Most clinical cancer therapy trials do not specifically consider the effect of patient age on treatment outcomes, and many even exclude older individuals. This is despite the fact that solid cancers are age-associated diseases and that there are many shared hallmarks between biological ageing and cancer. Thus, there is an increasing awareness of the serious gaps remaining in our knowledge of how older adults respond to cancer treatments, particularly immunotherapies. Emerging evidence suggests that it is not only the physiological and immunological changes associated with chronological ageing that impacts cancer treatment, but also those heterogeneous differences that impact treatment outcomes, such as frailty, comorbidities, and more generally, biological ageing. Importantly, it remains unclear which of these factors are negative or positive contributors, as has been illuminated by recent evidence pertaining to the incidence and severity of immune-related adverse events and survival. Much of our information on older patients in this context is essentially anecdotal, mostly deriving from the treatment of older adults in real-world practice or clinical trials that happened to include some older patients. Given the lack of comprehensive articles on the heterogeneity of ageing as a core determinant of cancer treatment outcomes, we briefly consider the state of the art of cancer research and treatment in the older patient, with an emphasis on immunotherapy and geriatric oncology.

Background and Objectives: This study aimed to comparatively evaluate the association of commonly used comorbidity scores with survival, mortality, and recurrence in ovarian cancer patients aged 50 years and above. Materials and Methods: In this single-center, retrospective study, 130 female patients diagnosed between 2017 and 2024 who had received systemic therapy and had complete medical records were included. Comorbidity scores—including the Charlson Comorbidity Index (CCI), Cumulative Illness Rating Scale-Geriatric (CIRS-G), Adult Comorbidity Evaluation-27 (ACE-27), Elixhauser Comorbidity Index, Index of Coexistent Disease (ICED), and Functional Comorbidity Index (FCI)—were calculated for each patient. Survival analyses were conducted using the Kaplan–Meier method and Cox regression modeling. The prognostic accuracy of comorbidity scores was assessed via receiver operating characteristic (ROC) curve analysis. Results: Patients with higher CCI scores had significantly shorter survival, and CCI was identified as an independent prognostic factor in multivariate analysis. While other comorbidity scores were associated with overall survival in univariate analyses, they lost statistical significance in multivariate models. Patients with a higher comorbidity burden experienced more frequent disease recurrence and shorter time to recurrence. Conclusions: Comorbidity burden is a key clinical determinant of survival and disease trajectory in older patients with ovarian cancer. The CCI demonstrated the highest prognostic accuracy in this population and may serve as a valuable tool in individualized treatment planning. Integration of comorbidity-based assessments into standard decision-making processes is recommended in geriatric oncology practice.

Cardiovascular and cancer-specific mortality in older patients with advanced non-small cell lung cancer following the introduction of immuno-oncology therapies.

Care at home program study of complex geriatric surgical oncology patients.

<br><b>Objective:</b> Standards for assessing muscle echogenicity in older adults with suspected sarcopenia remain poorly defined. While analysis of the full cross-sectional area (CSA) is accurate, it is often time-consuming. This study aimed to determine whether simplified regions of interest (ROIs) could provide comparable results without compromising measurement accuracy.</br> <br><b>Methods:</b> Geriatric oncology patients scheduled for elective surgery underwent muscle ultrasound using a Toshiba Aplio i700 system. Images were analysed with ImageJ software. Muscle echogenicity was measured using four ROIs of varying sizes and shapes compared to a reference ROI encompassing the entire CSA. Measurements were taken from selected upper and lower limb muscles.</br><br><b>Results:</b> All simplified ROIs demonstrated high agreement with CSA-based echogenicity values (ICC > 0.9). Larger ROIs more closely approximated the reference, while the smallest ROI showed reduced correlation. Bland–Altman analysis identified systematic bias: smaller ROIs for the biceps and larger ROIs for the thenar muscle introduced significant discrepancies.</br><br><b>Conclusions:</b> In geriatric oncology patients, muscle echogenicity can be reliably assessed using simplified ROIs as long as they conform to the muscle’s anatomical shape and encompass an adequately large portion of the muscle area. This approach may facilitate faster, standardised assessments in clinical practice.</br>

Frailty, a multidimensional syndrome characterized by decreased physiological reserves and increased vulnerability to stressors, is increasingly recognized as a critical determinant of outcomes in cancer patients, particularly among the elderly.

IntroductionCancer among the oldest-old (aged ≥85) is an escalating public health concern, particularly in the Middle East and North Africa (MENA), where demographic aging is advancing rapidly.MethodsWe analyzed cancer incidence and mortality trends among the oldest-old in MENA from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data, and compared these trends to global patterns.ResultsCancer incidence and mortality among the oldest-old in MENA increased substantially, surpassing global trends. Between 1990 and 2021, incidence rose by 54.2% in MENA vs 25.3% globally, while mortality increased by 17.6% vs 3.1% globally. Females experienced steeper rises in both incidence and mortality. Annual percent change (APC) in MENA incidence was +1.96 (95% CI: 1.28-2.64) for females and +0.83 (95% CI: 0.59-1.08) for males, compared to +0.28 (95% CI: 0.18, 0.38) and +0.47 (95% CI: 0.40, 0.55) globally. APC for mortality in MENA was +1.27 (95% CI: 0.66-1.88) for females and +0.33 (95% CI: 0.12-0.54) for males, vs −0.07 (95% CI: −0.13, 0.0) and +0.11 (95% CI: 0.03, 0.18) globally. Leading cancers were prostate, lung, and colorectal for males, and breast, colorectal, and lung for females, with variation across countries.ConclusionThe rising cancer burden among the oldest-old in MENA underscores the urgent need for targeted interventions. Strengthening preventive measures, improving healthcare access, enhancing cancer registration, and implementing tailored screening and treatment strategies are critical. Policymakers must prioritize geriatric oncology and invest in healthcare infrastructure to ensure equitable, effective cancer care for the region’s aging population.

Time to modernise research in geriatric oncology: Reflections from the 2025 International Society of Geriatric Oncology Annual Meeting.

Do we need geriatricians in geriatric oncology? A SIOG geriatricians position statement.

Reduced food intake is a key aetiological factor of malnutrition. The study purpose was to validate the ingesta Verbal Analogue Scale (ingesta-VAS), a promising tool for rapid food intake assessment, in older adults with cancer in whom malnutrition is frequent and affects treatment outcomes and survival. This prospective study focused on ≥70-year-old patients with a diet history undergoing their first oncological treatment at a French cancer centre. Exclusion criteria included surgery, oral intake cessation, or artificial nutrition use. Dietitians evaluated nutritional status, daily energy intake, and used the ingesta-VAS and Mini-Nutritional Assessment-Short Form (MNA-SF). The ingesta-VAS validity, sensitivity, specificity, and prognostic impact were assessed using daily food intake as primary criterion, then <25 kcal/kg/day as reference standard for inadequate energy intake. The Area Under the Curve was used to select the cut-off. Overall survival was assessed with the Kaplan-Meier analysis. The analysis involved 441 participants. The correlation between ingesta-VAS scores and energy intake was strong ( = 0.71), and moderate with the MNA-SF scores ( = 0.55, p < .001). Its sensitivity and specificity for detecting inadequate energy intake was 79.0% and 72.6%, respectively. Combined with performance status and body mass index, ingesta-VAS significantly predicted the inadequate energy intake (odds ratio: 10.2, p < 0.001). Difference in overall survival groups was significant with the cut-off of ≤7 [HR = 1.60 (95% CI: 1.29-1.98), p < 0.001]. The ingesta-VAS exhibits reliable metrological properties and may serve as an early, non-invasive, and simple tool to screen reduced food intake in older adults with cancer for detecting the risk of malnutrition.

Decision-making for chemotherapy in early breast cancer (EBC) in OA (older adults: age ≥ 65years) is complex due to frailty, multimorbidity, and competing risks for mortality. Magnuson (2021) developed a chemotherapy toxicity prediction score, CARG-BC; its external validation can improve generalizability. CARG-BC's ability to predict grade 3 + chemotoxicity in OA with EBC (primary), unplanned healthcare use, and changes to chemotherapy protocol (secondary). A single center retrospective cohort study comprising OA with EBC who received (neo) adjuvant chemotherapy from 2013-2023. Clinical, demographic, CARG-BC, and healthcare usage variables were extracted from patient records. Risk groups based on CARG-BC score were compared using T-test (continuous variables) & χ2 test (categorical variables). Toxicity risk based on CARG-BC score was assessed using logistic regression. The predictive ability of the CARG-BC score was evaluated by calculating AUC. Of 243 patients, the median age was 70years (range 65-86), 99.6% female, 80.2% with comorbidities, 33.7% with polypharmacy, 28.8% living alone, and 8.2% seen in the geriatric oncology clinic. Over half (53.9%) had grade 3 + toxicities. Healthcare utilization included 19.8% of patients with at least one unplanned clinic visit, 29.6% an emergency care visit, and 14.4% a hospitalization. The median CARG-BC score was 7 (IQR 3, 8) and the CARG-BC AUC was 0.76 (95% Confidence interval [CI] 0.70, 0.82). The odds of grade 3 + toxicity is increased by 1.33 times per CARG-BC point increase. The CARG-BC model retained good discrimination for grade ≥ 3 chemotoxicity and should be used in shared-decision-making with OA.

Intrinsic capacity in community-dwelling older adults and cancer survivors: a comparative study.

INTRODUCTION. The risk of cancer increases with age. Furthermore, frailty and age-related impairments significantly impact treatment outcomes. With an aging population, it is crucial to ensure a tailored, evidence-based cancer care approach. This study evaluated the extent to which frailty and age-related considerations are incorporated into current Danish national cancer guidelines across six frequent cancer types. METHODS. We systematically reviewed all guidelines from the Danish Multidisciplinary Cancer Groups on lung, breast, colorectal, ovarian, bladder and prostate cancer. Guidelines were screened to identify how they address age, frailty, performance status (PS), comorbidity, functional status, general health status and individualised assessment. Identified comments were graded based on their level of specificity and clinical applicability. RESULTS. All cancer guidelines addressed age and comorbidity. Frailty was explicitly mentioned in four out of six, of which only one guideline provided specific recommendations. PS was frequently included (5/6), and individualised assessments were encouraged in four of six guidelines, but lacked clarity regarding implementation. CONCLUSIONS. Danish national cancer guidelines acknowledge age, PS and comorbidity, but lack specific recommendations for frailty assessment and management. By addressing these gaps, we encourage future guidelines to include recommendations on frailty assessment to help clinical decision-making and improve treatment outcomes for older people with cancer. FUNDING. None. TRIAL REGISTRATION. Not relevant.

In geriatric oncology, family members frequently accompany patients during medical consultations, providing emotional and practical support while participating in shared decision-making (SDM). Family involvement in SDM can facilitate the decision-making process but also pose challenges for healthcare professionals. Additionally, much of the SDM deliberation occurs outside the clinical setting, making it important to understand family dynamics to ensure treatment decisions align with the patient's values and preferences. Therefore this study aims to explore the experiences and perspectives of family members regarding their involvement in decision-making processes for older patients with cancer, and the subsequent impact on roles and family dynamics. Qualitative open in-depth interviews were conducted with 16 family members of 11 patients with cancer of 70 years and older in the Netherlands. Qualitative data analysis was conducted using a thematic analysis approach. Four interconnected themes emerged. The first theme, "Roles" revealed that family members often provide both practical and informational support, and sometimes act as advocates for the patient. The second theme, "Family Values and Beliefs," highlighted a strong sense of unconditional and reciprocal support within families, emphasizing the core value of caring for one another. Third, "Family Dynamics," encompasses: keeping everyone informed, dividing caregiver tasks, dealing with disappointment and sadness, managing different opinions, and coping with uncertainty. Finally, "Dilemma's" describes: family members balancing their own opinions with the patient's preferences, reconciling hope and fear, weighing trust in medical professionals against their own judgment, and balancing caregiving responsibilities with their personal lives. These dilemmas were shaped by roles the family members assumed, the underlying values and beliefs, and family dynamics. The findings of this interview study provide valuable insights into the complex roles that family members of older patients with cancer play in medical consultations and treatment decision-making and their dilemma's. These roles are deeply influenced by family values and dynamics, which can significantly shape decision-making processes and outcomes. Understanding these factors can help healthcare professionals as it highlights the evolving responsibilities of family caregivers and the importance of supporting them in navigating the intricacies of treatment decisions while maintaining respect for patient autonomy.

Rationale:Head and neck osteosarcoma is a rare malignancy, accounting for 6%–10% of all osteosarcomas, and typically affects younger individuals. Its occurrence as a metachronous tumor in elderly patients, particularly after radiotherapy, is exceedingly uncommon.Patient concerns:A 91-year-old man with a history of right lateral tongue verrucous carcinoma treated by surgery and adjuvant radiotherapy (50 Gy) in 2006 presented in 2024 with progressive hoarseness and dysphagia for 6 months.Diagnoses:Clinical examination revealed a firm neck mass. Laryngeal biopsy showed benign keratosis, while core needle biopsy demonstrated a malignant mesenchymal tumor with osteoid production. Immunohistochemistry showed negative cytokeratin and p63, and Ki-67 positivity in 20% of cells, confirming osteosarcoma. Imaging revealed a calcified lesion involving the hyoid, thyroid cartilage, and tongue base, consistent with metachronous head and neck osteosarcoma.Interventions:Due to advanced age and comorbidities (hypertension and diabetes), palliative radiotherapy (30 Gy in 15 fractions) was administered. Surgery and chemotherapy were avoided because of frailty and limited benefit.Outcomes:The patient tolerated treatment well, achieving partial symptom relief without major toxicity. Long-term follow-up continues with a focus on quality of life.Lessons:This case highlights the diagnostic challenges of secondary head and neck osteosarcoma following radiotherapy and the importance of long-term surveillance in elderly patients. Individualized management balancing treatment efficacy and tolerability is essential in geriatric oncology.

BackgroundSkeletal muscle index (SMI), grip strength, and physical performance have been shown to predict clinically relevant outcomes in geriatric oncology. However, their predictive ability for chemotherapy toxicity is poorly understood. We examined whether SMI, grip strength, or physical performance are independently associated with severe toxicity among older adults receiving chemotherapy.MethodsOlder adults (≥65y) who had received chemotherapy at an academic cancer center between June 2015 and June 2022 were included in the analysis. SMI prior to chemotherapy was determined via computed tomography (CT), using the entire cross-sectional area of the muscle (cm2) at the third lumbar vertebra (L3) divided by the square of patient height in meters. Grip strength and lower extremity physical performance were measured prior to chemotherapy. Multivariable logistic regression was used to examine the independent associations between SMI, low grip strength, and low physical performance with severe (grade≥3) chemotherapy toxicity.ResultsOf the 115 older adults in the study, 71.3% were males. The most common disease site was genitourinary (53.9%) and most participants received chemotherapy with palliative intent (67.8%). A total of 69 (60.0%) participants experienced at least one grade ≥3 toxicity during the study. In multivariable analyses, low grip strength per the Sarcopenia Definitions and Outcomes Consortium (SDOC) definition was significantly associated with grade ≥3 toxicity (adjusted odds ratio (OR): 2.77, 95%CI: 1.03–7.45, p = 0.044). SMI either as a continuous (OR: 1.03, 95%CI: 0.97–1.09, p = 0.40) or categorical variable (OR: 1.17, 95%CI: 0.47–2.89, p = 0.74) was not predictive of grade ≥3 toxicity. Similarly, low physical performance did not have significant associations with grade ≥3 toxicity (OR: 2.06, 95%CI: 0.86–4.95, p = 0.11).ConclusionLow grip strength may predict grade ≥3 toxicity among older adults receiving chemotherapy. Integrating grip strength into geriatric assessment may help clinicians identify older adults who might be at greater risk for severe chemotherapy toxicity.

Abstract With the acceleration of China’s aging society, elderly patients have become a high-risk group for malignant tumors and exhibit high prevalence of pain. For a long time, the diagnosis, treatment, and management of cancer pain in elderly Chinese patients have been inadequate. This study used "Older adults, geriatric patients, cancer pain, pain assessment, pain management, elderly cancer, geriatric oncology, medication management, palliative care, interdisciplinary pain management, Analgesics, quality of life" as key words. We systematically searched PubMed, Web of Science, CNKI, and Wanfang databases from their inception to September 2024. The search primarily included phase I to III clinical trials, randomized controlled trials, meta-analyses, systematic reviews, and case reports. Elderly patients typically present with complex pain mechanisms, including both cancer-related and non-cancer pain, cognitive dysfunction, comorbidities, and polypharmacy, posing significant challenges for clinical diagnosis and treatment. Notable clinical differences exist between elderly and younger patients in the epidemiology, assessment, diagnosis, and treatment of cancer pain. Currently, the awareness of comprehensive management for elderly cancer pain patients is limited, and specific, implementable clinical guidelines are lacking. Therefore, developing a comprehensive, localized management model for elderly cancer pain patients in China—incorporating factors such as age-related impacts, organ function status, and comorbidities—has become an urgent necessity.

Abstract BACKGROUND Glioblastoma (GBM) in elderly patients (≥65 years) is associated with poor prognosis and increased treatment toxicity. As a result, many receive de-escalated treatment regimens, often guided by MGMT promoter methylation status. However, real-world outcome data across treatment strategies remain limited. METHODS We conducted a retrospective cohort study of 573 elderly GBM patients treated between 2009–2023 at two Israeli tertiary centers. Patients were categorized by post-operative treatment: (1) chemoradiotherapy (CRT; 60Gy/30 fractions or 40Gy/15 fractions) (2) temozolomide (TMZ) monotherapy, (3) radiotherapy alone (RT), or (4) best supportive care. MGMT methylation status and Karnofsky Performance Status (KPS) were analyzed where available. Survival was assessed using Kaplan-Meier and log-rank tests. RESULTS Median overall survival (mOS) was longest in the CRT group (14 months) compared to 8 months for TMZ and RT monotherapies and 2 months for best supportive care. Among MGMT-methylated patients, CRT was associated with mOS of 24 months, versus 8 months for TMZ alone. Younger age, surgical resection and higher KPS at diagnosis predicted longer survival. In the TMZ group, toxicity was low (6% hematologic, 12% non-hematologic grade 3/4 events) and survival increased with number of TMZ cycles received. Salvage therapy after progression was associated with longer overall survival (4 vs, 10 months) and extended post-progression survival (59 vsv, 131 days). CONCLUSION Fit elderly patients derive significant benefit from full standard-of-care treatment, particularly when MGMT-methylated. Age alone should not dictate treatment intensity. These real world findings support integrating clinical, molecular, and functional factors into geriatric oncology decision-making.

Geriatric hematologic care in Latin America: Results from a regional survey of hematology centers

Trends and disparities in mortality from chronic lymphocytic leukemia in the geriatric population in the United States from 1999 to 2020: A nationwide analysis