Cip is not Afraid

(Italy 2010)

The Story of the Elderly person at CRO is an “Old Story”

Umberto Tirelli, Lucia Fratino

When at the end of the Seventies we decided to begin a systematic study of the cancer that strikes the older segment of the population, there was the widespread opinion in the world of oncology that old people tolerated chemotherapy and radiotherapy poorly. The general attitude was to reserve for these patients only treatments of a palliative nature with the consequence that old people were basically excluded from most of the clinical studies. Furthermore, when treated, the old people affected by tumors were subjected to empirical choices of reductions of doses and therefore were basically treated in an inadequate way.

The Istituto Nazionale Tumori of Aviano was among the first in Europe to advocate research of the tumors of elderly people promoting the integration of the methodologies suitable for geriatrics with the more traditional ones of oncology. Thus the basis was laid for a new branch of oncology: Geriatric Oncology. We were at the time aware that aging is a complex phenomenon and highly individualized, in that there are different kinds of aging. One could affirm that one exists for every single individual on the basis of genetic and environmental factors, as well as the habits of a lifetime. Vulnerability and fragility characterize all of the stages of aging, exposing old people to a high risk of developing disabilities, and for this reason making personalized assistance and operational models necessary that were completely unheard of in the world of clinical oncology at the time. Not only to treat them, then, but to take care of them.

For this reason, since January 2007 there exists a Program of Treatment of the Oncological Old Person, in the Department of Oncological Medicine, in collaboration with the Department of Breast Cancer. It is suitably structured in order to identify in a systematic and reproducible manner the complex socio-assistance requirements of the elderly patient without relinquishing the institutional job of a research clinic. Among the objectives of this program is the precise intention to offer old people the same treatment opportunities as younger people: that way getting cancer won’t be equivalent to a fatalistic renunciation of every attempt at treatment because “old”, but the beginning of a course of treatment, certainly difficult, but not hopeless, and above all not in solitude.

Since then we have followed about 400 patients. Some of them have recovered, some haven’t. For others, instead, the illness has become an experience of life and solidarity with the personnel and with the place of treatment. One day Mr Costalunga, during a stay in hospital, told us a story, the story of Blackie, Mr Pietro’s English setter, and his friend Cip, a little bird that is in the habit of flying and perching tranquilly on Blackie’s nose. There is a photo which documents this extraordinary friendship, and Mr Pietro has made a gift of it to our ward with this dedication:

“Cip is not afraid: he has faith in Blaky because he’s trustworthy and patient. Thus I put my faith in this Hospital and in its Service, active and constant, combined with the competence, willingness, courtesy and patience that it so generously provides to all of its patients. This is what I mean to express, by dedicating this account to them, with all my gratitude and a heartfelt thank you”.

From this the idea was born to give voice and testimony to our elderly patients, conscious protagonists and responsible subjects of the therapeutic choices that they have been offered. That is how the photographer’s objective has portrayed them: not only CAT scans, dripfeeds and waiting rooms, but also domestic places in which to live the illness together with their loved ones, in the company of their pets and objects, in the familiarity of everyday gestures.