What kind of psycho-oncological care for elderly cancer patients? Short guidelines from the French Society of Psycho-Oncology

The specific frailty of the elderly make them more exposed to the multiple stresses of cancer and treatments. Psychological adjustment in older cancer patients may be impaired by their multifactorial vulnerability, especially when cancer threatens their autonomy in daily life. Emotional and cognitive disorders are more frequent. Exchanges of information and decisional processes can be impaired. The 27th Congress of the French Psycho-oncology Society was dedicated to the psychological care of older cancer patients. A multidisciplinary group of experts from psychiatry, neuropsychology, oncology, and geriatric oncology, worked to establish some guidelines for psycho-oncological care of the elderly. Those guidelines were discussed and validated in a plenary session during the congress. This paper summarizes those guidelines, and emphasizes the following main points: 1) psychological evaluation of cancer patients must include the systematic evaluation of frailty; this involves evaluating the patient's emotional state and psychiatric history; 2) identification of socio-familial support is needed, as much as the identification of the carers potential support needs; 3) the psycho-oncological evaluation should be performed by a psycho-oncologist, and at least at the time of the diagnosis, at every important treatment change, and at the end of the treatments; 4) the report of this psycho-oncological evaluation must be integrated in the medical chart; 5) access of the elderly to psychotherapeutic and pharmacological care must be promoted via an educational process giving them information on psychological distress and psychological care; 6) a high level of collaborative care is required, and professional caregivers should benefit from specific training particularly in the psychological evaluation of older patients; 7) research should be promoted in order to better adjust the care system to these patients, from cancer screening to cancer treatments and rehabilitation.