Acceptability of a practical geriatric assessment intervention with older adult cancer survivors and community health workers/promotoras: a qualitative investigation

Introduction: Older adult breast cancer survivors have an average of five chronic conditions, and frequently report worse physical functioning, greater fatigue, and emotional distress, which hinders their ability to perform activities of daily living and achieve whole-person, often function-oriented goals during survivorship care. The Patient Priorities Care (PPC) framework was initially developed on a cohort of older adult cancer survivors and offers a structured approach to: 1) elicit patients’ goals, and 2) align survivorship care with what matters most. Despite evidence that reduces treatment burden in patients with multiple chronic conditions, its application in breast cancer survivorship remains underexplored. Objective: To describe older adults' goals for breast cancer survivorship care based on preliminary findings from a quality improvement initiative aimed at identifying older adult cancer survivors’ care priorities and aligning survivorship care using the Patient Priorities Care (PPC) framework. Methods: We conducted a randomized quality improvement project focused on older adults (≥65 years) with early stage breast cancer, post active cancer therapy (3 months after curative treatment and up to 10 years in their survivorship care) with evidence of burdensome care (having ≥ 3 comorbidities or taking ≥10 medications or seeing more than ≥specialists per year or having ≥ 2 emergency department/hospital visits per year). Using the PPC framework, with the help of a trained facilitator, the participants identified their care preferences and health outcomes goals, as well as barriers (symptoms, medical problems) that were in the way of achieving their goals. Interviews were conducted via telephone or the Teams online platform. A summary of the health priorities identification encounter was provided to the oncology team to use for further care alignment. Demographic data was gathered at baseline and evaluated through frequentist statistical methods. Goal attainment scaling was done at baseline and 3 months following the National Committee for Quality Assurance (NCQA) guidelines. Results: Since January 2025, a total of 32 patients have been enrolled, with a mean age of 73 years. The majority of participants (40%) were diagnosed with stage I breast cancer, followed by ductal carcinoma in situ (18%), stage II (31%), and stage III (9.3%). Regarding treatment received, 97% of patients underwent surgery, 81% received radiation therapy, and 78% received systemic treatment, including hormonal therapy (37.5%), neoadjuvant therapy (6%), and 6% adjuvant therapy (6%). Sixty percent of the patients reported that functional status and maintaining independence were their priority for survivorship care, leading participants to establish goals centered around these themes. Factors influencing goal-setting included physical function, social support, and the presence of chronic comorbidities. Among the 10 patients who reached the 3-month follow-up time point, 9 patients had successfully achieved their stated goal within that timeframe. Conclusions: Preliminary findings suggest that older adult cancer survivors value survivorship care that supports functional goals. The PPC framework may be a useful tool to guide individualized breast cancer survivorship planning and promote goal-concordant care. Future work should explore how these priorities evolve over time and influence decision-making. This project is supported through a K12 NIH Institutional Grant (5K12TR004908-02) and by NIA through a GEMSSTAR (1R03AG089057-01). Citation Format: D. E. Giza, A. Gonzalez, I. Doostan, B. Basbayraktar, A. Mera, G. Yalavarthy, V. Kaklamani, J. A. Barrera, M. Karuturi, S. Ghosh, H. Holmes, A. Naik. Patient priorities for breast cancer survivorship: a preliminary descriptive analysis of the health outcome goals that matter most to older adults breast cancer survivors [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-04-23.

By 2040, there will be an estimated 26.1 million cancer survivors in the United States, with 73% over age 65. Compared to younger survivors and those without cancer, older adult cancer survivors have an elevated comorbidity burden. Lifestyle interventions can play a key role in preventing and managing chronic health conditions and promoting quality of life during and after cancer treatment. Yet, behavioral interventions for maximizing health are under-utilized in older adults with cancer. At times, older adults may have unique needs that require tailoring to increase accessibility, optimization, and uptake of behavioral interventions.This symposium will showcase innovative approaches for enhancing health among older adult cancer survivors during and after cancer treatment. Dr. Bluethmann will discuss design considerations for using geriatric assessment in an ongoing exercise trial to manage side effects of aromatase inhibitors. Dr. Gell will present data on older survivors’ preferences regarding text messaging to support physical activity maintenance from an intervention study. Dr. Leach will discuss the use of technology to facilitate lifestyle change in older cancer survivors, presenting data on older adults’ user preferences and benefits from an eHealth tool. The discussant, Dr. Trevino, will summarize how these interventions can be leveraged to promote engagement in managing older survivors’ health and to inform next steps in intervention development. Collectively, this multidisciplinary group of speakers will provide practical information and “lessons learned” from designing behavioral and technology-based interventions, and highlight the promise that these approaches hold for improving quality of life in aging cancer survivors. Cancer and Aging Interest Group Sponsored Symposium.

BackgroundOlder adults (aged >65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults’ transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns.ObjectiveThis pilot study, which examined older adult cancer survivors’ use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors’ perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers.MethodsA qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (#21‐0421) was obtained. Interpretive description inquiry—a practice-based approach suitable for generating applied knowledge—supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes).ResultsAssessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors.ConclusionsOverall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelings of empowerment. DHTs are an important aspect of contemporary health care; yet, these technologies must be seen as complementary and not as replacements for human interaction. Otherwise, we risk dehumanizing patients and disconnecting them from the care that they need and deserve.

Frailty in older adult cancer survivors after cancer treatments is associated with various health outcomes. However, there is less agreement on how frailty affects symptoms and health-related quality of life (HRQOL). This systematic review and meta-analysis aimed to evaluate the current literature on frailty, symptoms, and HRQOL, as well as the associations of frailty with these factors in older adult cancer survivors with chemotherapy. A review was conducted on peer-reviewed publications from 2008 to 2023, using seven electronic databases. Meta-analyses were performed using random effects models to determine pooled effect estimates for frailty prevalence, symptom severity, and HRQOL scores. A total of 26 studies involving older cancer survivors were included in the analysis. Most of these studies were conducted in Western countries and focused on White survivors, particularly those with breast cancer. The mean pooled prevalence of frailty was 43.5%. Among frail survivors, the most common symptoms reported after cancer treatments were pain (36.4%), neuropathy (34.1%), and fatigue (21.3%). Frailty was associated with higher pooled mean symptom severity (B = 1.23, p = 0.046) and lower functional HRQOL (B = -0.31, p = 0.051, with marginal significance) after cancer treatments. Frail older cancer survivors are at high risk of adverse symptoms and poor HRQOL after cancer treatment. Further research on screening for frailty is needed to prevent older adults from developing worse symptoms burden and maintain HRQOL. It is also essential to understand the mechanisms of the associations between frailty, symptoms and HRQOL in this population.

Objectives: The primary aim of this paper was to examine the potential differences in health-related quality of life (HRQOL) between middle-aged (45–64 years old) and older adult (65 years and older) cancer survivors utilizing the contextual model of health-related quality of life.
 Methods and Materials: The author conducted a secondary data analysis of the 2014 behavioral risk factor surveillance system cancer survivorship module survey. Only respondents age 45 and older were included, resulting in n = 5656.
 Results: Older adult cancer survivors reported significantly better physical and mental HRQOL than middle-aged cancer survivors. In regard to physical HRQOL, respondents who were older adults, employed, completed treatment, and exercised recently were more likely to report good physical HRQOL. Respondents with comorbid conditions and those with greater years since diagnosis were more likely to report poor HRQOL. In regard to mental HRQOL, respondents who were older, married, or had completed treatment were more likely to have good mental HRQOL. Respondents who were unemployed, had experienced financial cost as a barrier to care, had stroke or chronic obstructive pulmonary disorder, or a history of depression were more likely to report poor mental HRQOL.
 Conclusion: Older adult cancer survivors experience better mental and physical HRQOL compared to their middle-aged counterparts. Efforts to improve HRQOL in cancer survivors should include middle-aged adults as well as cancer survivors who are unmarried, still in treatment, or have comorbidities. Greater research is needed to better understand how age differentially affects HRQOL in persons with a cancer history.
 This paper was published by Scientific Scholar and has been archived here.

The association between geriatric assessment (GA)-identified impairments and long-term health care use in older cancer survivors remains unknown. Our objective was to evaluate whether a GA performed at cancer diagnosis was predictive of hospitalizations and long-term care (LTC) use in older adult cancer survivors. Older adults with GA performed between 3 months before through 6 months after diagnosis were included (N = 125). Patients with Medicare Parts A and B coverage and no managed care were identified. Hospitalizations and LTC use (skilled nursing or assisted living) were assessed up to 5 years postdiagnosis. GA risk measures were evaluated in separate Poisson models estimating the relative risk (RR) for hospital and LTC visits, adjusting for age and Charlson comorbidity score. The mean age of patients was 74 years, and the majority were female (80%) and white (90%). Breast cancer (64%) and early-stage disease (stages 0 to III, 77%) were common. Prefrail/frail status (RR, 2.5; P < .001), instrumental activities of daily living impairment (RR, 5.47; P < .001), and limitations in climbing stairs (RR, 2.94; P < .001) were associated with increased hospitalizations. Prefrail/frail status (RR, 1.86; P < .007), instrumental activities of daily living impairment (RR, 4.58; P < .001), presence of falls (RR, 6.73; P < .001), prolonged Timed Up and Go (RR, 5.45; P < .001), and limitations in climbing stairs (RR, 1.89; P < .005) were associated with LTC use. GA-identified impairments were associated with increased hospitalizations and LTC use among older adults with cancer. GA-focused interventions should be targeted toward high-risk patients to reduce long-term adverse health care use in this vulnerable population.

Background: As the population ages and the number of cancer survivors in the USA continues to rise, fall-related injuries are becoming an increasingly critical public health issue. The purpose of this study is to assess the incidence and prevalence of fall-related injuries among older adult cancer survivors, with a particular focus on identifying and understanding racial disparities in fall risk between Black and White cohorts. Methods: A retrospective cohort study using data from 19,370 older adult cancer survivors aged 65 and above, extracted from the TriNetX network at Virginia Commonwealth University Health System (VCUHS). The study spanned from January 1, 2013, to December 31, 2023. Demographic information, including age, sex, race, and ethnicity, as well as ICD-10 codes for cancer history and fall-related injuries, were analyzed. Incidence rates were calculated as cases per person-day. Results: The study found that 7% of the cancer survivors experienced a new fall-related injury, with a prevalence rate of 8% over the study period. The incidence rate was calculated at 0.00005432 cases per person-day. Black or African American survivors exhibited a higher fall risk (4.915%) compared to their White counterparts (4.048%), with a statistically significant risk difference of 0.867% (95% CI: 0.199% to 1.534%). Discussion The findings of this study are consistent with existing literature that highlights the increased fall risk among older adult cancer survivors. The observed racial disparities in fall-related injuries underscore the need for targeted interventions that address the specific challenges faced by minority populations. The study's large sample size and comprehensive dataset strengthen the generalizability of the results, although the reliance on automated ICD-10 coding presents a potential limitation in data accuracy. Conclusions This study reveals significant racial disparities in fall-related injuries among older adult cancer survivors, particularly between Black and White individuals. The findings suggest the need for culturally sensitive and equitable healthcare strategies to improve the quality of life for all cancer survivors.

12043 Background: Little is known about the etiology of second primary cancers among survivors of older adult-onset cancers. Descriptive studies have suggested that lifestyle factors, including body mass index (BMI), may be important. Here we investigated whether BMI is associated with the risk of a subsequent malignancy among older adult cancer survivors. Methods: This analysis was conducted among men and women enrolled in the Cancer Prevention Study II Nutrition cohort who were diagnosed with a first non-metastatic incident cancer between 1992 and 2015. Survivors were followed-up until 2017 for the diagnosis of a subsequent primary malignancy at a different organ to avoid the inclusion of recurrences, as their etiology may differ. Analyses were restricted to those who were younger than 85 years at their initial diagnosis. Subsequent malignancies were included if they were diagnosed at least 60 days after the first cancer. Outcomes of interest were second cancers and obesity-related second cancer as defined by the IARC. BMI at the time or before their first cancer was self-reported (median: 1.3 years from BMI report to diagnosis). Participants who were underweight (BMI&lt;18.5 kg/m2) were excluded. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) to estimate the risk of second cancers associated with BMI. Models were adjusted for age, sex, race, diagnosis year, and stage of the first cancer. Results: This cohort included 26,894 participants diagnosed with a first cancer. The median age at diagnosis of the first cancer was 72.5 years (interquartile range (IQR): 67.7, 77.0). Most participants were women (59%), overweight or obese (60%) and diagnosed with localized disease (71%). During a median of follow-up of 7.5 years (IQR: 3.2, 13.1), 3,748 participants were diagnosed with a second cancer, including 1,140 obesity-related second cancers. Approximately 90% of second malignancies were diagnosed at least 1 year, and 70% at least 5 years after the first cancer. Compared with cancer survivors whose BMI was in the normal range (18.5≤BMI&lt;25), those who were overweight or obese were at an increased risk of any second cancer (25≤BMI&lt;30: HR=1.12, 95% CI: 1.05, 1.21; BMI≥30: HR=1.29, 95% CI: 1.18, 1.42) and BMI-related cancers (25≤BMI&lt;30: HR=1.37, 95% CI: 1.20, 1.57; BMI≥30: HR=1.60, 95% CI: 1.36, 1.88). In particular, obesity was associated with increased risks of breast (HR=1.43, 95% CI: 1.03, 1.98) and colorectal (HR=1.91, 95% CI: 1.42, 1.56) second cancers. Conclusions: Older adult cancer survivors who were overweight or obese at the time of their first cancer diagnosis were at higher risk of developing a second cancer, especially a BMI-related cancer. These findings have important public health implications given the high prevalence of overweight and obesity in this population. Weight loss strategies should be considered and heightened awareness of second cancers among physicians of older cancer survivors.

Survivorship care for older adults with cancer: U13 conference report.

Background/Objectives: Functional limitations are common among older cancer survivors and tend to increase with age and survivorship duration. Physical activity (PA) associates with better functional outcomes, but little is known about how these associations vary as time passes post-diagnosis. This study examined how years since diagnosis, three types of physical activity, and their interactions associate with functional limitations in older cancer survivors. Methods: Data drawn from the 2021 National Health Interview Survey (NHIS), representing adults aged 55+ and with a prior cancer diagnosis (n = 9356; mean age = 72.17 ± 8.5 years), were studied. A four-item self-reported difficulty index (i.e., washing/dressing, walking one block, climbing stairs, and picking up/opening objects) was summed to measure functional limitations. PA was assessed using the items aligned with the United States PA Guidelines. Hierarchical regression was used to evaluate associations between functional limitations and years since diagnosis, vigorous physical activity, moderate physical activity, and strength training. Interaction effects of years since diagnosis and each activity type were also examined. Covariates were age, sex, BMI, and educational attainment. Results: Elapsed time since cancer diagnosis positively associated with functional limitations in interaction with physical behaviors, while moderate physical activity and strength training negatively associated with functional limitations. Interactions of years since diagnosis and both moderate physical activity and strength training revealed smaller increases in functional limitations. No interaction effects were observed for vigorous physical activity. Conclusions: Among older cancer survivors, the association between survivorship duration and functional limitations differs by engagement in moderate and resistance-based physical activity. These findings support the clinical importance of promoting sustainable, non-vigorous physical activity in long-term survivorship care.

Objectives: Despite widespread agreement that personality traits change across the lifespan into older adulthood, the association between changes in personality and depression among older adult cancer survivors is unknown. It was hypothesized that older adults with (vs. without) a past cancer diagnosis would experience an increase in neuroticism, and decreases in conscientiousness, agreeableness, openness, and extraversion, and that changes in these traits would mediate the relationship between receiving a cancer diagnosis and change in depression. Two hypotheses were tested in a cancer survivor sample. First, that increased chronic stressors and decreased physical health would mediate the link between personality change and increased depression. Second, that personality change would mediate the link between changes in chronic stressors/health and increased depression.Method: Secondary data analysis utilizing three waves of data from the Health and Retirement Study. Data was compiled from 5,217 participants, among whom 707 received a cancer diagnosis.Results: Older adults with (vs. without) a cancer diagnosis decreased in conscientiousness, which was associated with increased depression. Among cancer survivors, worsening chronic stressors/health mediated many pathways between personality change and an increased depression. Increased neuroticism mediated the link between worsening health/chronic stressors and increased depression.Conclusion: With the exception of conscientiousness, changes in personality did not mediate the link between cancer survivor status and depression. Among older adult cancer survivors, changes in personality traits may increase depression through worsening physical health and chronic stressors, potentially informing targeted interventions. Interventions that target increased neuroticism may be particularly useful in older adult cancer survivors.

Cancer is a disease associated with aging, with approximately 60% of cancer diagnoses occurring in patients age 65 and older. Of 10.8 million cancer survivors in the US, approximately 6.8 million are age 65 or older. With the aging of the baby boomer population and rises in life expectancy, the number of cancer cases and the number of cancer survivors is anticipated to grow over the coming decades.1 Optimal care of this growing population of older adult cancer survivors will require an understanding of the interaction between cancer, cancer therapy, and the aging process. In particular there is a gap in knowledge regarding whether cancer and/or cancer treatment accelerates the aging process, and if so whether the accelerated aging is transient or permanent. This lecture will provide an overview of the available data regarding the intersection between aging and survivorship, as well as specific considerations in the assessment and treatment of older adult survivors. Cancer and cancer treatment has a potential long term impact on the health status and physical function of older adults.2–3 The Health and Retirement study evaluated the health and functional status of older cancer survivors in comparison to controls. Older cancer survivors were less likely to report excellent or good health (P&amp;lt;0.001), reported more mobility limitations (P&amp;lt;0.001), and reported more limitations with activities of daily living (P=0.01). Among older cancer survivors, obesity, lack of exercise, and poor diet are associated with a poorer quality of life.4 A randomized study tested the benefits of an exercise and diet intervention in older cancer survivors and demonstrated that the intervention was associated with a decrease in self-reported functional decline.5 Older cancer survivors have an increased number of comorbid conditions in comparison to individuals without a history of cancer.2 The NIA/NCI Collaborative Study on Cancer and Comorbidity in the Elderly provided summary data on the comorbidity of 7,600 patients age 55 and older with a history of cancer. The most common comorbid conditions included hypertension (43%), heart conditions (39%) and arthritis (35%).6 Patients may be at increased risk for specific comorbid conditions based on their preexisting comorbid conditions and the therapeutic exposures received. For example, therapy with doxorubicin is associated with an increased risk of congestive heart failure and cardiomyopathy.7–8 Risk factors include a history of diabetes mellitus, coronary artery disease, and hypertension. Therapy with an aromatase inhibitor is associated with a loss in bone mineral density and this risk is most pronounced in patients with pre-existing bone loss.9 These examples highlight the need to better understand the association between a history of cancer, patient characteristics (including pre-existing comorbid conditions), specific therapeutic exposure, and the subsequent development or acceleration of comorbid conditions. Although our knowledge of the potential survivorship issues facing older adults is growing, several gaps in knowledge remain.10 As the number of cancer survivors is on the rise, it is critical to improve our evidence-based knowledge to identify and reduce the risk of late side effects from treatment. Prospective longitudinal studies of the long term impact of cancer therapies and interventions to decrease the risk are needed.

As the population ages and the survival rate of cancer patients increases, long-term management of older adult cancer survivors has become important. Subjective life expectancy (SLE) is a concept that refers to an individual's particular predicted lifespan, which enables individuals to live an active life with hopeful expectations for the extension of a healthy life. Therefore, this study aims to identify the factors related to SLE according to age group, to help enable middle-aged and older adult cancer survivors to actively live out their lives with a sense of control. A descriptive, cross-sectional study was used. This study included 538 participants in the fifth to seventh survey data of the Korean Longitudinal Study of Aging dataset. Moreover, we conducted multivariable regression analyses. The participants of this study were 137 middle-aged (under 64 years), 196 young-old (65-74 years), 164 old-old (75-84 years) and 41 oldest-old (over 85 years) cancer survivors. The mean age of the participants was 71.22 ± 9.4 years. The factors related to SLE were employment status (β=7.43, p =0.018) and quality of life (QOL) (β=0.25, p=0.010) for the middle-aged group and age (β=-1.50, p=0.002) and employment status (β=10.44, p=0.003), and QOL (β=0.31, p < 0.001) in the young-old group; in the old-old group and oldest-old group, the predictors of SLE were QOL (β=0.35, p=0.004) and social network (β=2.76, p=0.018). The SLE of middle-aged and older adult cancer survivors was different by age group, and related factors also varied by it. Therefore, an individual approach for each age group is required to effectively promote SLE. By developing and applying differentiated nursing interventions suitable for each age group for middle-aged and older adult cancer survivors, it should be possible to help them make a healthy transition with positive expectations for life extension.

BackgroundCurrently, 64% of cancer survivors are aged 65+. Older cancer survivors have unique complications after chemotherapy and are often excluded from cancer clinical trials. Although there is research on barriers to clinical trial participation of older adult cancer survivors, to date no research has explored barriers to clinical trial participation unique to rural older adult cancer survivors.MethodsThis study is a secondary qualitative analysis from a study exploring survivorship challenges of rural older adults. Eligible participants were rural residents over age 65 who have completed curative‐intent chemotherapy in the past 12 months. Participants (n = 27) completed open‐ended semi‐structured interviews that included questions on barriers to clinical trial participation. Transcripts were coded independently by two coders using thematic analysis. We have adhered to the standards for reporting qualitative research.FindingsParticipants reported a variety of barriers that included limited knowledge and fear about clinical trials, transportation challenges, their physicians not informing them of clinical trials, and thinking they are too old to participate in clinical trials. However, participants also reported facilitators to participating in clinical trials, including acknowledging benefits to their own health and society, and understanding the importance of clinical trials.ConclusionRural older cancer survivors face numerous interpersonal, intrapersonal, and organizational barriers to clinical trial participation. Aging‐ and location‐sensitive interventions that focus on patients, their caregivers, and health care providers may lead to improved participation of rural older adult survivors into clinical trials.

Objectives: To descriptively assess cannabis perceptions and patterns of use among older adult cancer survivors in a state without a legal cannabis marketplace. Methods: This study used weighted prevalence estimates to cross-sectionally describe cannabis perceptions and patterns of use among older (65+) adults (N = 524) in a National Cancer Institute-designated center in a state without legal cannabis access. Results: Half (46%) had ever used cannabis (18% following diagnosis and 10% currently). Only 8% had discussed cannabis with their provider. For those using post-diagnosis, the most common reason was for pain (44%), followed by insomnia (43%), with smoking being the most common (40%) mode of use. Few (<3%) reported that cannabis had worsened any of their symptoms. Discussion: Even within a state without a legal cannabis marketplace, older cancer survivors might commonly use cannabis to alleviate health concerns but unlikely to discuss this with their providers.