Skip to main content
Erschienen in: Zeitschrift für Gerontologie und Geriatrie 1/2019

09.01.2019 | Onkologie | CME

Geriatrische Onkologie

verfasst von: PD Dr. Ulrich Wedding

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 1/2019

Einloggen, um Zugang zu erhalten

Zusammenfassung

Aufgrund der demografischen Entwicklung mit einer zunehmenden Zahl alter Menschen und des altersabhängigen Anstiegs der Inzidenzrate der Krebserkrankungen wird die Zahl alter Menschen mit Krebserkrankungen in den kommenden Jahrzehnten erheblich ansteigen. In der Geriatrie wurde ein strukturiertes systematisches Assessment etabliert, um Defizite und Ressourcen des einzelnen Patienten zu erkennen und individuelle Therapieplanungen vornehmen zu können. Die Forschung in der geriatrischen Onkologie hat bisher gezeigt, dass die Übertragung des Assessments von der Geriatrie zur Onkologie hilft, unabhängig vom chronologischen Alter, Patienten mit altersabhängigen Einschränkungen besser zu erkennen. Solche Einschränkungen sind zudem prädiktiv für ein höheres Risiko der Therapieunverträglichkeit und für geringeres Überleben. Geriatrisches Assessment hilft dabei, eine onkologische Therapie besser zu stratifizieren und somit Über- und Untertherapie zu vermeiden. In aktuellen Studien wird untersucht, ob auf den Ergebnissen des Assessments aufbauende Interventionen zu einer Verbesserung von für die Patienten relevanten Endpunkten beitragen. Für alte Patienten relevante Endpunkte, wie der Erhalt der Fähigkeit zur Selbstversorgung, sind bisher unzureichend in onkologische Therapiestudien integriert worden.
Literatur
1.
Zurück zum Zitat Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2013) GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2013) GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11
2.
Zurück zum Zitat Mangoni AA, Jackson SH (2004) Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 57(1):6–14CrossRefPubMedPubMedCentral Mangoni AA, Jackson SH (2004) Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 57(1):6–14CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Williams GR, Deal AM, Lund JL, Chang Y, Muss HB, Pergolotti M, Guerard EJ, Shachar SS, Wang Y, Kenzik K, Sanoff HK (2018) Patient-reported comorbidity and survival in older adults with cancer. Oncologist 23(4):433–439CrossRefPubMed Williams GR, Deal AM, Lund JL, Chang Y, Muss HB, Pergolotti M, Guerard EJ, Shachar SS, Wang Y, Kenzik K, Sanoff HK (2018) Patient-reported comorbidity and survival in older adults with cancer. Oncologist 23(4):433–439CrossRefPubMed
4.
Zurück zum Zitat Sharma M, Loh KP, Nightingale G, Mohile SG, Holmes HM (2016) Polypharmacy and potentially inappropriate medication use in geriatric oncology. J Geriatr Oncol 7(5):346–353CrossRefPubMedPubMedCentral Sharma M, Loh KP, Nightingale G, Mohile SG, Holmes HM (2016) Polypharmacy and potentially inappropriate medication use in geriatric oncology. J Geriatr Oncol 7(5):346–353CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, Mor V, Monfardini S, Repetto L, Sorbye L, Topinkova E (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55(3):241–252CrossRefPubMed Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, Mor V, Monfardini S, Repetto L, Sorbye L, Topinkova E (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55(3):241–252CrossRefPubMed
6.
Zurück zum Zitat Friedrich C, Kolb G, Wedding U, Pientka L (2003) Comprehensive geriatric assessment in the elderly cancer patient. Onkologie 26(4):355–360PubMed Friedrich C, Kolb G, Wedding U, Pientka L (2003) Comprehensive geriatric assessment in the elderly cancer patient. Onkologie 26(4):355–360PubMed
7.
Zurück zum Zitat Pallis AG, Fortpied C, Wedding U, Van Nes MC, Penninckx B, Ring A, Lacombe D, Monfardini S, Scalliet P, Wildiers H (2010) EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 46(9):1502–1513CrossRefPubMed Pallis AG, Fortpied C, Wedding U, Van Nes MC, Penninckx B, Ring A, Lacombe D, Monfardini S, Scalliet P, Wildiers H (2010) EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 46(9):1502–1513CrossRefPubMed
8.
Zurück zum Zitat Pallis AG, Wedding U, Lacombe D, Soubeyran P, Wildiers H (2010) Questionnaires and instruments for a multidimensional assessment of the older cancer patient: what clinicians need to know? Eur J Cancer 46(6):1019–1025CrossRefPubMed Pallis AG, Wedding U, Lacombe D, Soubeyran P, Wildiers H (2010) Questionnaires and instruments for a multidimensional assessment of the older cancer patient: what clinicians need to know? Eur J Cancer 46(6):1019–1025CrossRefPubMed
9.
Zurück zum Zitat Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342(8878):1032–1036CrossRefPubMed Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342(8878):1032–1036CrossRefPubMed
10.
Zurück zum Zitat Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16(4):1582–1587CrossRefPubMed Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16(4):1582–1587CrossRefPubMed
11.
Zurück zum Zitat Repetto L, Venturino A, Vercelli M, Gianni W, Biancardi V, Casella C, Granetto C, Parodi S, Rosso R, Marigliano V (1998) Performance status and comorbidity in elderly cancer patients compared with young patients with neoplasia and elderly patients without neoplastic conditions. Cancer 82(4):760–765 (see comments)CrossRefPubMed Repetto L, Venturino A, Vercelli M, Gianni W, Biancardi V, Casella C, Granetto C, Parodi S, Rosso R, Marigliano V (1998) Performance status and comorbidity in elderly cancer patients compared with young patients with neoplasia and elderly patients without neoplastic conditions. Cancer 82(4):760–765 (see comments)CrossRefPubMed
12.
Zurück zum Zitat Extermann M, Meyer J, McGinnis M, Crocker TT, Corcoran MB, Yoder J, Haley WE, Chen H, Boulware D, Balducci L (2004) A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Crit Rev Oncol Hematol 49(1):69–75CrossRefPubMed Extermann M, Meyer J, McGinnis M, Crocker TT, Corcoran MB, Yoder J, Haley WE, Chen H, Boulware D, Balducci L (2004) A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Crit Rev Oncol Hematol 49(1):69–75CrossRefPubMed
13.
Zurück zum Zitat Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, Levine RM, Lubiner ET, Reyes P, Schreiber FJ 3rd, Balducci L (2012) Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 118(13):3377–3386CrossRefPubMed Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, Levine RM, Lubiner ET, Reyes P, Schreiber FJ 3rd, Balducci L (2012) Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 118(13):3377–3386CrossRefPubMed
14.
Zurück zum Zitat Freyer G, Geay JF, Touzet S, Provencal J, Weber B, Jacquin JP, Ganem G, Tubiana-Mathieu N, Gisserot O, Pujade-Lauraine E (2005) Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol 16(11):1795–1800CrossRefPubMed Freyer G, Geay JF, Touzet S, Provencal J, Weber B, Jacquin JP, Ganem G, Tubiana-Mathieu N, Gisserot O, Pujade-Lauraine E (2005) Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol 16(11):1795–1800CrossRefPubMed
15.
Zurück zum Zitat Hurria A, Mohile S, Gajra A, Klepin H, Muss H, Chapman A, Feng T, Smith D, Sun CL, De Glas N, Cohen HJ, Katheria V, Doan C, Zavala L, Levi A, Akiba C, Tew WP (2016) Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol 34(20):2366–2371CrossRefPubMedPubMedCentral Hurria A, Mohile S, Gajra A, Klepin H, Muss H, Chapman A, Feng T, Smith D, Sun CL, De Glas N, Cohen HJ, Katheria V, Doan C, Zavala L, Levi A, Akiba C, Tew WP (2016) Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol 34(20):2366–2371CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Corre R, Greillier L, Le Caer H, Audigier-Valette C, Baize N, Berard H, Falchero L, Monnet I, Dansin E, Vergnenegre A, Marcq M, Decroisette C, Auliac JB, Bota S, Lamy R, Massuti B, Dujon C, Perol M, Daures JP, Descourt R, Lena H, Plassot C, Chouaid C (2016) Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase III randomized ESOGIA-GFPC-GECP 08-02 study. J Clin Oncol 34(13):1476–1483CrossRefPubMed Corre R, Greillier L, Le Caer H, Audigier-Valette C, Baize N, Berard H, Falchero L, Monnet I, Dansin E, Vergnenegre A, Marcq M, Decroisette C, Auliac JB, Bota S, Lamy R, Massuti B, Dujon C, Perol M, Daures JP, Descourt R, Lena H, Plassot C, Chouaid C (2016) Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase III randomized ESOGIA-GFPC-GECP 08-02 study. J Clin Oncol 34(13):1476–1483CrossRefPubMed
17.
Zurück zum Zitat Frasca M, Soubeyran P, Bellera C, Rainfray M, Leffondre K, Mathoulin-Pelissier S, oncodage group (2018) Alterations in comprehensive geriatric assessment decrease survival of elderly patients with cancer. Eur J Cancer 90:10–18CrossRefPubMed Frasca M, Soubeyran P, Bellera C, Rainfray M, Leffondre K, Mathoulin-Pelissier S, oncodage group (2018) Alterations in comprehensive geriatric assessment decrease survival of elderly patients with cancer. Eur J Cancer 90:10–18CrossRefPubMed
18.
Zurück zum Zitat Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32(24):2595–2603CrossRefPubMedPubMedCentral Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32(24):2595–2603CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Soto-Perez-de-Celis E, Li D, Yuan Y, Lau YM, Hurria A (2018) Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol 19(6):e305–e316CrossRefPubMed Soto-Perez-de-Celis E, Li D, Yuan Y, Lau YM, Hurria A (2018) Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol 19(6):e305–e316CrossRefPubMed
20.
Zurück zum Zitat Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, Rostoft S, Overcash J, Wildiers H, Steer C, Kimmick G, Kanesvaran R, Luciani A, Terret C, Hurria A, Kenis C, Audisio R, Extermann M (2015) Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendationsdagger. Ann Oncol 26(2):288–300CrossRefPubMed Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, Rostoft S, Overcash J, Wildiers H, Steer C, Kimmick G, Kanesvaran R, Luciani A, Terret C, Hurria A, Kenis C, Audisio R, Extermann M (2015) Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendationsdagger. Ann Oncol 26(2):288–300CrossRefPubMed
21.
Zurück zum Zitat Soubeyran P, Bellera C, Goyard J, Heitz D, Cure H, Rousselot H, Albrand G, Servent V, Jean OS, van Praagh I, Kurtz JE, Perin S, Verhaeghe JL, Terret C, Desauw C, Girre V, Mertens C, Mathoulin-Pelissier S, Rainfray M (2014) Screening for vulnerability in older cancer patients: the ONCODAGE prospective multicenter cohort study. PLoS ONE 9(12):e115060CrossRefPubMedPubMedCentral Soubeyran P, Bellera C, Goyard J, Heitz D, Cure H, Rousselot H, Albrand G, Servent V, Jean OS, van Praagh I, Kurtz JE, Perin S, Verhaeghe JL, Terret C, Desauw C, Girre V, Mertens C, Mathoulin-Pelissier S, Rainfray M (2014) Screening for vulnerability in older cancer patients: the ONCODAGE prospective multicenter cohort study. PLoS ONE 9(12):e115060CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Kenis C, Decoster L, Van Puyvelde K, De Greve J, Conings G, Milisen K, Flamaing J, Lobelle JP, Wildiers H (2014) Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 32(1):19–26CrossRefPubMed Kenis C, Decoster L, Van Puyvelde K, De Greve J, Conings G, Milisen K, Flamaing J, Lobelle JP, Wildiers H (2014) Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 32(1):19–26CrossRefPubMed
23.
Zurück zum Zitat Wedding U (2015) Geriatrisches Assessment in der onkologischen Betreuung älterer Patienten. Onkologe 21:469CrossRef Wedding U (2015) Geriatrisches Assessment in der onkologischen Betreuung älterer Patienten. Onkologe 21:469CrossRef
24.
Zurück zum Zitat Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762CrossRef Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762CrossRef
25.
Zurück zum Zitat Stauder R, Eichhorst B, Hamaker ME, Kaplanov K, Morrison VA, Osterborg A, Poddubnaya I, Woyach JA, Shanafelt T, Smolej L, Ysebaert L, Goede V (2017) Management of chronic lymphocytic leukemia (CLL) in the elderly: a position paper from an international Society of Geriatric Oncology (SIOG) Task Force. Ann Oncol 28(2):218–227PubMed Stauder R, Eichhorst B, Hamaker ME, Kaplanov K, Morrison VA, Osterborg A, Poddubnaya I, Woyach JA, Shanafelt T, Smolej L, Ysebaert L, Goede V (2017) Management of chronic lymphocytic leukemia (CLL) in the elderly: a position paper from an international Society of Geriatric Oncology (SIOG) Task Force. Ann Oncol 28(2):218–227PubMed
26.
Zurück zum Zitat Palumbo A, Rajkumar SV, San Miguel JF, Larocca A, Niesvizky R, Morgan G, Landgren O, Hajek R, Einsele H, Anderson KC, Dimopoulos MA, Richardson PG, Cavo M, Spencer A, Stewart AK, Shimizu K, Lonial S, Sonneveld P, Durie BG, Moreau P, Orlowski RZ (2014) International Myeloma Working Group consensus statement for the management, treatment, and supportive care of patients with myeloma not eligible for standard autologous stem-cell transplantation. J Clin Oncol 32(6):587–600CrossRefPubMedPubMedCentral Palumbo A, Rajkumar SV, San Miguel JF, Larocca A, Niesvizky R, Morgan G, Landgren O, Hajek R, Einsele H, Anderson KC, Dimopoulos MA, Richardson PG, Cavo M, Spencer A, Stewart AK, Shimizu K, Lonial S, Sonneveld P, Durie BG, Moreau P, Orlowski RZ (2014) International Myeloma Working Group consensus statement for the management, treatment, and supportive care of patients with myeloma not eligible for standard autologous stem-cell transplantation. J Clin Oncol 32(6):587–600CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Morrison VA, Hamlin P, Soubeyran P, Stauder R, Wadhwa P, Aapro M, Lichtman SM, International Society of Geriatric Oncology (2015) Approach to therapy of diffuse large B‑cell lymphoma in the elderly: the International Society of Geriatric Oncology (SIOG) expert position commentary. Ann Oncol 26(6):1058–1068CrossRefPubMed Morrison VA, Hamlin P, Soubeyran P, Stauder R, Wadhwa P, Aapro M, Lichtman SM, International Society of Geriatric Oncology (2015) Approach to therapy of diffuse large B‑cell lymphoma in the elderly: the International Society of Geriatric Oncology (SIOG) expert position commentary. Ann Oncol 26(6):1058–1068CrossRefPubMed
28.
Zurück zum Zitat Droz JP, Albrand G, Gillessen S, Hughes S, Mottet N, Oudard S, Payne H, Puts M, Zulian G, Balducci L, Aapro M (2017) Management of prostate cancer in elderly patients: recommendations of a task force of the International Society of Geriatric Oncology. Eur Urol 72(4):521–531CrossRefPubMed Droz JP, Albrand G, Gillessen S, Hughes S, Mottet N, Oudard S, Payne H, Puts M, Zulian G, Balducci L, Aapro M (2017) Management of prostate cancer in elderly patients: recommendations of a task force of the International Society of Geriatric Oncology. Eur Urol 72(4):521–531CrossRefPubMed
29.
Zurück zum Zitat Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, Kohne CH, Rostoft S, Lemmens V, Mitry E, Rutten H, Sargent D, Sastre J, Seymour M, Starling N, Van Cutsem E, Aapro M (2015) Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 26(3):463–476CrossRefPubMed Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, Kohne CH, Rostoft S, Lemmens V, Mitry E, Rutten H, Sargent D, Sastre J, Seymour M, Starling N, Van Cutsem E, Aapro M (2015) Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 26(3):463–476CrossRefPubMed
30.
Zurück zum Zitat Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M, Luciani A, O’Brien M (2014) Management of elderly patients with NSCLC; updated expert’s opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 25(7):1270–1283CrossRefPubMed Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M, Luciani A, O’Brien M (2014) Management of elderly patients with NSCLC; updated expert’s opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 25(7):1270–1283CrossRefPubMed
31.
Zurück zum Zitat Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R (2012) Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 13(4):e148–e160CrossRefPubMed Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R (2012) Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 13(4):e148–e160CrossRefPubMed
33.
Zurück zum Zitat Mohile SG, Velarde C, Hurria A, Magnuson A, Lowenstein L, Pandya C, O’Donovan A, Gorawara-Bhat R, Dale W (2015) Geriatric assessment-guided care processes for older adults: a Delphi consensus of geriatric oncology experts. J Natl Compr Canc Netw 13(9):1120–1130CrossRefPubMedPubMedCentral Mohile SG, Velarde C, Hurria A, Magnuson A, Lowenstein L, Pandya C, O’Donovan A, Gorawara-Bhat R, Dale W (2015) Geriatric assessment-guided care processes for older adults: a Delphi consensus of geriatric oncology experts. J Natl Compr Canc Netw 13(9):1120–1130CrossRefPubMedPubMedCentral
34.
Metadaten
Titel
Geriatrische Onkologie
verfasst von
PD Dr. Ulrich Wedding
Publikationsdatum
09.01.2019
Verlag
Springer Medizin
Schlagwort
Onkologie
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 1/2019
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-018-01499-8

Weitere Artikel der Ausgabe 1/2019

Zeitschrift für Gerontologie und Geriatrie 1/2019 Zur Ausgabe

Mitteilungen der ÖGGG

Mitteilungen der ÖGGG

Journal Club

Journal Club