancies. In contrast with G8, an 8-item questionnaire, hand grip strength is a performance-based measure and therefore a more objective reproduction of a patient’s functional reserves. In contrast with healthy individuals, we found that hand grip strength was reduced in patients with haematological malignancies, even before onset of treatment. Using a Martin vigorimeter, we also determined minimum values for hand grip strength in men and women. Below these values, all patients should be referred for further geriatric evaluation. This doctoral thesis should be considered a first onset in the development of a multidisciplinary approach in older patients with haematological malignancies. Further research should focus for one thing on interventions that, before start of treatment, can optimize the functional reserves of a frail patient, and for another thing on new treatment modalities incorporating the results of the CGA. Integration of the results of both lines of investigation should eventually lead to a treatment plan tailored to the individual patient

De Belgische zeevisserij: aanvoer en besomming 2005

Contains detailed data on landings and totals of Belgian fisheries in 2005, and additionally information on retained fish, rejected fish and fishery grounds

De Belgische zeevisserij: aanvoer en besomming 2007

This annual report gives the statistical overview for landings and totals of the fisheries in Belgian ports for the year 2007