We previously reported the results of a prospective observational study evaluating activities of daily living (ADL) at six months after curative surgical resection in patients aged ≥75 years with non-small cell lung cancer (NSCLC). In this manuscript, we report the 24-month longitudinal ADL outcomes in this population, providing important data to support treatment decision-making and to identify risk factors for long-term functional decline.

This is a prospective, multi-institutional observational cohort study conducted in Japan. We evaluated patients aged ≥75 years who underwent curative surgery for stage 0-III NSCLC. ADL were evaluated at 6, 12, and 24 months postoperatively using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), which encompasses dimensions of instrumental activities of daily living. We defined ADL deterioration as a decline of ≥3 points or missing data and performed multivariable analyses for ADL deterioration.

The follow-up data of 876 patients were available for a median of 24.2 months. At 6, 12, and 24 months postoperatively, the proportion of patients with ADL deterioration was 11.0 %, 10.3 %, and 12.6 %, respectively. Multivariable analysis revealed that factors such as poor performance status, low G8 score, undergoing segmentectomy instead of wedge resection, and surgery duration <3 h were associated with ADL deterioration after six months. Conversely, a low G8 score was sole factor associated with a decline in the TMIG-IC score after 24 months. Multivariable analysis demonstrated that at six months, segmentectomy was significantly associated with more ADL deterioration compared with wedge resection, with an odds ratio (OR) of 4.96 (95 % confidence interval [CI]: 1.88-13.07). However, segmentectomy and wedge resection showed no significant difference at 24 months (OR: 0.92, 95 % CI: 0.40-2.10).

Among patients aged ≥75 years undergoing lung cancer surgery, approximately 10 % experienced a decline in ADL at six months postoperatively; however, the proportion remained stable thereafter, suggesting no further functional deterioration. Short-term ADL tended to be preserved with wedge resection, but this advantage diminished over time. The insights from this study are also expected to inform patient decision-making regarding treatment strategy.

The Geriatric Depression Scale is a useful tool in screening for depression in older adults, a particularly vulnerable population in oncology. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) has been validated as a fast and effective screening tool for psychological distress in general oncology populations, and it could possibly be used as a surrogate for the longer Geriatric Depression Scale (GDS) test in older adults with cancer.

In this retrospective cross-sectional study in older adults prior to starting cancer treatment, we evaluated the relationship between the DT and GDS by comparing 242 older adults with cancers' DT scores to their GDS scores, used receiver operating characteristic analysis to determine a DT cutoff score, and used logistic regression to identify variables associated with higher distress.

The Spearman correlation coefficient between GDS and DT was 0.41, p < 0.001. A cutoff score of 4 was found to be most sensitive and specific (0.66,0.68) for predicting a positive GDS (c-index = 0.70).

These results indicate the potential utility of the DT as a mildly to moderately effective screening tool for depression in older adults with cancer starting treatment and support the current NCCN cutoff guidelines to indicate the need for additional distress interventions.

Patients older than 65 years have unique needs and treatment outcome goals. The objective of this study was to evaluate the impact of Geriatric Surgery Verification (GSV) initiative in oncology patients 65 years or older undergoing major abdominal operation.

We implemented the American College of Surgeons GSV program protocols for patients 65 years and older starting in 2022. A retrospective review was conducted of patients undergoing major abdominal oncologic operation from January 2021 through December 2022 to create pre-GSV and post-GSV initiative cohorts. Main outcome variables were postoperative institutionalization and change in the patient's primary residence disposition (measured as Primary Residence Score as a proxy for loss of independence).

A total of 57 patients in the control group and 43 patients in the intervention group met inclusion criteria. The average age was 76.5 and 75 years, respectively. Patients were well matched for clinical and sociodemographic characteristics. The intervention group had a shorter mean length of stay (4.4 ± 2.5 days vs 6.5 ± 3.6 days in the control group [p < 0.01]) and were less likely to be newly discharged to an institution (7.3% vs 24.1%, p = 0.03). The GSV initiative was associated with 72% lower odds of increased Primary Residence Score (ie care needs) at time of discharge (odds ratio 0.28, 95% CI 0.1 to 0.81).

The GSV initiative intervention in geriatric oncology patients undergoing major abdominal operation was associated with reducing postoperative institutionalization and change in primary residence disposition. Further studies to explore different mechanisms within GSV that lead to improved outcomes in geriatric oncologic population will be informative.

As patients with cardiac disease age and become frail, their care needs become more complex. Therefore geriatric care might benefit these patients. This review summarizes current research investigating the impact of geriatric care on clinical outcomes in older cardiac patients.

The MEDLINE, Embase, and Cochrane databases were searched on 11 May 2023 for randomized controlled trials (RCTs) and observational studies comparing additional geriatric care to usual care in older (+70) cardiac patients. The Cochrane risk of bias tool and Robbins-E tool were used for quality assessment of RCTs and observational studies respectively. Data on mortality rates, readmissions, length of stay, complications, discharge destinations, functional outcomes, and quality of life (QoL) were extracted. Two authors independently selected studies, extracted data and assess study quality.

Twelve articles involving 3531 patients (average age 73-85 years; 44-59 % male) were identified, mainly focussing on heart failure or patients requiring cardiothoracic surgery. The studies had a moderate to high risk of bias. Two out of three studies (n = 771) showed reduced complication rates (e.g. delirium incidence) when comparing geriatric assessment to usual care. Additionally, two out of three studies (n = 449), indicated improved QoL scores for patients who received a geriatric care. No significant effects were found for other outcomes.

Low-quality evidence suggests that geriatric care may be associated with lower complication rates and an improved quality of life in older cardiac patients. However, more research is needed to clarify the effect of a geriatric care in this patient population.

The study protocol was registered in the international prospective register of systematic reviews (PROSPERO 2022 CRD42022337353).

Comprehensive geriatric assessment (CGA) can prevent functional decline in patients with hematological malignancies (HM). The Integrated Care for Older People (ICOPE) program has been developed to monitor intrinsic capacity (IC) and to propose patient-centred interventions to prevent functional decline. ICOPE may also be relevant in older adults with HM. The objective of this study was to describe IC in older patients with HM.

Patients aged above 60 years old diagnosed with a HM, with an activities of daily living (ADL) score ≥ 5, were recruited from the Oncological Geriatric department of the Toulouse University Hospital during routine cancer assessment. The ICOPE Step 1 was implemented in all participants using a digital tool. IC was assessed in these domains: cognition, mobility, nutrition, mood, vision, and hearing. A follow-up Step 1 was proposed systematically at six months.

A total of 403 patients with HM aged 82 (±6.5) years underwent a Step 1 assessment. Three hundred and seventy-one (92.1 %) patients presented an altered Step 1 assessment with 2.4 ± 1.4 altered IC domains. The most frequent altered domains were cognition in 203 (50.4 %), hearing in 193 (47.9 %), and mobility in 177 (43.9 %). Two hundred twelve (65.8 %) underwent a Step 1 follow-up at six months.

ONCO-ICOPE provides an innovative framework to assess and monitor IC in patients with HM at high risk of functional decline. With a digital solution, its objective is to expand IC assessment and bridge the gap between primary care and oncologic care for a more personalized patient care plan.

With the global population aging, the care of elderly cancer patients has become increasingly complex and significant. Comprehensive geriatric assessment (CGA), a multidimensional evaluation tool, has been widely implemented in oncology nursing to enhance the precision of treatment decisions and improve patient outcomes. This review examines the application of CGA in oncology nursing, drawing on literature published between 2010 and 2024 in major databases using keywords such as "Comprehensive Geriatric Assessment" and "Oncology Nursing". It highlights how CGA contributes to optimizing treatment selection, monitoring the treatment process, and improving patients' quality of life and long-term outcomes. CGA provides a comprehensive evaluation of elderly cancer patients, including physical, psychological, and social aspects, enabling the identification of high-risk patients and reducing treatment-related side effects and complications. It also offers a critical foundation for developing personalized care plans. The article discusses various practical examples of CGA implementation across different countries and regions, including multidisciplinary collaborative models in France, the United States, and Australia, demonstrating CGA's flexible application in diverse healthcare settings. Although significant progress has been made in applying CGA in oncology nursing, numerous challenges remain in its implementation, such as resource limitations and insufficient personnel training. Future research will focus on integrating CGA with emerging technologies, such as artificial intelligence and precision medicine, to further improve the quality of care and treatment outcomes for elderly cancer patients. By summarizing the current status and challenges of CGA in oncology nursing, this review provides guidance for future research and clinical practice, emphasizing the importance of advancing CGA application to meet the growing demands of elderly oncology care.

Prostate cancer is the most common cancer in men aged above 75 years old. Given their heterogeneity, the International Society of Geriatric Oncology recommends using a comprehensive geriatric assessment (CGA) to adapt anticancer treatment management according to their geriatric status. While the theoretical value of this approach is in no doubt, the impact of the CGA on the final therapeutic decision remains elusive. This study therefore investigated the impact of comprehensive geriatric assessment on treatment decisions in older patients diagnosed with prostate cancer and described the factors associated with a change in treatment plan.

This single-centre retrospective study included prostate cancer patients who received a CGA prior to a therapeutic decision from January 2012 to December 2022. The CGA included medical, nutritional, cognitive, social, functional and psychological evaluation.

140 patients were included, of whom 57 (40.7%) benefited from a change in their therapeutic plan after CGA, all in favour of a less aggressive treatment. There was no difference in event-free (EFS) or overall survival (OS) between patients with or without a therapeutic modification (HR for OS = 1.12 [0.68;1.84] p = 0.048). Factors associated with a change in treatment plan were a WHO performance status > 1, a high age-adjusted Charlson score, polymedication, an impaired functional independence with the ADL (Activities of Daily Living) scale and a 'frail' or 'vulnerable' geriatric profile according to Balducci's classification.

A comprehensive geriatric assessment prior to prostate cancer treatment plan initiation lead to therapeutic de-escalation in 40% of cases of without affecting overall survival or event-free survival. This adaptation offering a more tailored cancer management while preventing functional impact of treatment due to toxicity and improving patient quality of life.

The study was registered as (number's register: F20240123102237) and MR004 (CNIL number: 23RDUROL01).

In chemotherapy for unresectable advanced pancreatic cancer (UPC), the clinical utility of pre-treatment health assessment questionnaires, EuroQoL 5-Dimension 5-Level (EQ-5D-5L) and G8, is unknown. This study aimed to fill this gap.

This multicenter, prospective, observational study investigated the association of EQ-5D-5L and G8 with the clinical outcomes of first-line gemcitabine plus nab-paclitaxel (GnP) for UPC. Differences in survival were analyzed using the log-rank test, and multivariate analyses were performed using the Cox proportional hazards model.

Between April 2022 and September 2023, 60 patients were enrolled, and their data were analyzed. When patients were classified into two groups using the median EQ-5D-5L utility value (0.824), progression-free survival (PFS) and overall survival (OS) were significantly longer in patients with high EQ-5D-5L utility values than in those with low utility values (median PFS 7.0 vs. 4.7 months, P < 0.01; median OS 12 vs. 8.0 months, P = 0.023). Such differences were not observed in the EQ-5D-5L Visual Analog Scale or G8 scores. There was no association between the occurrence of severe adverse events and EQ-5D-5L or G8 scores. Multivariate analyses showed that high EQ-5D-5L utility value (≥ 0.824), high albumin (≥ 3.8 g/dl), and low carcinoembryonic antigen (CEA) (< 5.4 ng/mL) were preferable independent efficacy predictors for PFS and also independent prognostic factors for OS.

Pre-treatment EQ-5D-5L utility value, along with albumin and CEA, was an independent efficacy predictor and prognostic factor in patients with UPC treated with first-line GnP. Their usefulness should be validated in future studies.

Surgery is an essential part of cancer treatment, particularly for localised solid tumours. Geriatric assessments (GA) with tailored interventions or comprehensive GA (CGA) can identify frailty factors and needs of older adults with cancer, assisting treatment decisions and care strategies to reduce postoperative complications. This systematic review summarises the effects of GA/CGA compared to usual care for older adults with cancer intended for surgery: their impact on treatment decisions, supportive care interventions, postoperative complications, survival, and health-related quality of life (HRQOL).

We conducted a systematic search of MEDLINE, EMBASE, CINAHL, and PubMed (January 2000-October 2022) for randomised controlled trials (RCTs) or cohort studies with a comparison group on the effects of GA/CGA in older adults with cancer (≥65 years) intended for surgery. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to heterogeneity in study designs and reporting, a meta-analysis was not possible; results are narratively described.

From 12,440 citations, 312 were selected for full-text review. Thirteen studies reporting on 12 trials were included for analysis: four RCTs and eight cohort studies with comparison groups (three prospective, five retrospective). RCTs ranged in sample size (122-475; mean 249), with variability in who performed GA/CGA, disciplines involved, and team integration. Primary outcomes included impact of GA/CGA on postoperative delirium (two studies), Clavien-Dindo (CD) grade II-V postoperative complications (one study), hospital length of stay (one study), and a composite criterion including mortality, functional impairment, and weight loss (one study). All RCTs scored high for risk of bias due to underpowering for their primary outcome; none met their primary endpoint. After adjustment for prespecified factors in secondary analyses, one RCT found GA/CGA significantly reduced the odds of postoperative complications (CD grade I-V) (adjusted-OR: 0.33, 95 %CI: 0.11-0.95; p = 0.05) due to fewer grade I-II complications. One RCT reported no significant difference between groups in HRQOL: intervention patients reported less pain at discharge, but this difference disappeared at three-month follow-up.

Well-powered, high-quality trials are needed to determine the impact of GA/CGA on optimising surgical treatment decisions, supportive care and postoperative outcomes for older adults with cancer.

Pancreatic cancer resection in the elderly population represents a challenging problem. In addition, a chronological age for the "elderly" is lacking. The aim of the present review was to assess the safety and feasibility of major pancreatic tumor resection in elderly patients, considering different age cut-offs (≥70; ≥75 and ≥80 years old).

A search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on the PubMmed/MEDLINE database. The population analyzed included elderly patients undergoing pancreatic resection for pancreatic cancer as compared with younger patients to evaluate morbidity, mortality, clinically relevant postoperative pancreatic fistula, delayed gastric emptying, post-pancreatectomy hemorrhage, length of stay, overall survival, and disease-free survival.

The results of each study were reported using Risk Ratio (RR), Odds Ratio (OR) or Mean Difference and their P value. Twenty-four studies were included in the review for a total of 33,896 cases of which 25,937 (76.5%) were young people and 7378 (23.5%) were elderly people. The elderly age cut-off was mainly defined as ≥70 years old. Regarding the age cut-off ≥70 years old, the results comparing elderly patients (≥70 years) and younger patients (<70 years) were similar; for the age cut-offs ≥75 and ≥80 years old. Higher mortality and morbidity rates were found in the studies due to the fact that patients ≥75 and ≥80 years or older more frequently had major comorbidities than the younger patients.

This review showed that 1) elderly age cut-off has to be considered as ≥ 70 years old, and 2) age alone is not a contraindication for pancreatic cancer resection. However, elderly patients were frailer and more vulnerable than younger patients, and therefore required a careful preoperative assessment.

The evidence supporting geriatric assessment (GA) in cancer care is well established, and GA is recommended by the American Society of Clinical Oncology, the International Society of Geriatric Oncology, and other oncology bodies. However, effective implementation of GA remains inadequate. Using selected papers indexed in Medline from the most recent 18 months to July 2024, including two outstanding interest papers, this review aimed to describe enablers and barriers to GA implementation in oncology and contrasts implementation with and without an implementation science framework. Finally, we make recommendations on applying an implementation science framework to facilitate integrating GA in oncology.

Implementation science frameworks have been widely employed in health services research, but their use in geriatric oncology, particularly to guide GA implementation and evaluation, is limited. Lack of time in busy practices coupled with workforce shortages adds to the challenges of GA implementation and adoption. A variety of screening and assessment tools such as the G8, electronic rapid fitness assessment, and Eastern Cooperative Oncology Group are often used in lieu of geriatrician review and to streamline GA. When effectively implemented in oncology, GA informs care and treatment decisions for improved outcomes.

Despite the benefits for older adults, embedding GA into routine clinical practice is critical yet not common practice. The variety of available GA tools, logistics, and individual beliefs are some of the identified barriers to GA adoption in oncology. Enablers include organization readiness, adaptability, communication, and the use of multidisciplinary teams. Further research is needed to examine how implementation science frameworks could provide guidance and structure for successful GA implementation in oncology.

Frailty, a geriatric syndrome characterized by decreased resilience and physiological reserve, impacts the prognosis and management of older adults significantly, particularly in the context of surgical and oncological care.

To provide an overview of frailty assessment in the management of older patients with a renal mass/renal cell carcinoma (RCC), focusing on its implications for diagnostic workup, treatment decisions, and clinical outcomes.

A narrative review of the literature was conducted, focusing on frailty definitions, assessment tools, and their application in geriatric oncology, applied to the field of RCC. Relevant studies addressing the prognostic value of frailty, its impact on treatment outcomes, and potential interventions were summarized.

Frailty is a poor prognostic factor and can influence decision-making in the management of both localized and metastatic RCC. Screening tools such as the Geriatric Screening Tool 8 (G8) and the Mini-COG test can aid clinicians to select older patients (ie, aged ≥65 yr) for a further comprehensive geriatric assessment (CGA) performed by dedicated geriatricians. The CGA provides insights to risk stratify patients and guide subsequent treatment pathways. As such, the involvement of geriatricians in multidisciplinary tumor boards emerges as an essential priority to address the complex needs of frail patients and optimize clinical outcomes. Herein, we propose a dedicated care pathway as a first key step to implement frailty assessment in clinical practice and research for RCC.

Frailty has emerged as a crucial factor influencing the management and outcomes of older patients with RCC. Involvement of geriatricians in diagnostic and therapeutic pathways represents a pragmatic approach to screen and assess frailty, fostering individualized treatment decisions according to holistic patient risk stratification.

Frailty, a decline in resilience and physiological reserve, influences treatment decisions and outcomes in elderly patients with renal cell carcinoma, guiding personalized care. In this review, we focused on pragmatic strategies to screen patients with a renal mass suspected for renal cell carcinoma, who are older than 65 yr, for frailty and on personalized management algorithms integrating geriatric input beyond patient- and tumor-related factors.

High-quality decision making in radiation oncology requires the careful consideration of multiple factors. In addition to the evidence-based indications for curative or palliative radiotherapy, this article explores how, in routine clinical practice, we also need to account for many other factors when making high-quality decisions. Foremost are patient-related factors, including preference, and the complex interplay between age, frailty and comorbidities, especially with an ageing cancer population. Whilst clinical practice guidelines inform our decisions, we need to account for their applicability in different patient groups and different resource settings. With particular reference to curative-intent radiotherapy, we explore decisions regarding dose fractionation schedules, use of newer radiotherapy technologies and multimodality treatment considerations that contribute to personalised patient-centred care.

Diffuse large B-cell lymphoma (DLBCL) is one of the most common and aggressive forms of non-Hodgkin's lymphoma. This study aimed to evaluate the performance of the abbreviated Comprehensive Geriatric Assessment (aCGA) in assessing frailty and predicting clinical outcomes in elderly patients with DLBCL.

A total of 91 patients aged ≥ 65 years with newly diagnosed DLBCL and who received immunochemotherapy at a single medical center in Taiwan between August 2019 and December 2022 were prospectively enrolled. Frailty was assessed in all participating patients within seven days of the first cycle of immunochemotherapy. The primary objective was to compare aCGA's accuracy in assessing frailty with that of the full CGA. Secondary objectives included assessing correlations between frailty and severe adverse events (sAEs), early mortality, and overall survival (OS).

In the cohort, 50 (55%) and 38 (42%) patients were categorized as frail based on CGA and aCGA, respectively. A high number of aCGA domains impairment were positively associated with a high number of CGA domains impairment. The receiver operating characteristic for aCGA for detecting frailty was 0.846 (95% confidence interval [CI], 0.756-0.926). A cut-off point of ≥ 2 aCGA domain impairments indicated frailty, with a sensitivity of 70.0% and specificity of 92.7%. Based on aCGA, the early mortality rate was 7.5% and 26.3% (p = 0.019) for fit and frail patients, respectively. The 1-year and 2-year OS rates were 77.7% and 67.4% for fit patients, and 57.1% and 45.4% for frail patients, respectively. The adjusted hazard ratio for OS was 2.42 (95% CI, 1.06-5.49, p = 0.035) for frail patients compared to fit patients.

This finding suggested that aCGA could be used as an efficient alternative to the full CGA, potentially improving the clinical management and treatment decision-making for elderly patients with DLBCL.

Understanding the relationships between comorbidity, disability, and home health-care services aids in user-centered care design. This study identifies patterns of these factors among older adults with physical disability living at home and explores their associations. This cross-sectional study included community-dwelling older adults assessed for Long-term Care Insurance from September 1 to December 31, 2018, in Yiwu, Zhejiang, China. We analyzed deidentified data on sociodemographics, physical disability, chronic conditions, and care plans for 1882 participants using latent class analysis and multinomial logistic regression. Five comorbidity patterns (other sporadic diseases, cancer comorbidity, other sporadic comorbidities, coronary atherosclerotic heart disease, and fracture) and four home health-care service patterns (assistance & facilitation of elimination, bedridden assistance & stoma care, bedside assistance & stoma care, and assistance & tube feeding) were identified. Four disability patterns emerged (bedridden without incontinence, bedridden & with upper limb mobility, off-bed & ADLs limited, and bedridden with incontinence). Complex associations between these patterns were observed. The study highlights the heterogeneity and complexity of the above patterns, emphasizing the importance of person-centered home health-care services and technology-supported care strategies.

Endometrial cancer incidence and related mortality are on the rise due to aging demographics. This population often presents with unfavorable features, such as myometrial invasion, non-endometrioid histology, high-grade tumors, worse prognosis, etc. The role of age as an independent prognostic factor is still debated, and screening tools addressing frailty emerge as pivotal in guiding treatment decisions; however, they are still underutilized. Treatment disparities are evident in the case of older patients with endometrial cancer, who frequently receive suboptimal care, hindering their survival. Radiotherapy and minimally invasive surgical approaches could be performed in older patients. Data on chemotherapy and immunotherapy are scarce, but their potential remains promising and data are being gathered by recent trials, contingent on optimal patient selection through geriatric assessments. Overall, we recommend personalized, screening tool-guided approaches, adherence to guideline-recommended treatments, and inclusion of older people in clinical trials to help identify the best course of treatment.

The International Society of Geriatric Oncology recommends that all older people with cancer have a geriatric evaluation before beginning treatment.

To determine the prevalence of frailty in people 75 years and older diagnosed with lung or gynecological cancer and evaluate the adaptation of standard therapeutic strategies based on frailty, following the implementation of telephone-based frailty screening with the Vulnerable Elders Survey (VES-13).

We performed a retrospective observational study in 362 people screened by an advanced practice nurse before their first oncology appointment. We collected secondary data from electronic medical records. The main variables were degree of frailty (according to VES-13 and comprehensive geriatric assessment), type of cancer treatment (standard and prescribed), treatment completion, sociodemographic characteristics, and comorbidities.

The VES-13 detected 186 people (51.4%) at risk of health deterioration, and the comprehensive geriatric assessment confirmed some degree of frailty in 157 people (43.4%), with a κ coefficient of 0.84. People with more comorbidities, greater frailty, and more geriatric syndromes were more likely to need treatment readjustment ( P < .001).

Telephone-based frailty screening by an advanced practice nurse showed high applicability, with very good agreement between the proportion of people classified as frail before the initial visit and in the subsequent geriatric assessment.

A protocol for establishing frailty risk through telephone screening by an advanced practice nurse facilitates the care process and helps clinicians adapt therapeutic decision-making to the needs of each patient and their family.

Currently, the primary treatment modality for patients with colorectal adenocarcinoma (CRA) is radical surgery combined with postoperative adjuvant chemotherapy (PAC). However, many elderly patients decline PAC due to concerns about their underlying physiological condition, and the impact of PAC on the prognosis of elderly patients remains uncertain.

We extracted data from the SEER database for CRA patients aged 75 and above between 2010 and 2019. Utilizing propensity score matching (PSM), we stratified the patients into a PAC group and a non-PAC group, enabling us to compare the differences in Kaplan-Meier survival curves between these two groups. Furthermore, through univariate and multivariate Cox regression analyses, we identified the clinical factors that influence the survival of elderly CRA patients and compared the prognostic disparities between the two patient groups within specific subgroups of these clinical factors.

Following PSM, a total of 3668 patients were included and divided into the PAC group and the non-PAC group, with no statistically significant differences observed in crucial clinical characteristics between the two groups. Kaplan-Meier analysis revealed a significantly better prognosis for patients in the PAC group compared with those in the non-PAC group. In addition, age, chemotherapy, TNM staging, gender, and preoperative CEA levels were all identified as important factors affecting patient prognosis. Moreover, PAC provided survival benefits across the majority of levels within the aforementioned subgroups. However, in specific subgroups (age > 90, Grade IV stage, median household income < $40 000), PAC did not confer any survival benefits.

PAC can significantly improve the prognosis of elderly CRA patients. Nonetheless, in certain population subsets characterized by specific clinical features, PAC does not provide any survival benefits.

Improving care for older people with end-stage kidney disease (ESKD) requires the adaptation of standards to meet their needs. This may be complex due to their heterogeneity in terms of multimorbidity, frailty, cognitive decline and healthcare priorities. As benefits and risks are uncertain for these persons, choosing an appropriate treatment is a daily challenge for nephrologists. In this narrative review, we aimed to describe the issues associated with healthcare for older people, with a specific focus on decision-making processes; apply these concepts to the context of ESKD; identify components and modalities of shared decision-making and suggest means to improve care pathways. To this end, we propose a geronto-nephrology dynamic, described here as the necessary collaboration between these specialties. Underscoring gaps in the current evidence in this field led us to suggest priority research orientations.

As the global population ages, so does the number of older people being diagnosed, treated and surviving cancer. Challenges to providing appropriate healthcare management stem from the heterogeneity common in this population. Although malnutrition is highly prevalent in older people with cancer, ranging between 30 % and 80 % according to some analyses, is associated with frailty, and has been shown to be a major risk factor for poor treatment response and worse overall survival, addressing nutrition status is not always a priority among oncology healthcare providers. Evaluation of nutritional status is a two-step process: screening identifies risk factors for reduced nutritional intake and deficits that require more in-depth assessment. Screening activities can be as simple as taking weight and BMI measurements or using short nutritional questionnaires and asking the patient about unintentional weight loss to identify potential nutritional risk. Using geriatric assessment, deficits in the nutritional domain as well as in others reveal potentially reversible geriatric and medical problems to guide specific therapeutic interventions. The authors of this paper are experts in the fields of geriatric medicine, oncology, and nutrition science and believe that there is not only substantial evidence to support regularly performing screening and assessment of nutritional status in older patients with cancer, but that these measures lead to the planning and implementation of patient-centered approaches to nutrition management and thus enhanced geriatric-oncology care. This paper presents rationale for systematic nutrition screening and assessment in older adults with cancer.

Resilience to anticancer treatment for colorectal cancer (CRC) among older patients varies. Many experience weight loss, physical decline, falls, and hospitalization during treatment, often leading to early discontinuation of otherwise effective chemotherapy. Screening for vulnerability might help to identify patients at risk of these adverse outcomes in older adults.

This is a secondary analysis from the GERICO trial. Patients aged ≥70 years assessed for chemotherapy for CRC were screened for eligibility for the GERICO trial with the geriatric-8 (G8) frailty screening tool. The present study population comprised patients who were (1) screened with G8 but for reasons not included in the GERICO study and (2) patients who were randomized to the GERICO control group. We evaluated whether patients identified as vulnerable with G8 (≤14/17) or retrospectively constructed mG8 (≥6/35) had higher risk of experiencing decline in performance status (PS), falls, and unplanned hospitalization during treatment. The association between frailty status and the adverse outcomes was analyzed with univariate and multivariate logistic regression. The discriminative ability of G8/mG8 to predict outcomes was analyzed using the area under the curve for receiver operating characteristics curves.

In total, 238 patients (median age 74 years [range 70-91]) were included in this analysis. More vulnerable than fit patients experienced decline in PS (G8: 41% vs. 14%, p = 0.006 and mG8: 28% vs. 17%, p = 0.04) during treatment. Furthermore, more vulnerable than fit patients experienced falls (G8 14% vs. 6% p = 0.04) and unplanned hospitalization (G8: 31% vs. 14%, p = 0.009 and mG8: 34% vs. 13%, p < 0.001). Multivariate analyses showed an association between G8 vulnerability and decline in PS, falls, and hospitalization.

Patients with G8 or mG8 vulnerability were more likely to experience decline in PS and unplanned hospitalization during chemotherapy for CRC than fit patients. More G8 vulnerable patients experienced falls compared with fit patients. Appropriate interventions should be offered to older patients with CRC assessed as vulnerable with G8 or mG8 to maintain PS during chemotherapy.

The Cancer and Aging Research Group (CARG) score was developed to predict severe chemotherapy-induced toxicity risk in older adults; validation study results have varied. The Tolerance of Anti-cancer Systemic Therapy in the Elderly study sought to evaluate the CARG score prospectively in a chemotherapy-naïve UK population.

This multicentre, prospective, observational study recruited patients aged ≥65 years commencing first-line chemotherapy for any solid organ malignancy or setting. Baseline demographics and established frailty measures were recorded. Follow-up data including toxicity and hospital admissions were collected retrospectively. Baseline CARG score predictive ability was assessed.

339 patients were recruited from 19 centres; median age 73 years (range 65-92), 51.9% male and 54.9% gastrointestinal primary. At baseline, 85% of patients were of Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1, with median Rockwood Clinical Frailty Scale (CFS) 3 (range 0-8).314 (92.6%) patients had follow-up data; 69 (22.3%) patients experienced Common Terminology for Cancer Adverse Events grade ≥3 toxicity and 84 (27%) required hospital admission during treatment.Increasing CARG risk groups had increased grade ≥3 toxicity (low 19.6%, medium 22.2%, high 28.2%); however, this was non-significant with no evidence of robust predictive performance. Predictive performance of CFS and ECOG PS was superior to CARG. Importantly, patient and clinician perceptions of toxicity risk differed significantly.

In older UK patients with cancer commencing chemotherapy, baseline frailty was prevalent. CARG score did not robustly discriminate or predict high-grade toxicity risk. ECOG and CFS showed superior, although limited, ability to predict and discriminate. This study highlights the need for the development of tools that better predict toxicity in this population.

There are increased indications that physical activity timing, irrespective of intensity, impacts insomnia and circadian clock function. Here, we describe the rationale and design of a randomized cross-over study, called ON TIME, to examine the effects of (changing) physical activity timing on insomnia severity and on multiple exploratory outcomes that are linked to circadian clock function.

We will conduct a randomized cross-over trial in 40 healthy older adults (aged 65 to 75 years) with subclinical or clinical insomnia (Insomnia Severity Index (ISI) scores of ≥ 10) from the Dutch municipality of Leiden and surroundings. Participants will undergo 3 intervention periods (14 days each) consecutively: one sedentary period and two periods of increased physical activity (one period with morning activity and one period with evening activity). The intervention periods are separated by a wash-out period of 1 week. In both active intervention arms, participants will follow coached or uncoached outdoor physical exercise sessions comprising endurance, strength, and flexibility exercises for 14 days. The primary outcome is change in insomnia severity as measured by the ISI. Additional exploratory outcomes include multiple components of objective sleep quality measured with tri-axial accelerometry and subjective sleep quality assessed by questionnaires as well as dim light melatonin onset and 24-h rhythms in heart rate, heart rate variability, breathing rate, oxygen saturation, mood, and objective emotional arousal and stress. Additionally, we will collect diary data on eating patterns (timing and composition). Finally, fasting blood samples will be collected at baseline and after each intervention period for measurements of biomarkers of metabolic and physiological functioning and expression of genes involved in regulation of the biological clock.

We anticipate that this study will make a significant contribution to the limited knowledge on the effect of physical activity timing. Optimizing physical activity timing has the potential to augment the health benefits of increased physical exercise in the aging population.

Trial was approved by the Medical Ethics Committee Leiden, The Hague, Delft, The Netherlands (June, 2023). The trial was registered in the CCMO-register https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm under study ID NL82335.058.22 and named ("Ouderen op tijd in beweging" or in English "Older adults exercising on time"). At time of manuscript submission, the trial was additionally registered at ClinicalTrials.gov under study ID: NL82335.058.22 and is awaiting approval.

Previous studies of the treatment of elderly head and neck cancer (HNC) patients were very limited and sometimes controversial. Although conclusions differ across various reports, it is often concluded that advanced chronological age does not directly affect prognosis, but that comorbidities and declines in physical and cognitive functions promote the occurrence of adverse events, especially with surgical treatment. Geriatric assessment (GA) and its screening tools are keys to help us understand overall health status and problems, predict life expectancy and treatment tolerance, and to influence treatment choices and interventions to improve treatment compliance. In addition, personal beliefs and values play a large role in determining policies for HNC treatment for elderly patients, and a multidisciplinary approach is important to support this. In this review, past research on HNC in older adults is presented, and the current evidence is explained, focusing on the management of elderly HNC patients, with an emphasis on the existing reports on each treatment stage and modality, especially the surgical procedures.

Age is but one significant prognostic factor in lung cancer, influencing survival, treatment response, and outcomes. This narrative review synthesizes findings from searches of 11 leading databases of research studies, systematic reviews, book chapters, and clinical trial reports on lung cancer in senior patients, with a focus on geriatric assessment as well as biomarkers. Key prognostic factors for lung cancer in seniors include biological age, functional capability, physical and psychological comorbidities, frailty, nutrition, status, and biomarkers like DNA methylation age. We identified the most valuable assessments that balance efficacy with quality of life. Optimizing care and improving outcomes with senior lung cancer patients benefits from a tailored therapeutic approach incorporating a complex geriatric assessment. A multidisciplinary collaboration between geriatricians, oncologists, and pulmonologists is crucial.

With the aging population, older adults constitute a growing proportion of the new cancer cases. Given the heterogeneous health status among older adults and their susceptibility to aging-related vulnerabilities, understanding their diversity and its implications becomes increasingly crucial for prognostication and guiding diagnostics, treatment decisions, and follow-up, as well as informing supportive care interventions. Geriatric assessment and management (GAM) refers to the comprehensive evaluation of an older individual's health status with subsequent management plans focusing on both oncologic and non-oncologic interventions. In 2019, the European Society for Medical Oncology (ESMO) and the International Society of Geriatric Oncology (SIOG) established the ESMO/SIOG Cancer in the Elderly Working Group. This position paper reflects the recommendations of the working group. Our paper summarizes the existing evidence with a focus on recent key trials and based on this, we propose several recommendations and future directions.

Lung cancer stands as a malignant neoplasm bearing the highest burden of morbidity and mortality within the elderly population on a global scale. Among the lung cancer subtypes, non-small cell lung cancer (NSCLC) prevails as the most prevalent. As age advances, elderly patients often present with an increased prevalence of comorbidities, diminished organ reserve function, and alterations in drug pharmacokinetics, including absorption, distribution, metabolism, and clearance. These factors collectively contribute to a reduction in their capacity to tolerate therapeutic interventions. Regrettably, there exists a paucity of research data and evidence regarding the management of elderly patients afflicted by advanced lung cancer. This article endeavors to compile and elucidate strategies for the enhancement of treatment approaches, with the aim of aiding clinical decision-making. Prior to the selection of clinical treatment modalities for elderly patients with advanced NSCLC, a comprehensive assessment should be conducted, taking into account various facets, including tumor characteristics, patient age, physiological status, and the presence of comorbidities. The treatment strategy should be implemented in a tiered fashion, thereby affording the opportunity for the tailoring of individualized therapeutic approaches for elderly patients afflicted by advanced NSCLC. The demographic of elderly patients confronting advanced NSCLC presents a complex landscape marked by intricate underlying conditions, necessitating the imperative optimization of treatment strategies.

Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. Therefore, clinicians need enhanced competencies and skills to effectively care for this population. However, most clinicians receive minimal to no training in geriatrics. This study aims to evaluate the education and training levels in geriatric oncology among Turkish physicians and to understand the factors influencing oncologists' treatment decisions for geriatric cancer patients.

A 24-question survey was prepared to obtain the participating physicians' demographic information, as well as to inquire whether they had received training during their medical education and residency on how to approach geriatric patients, in what process(es) they had received the training, whether they were currently treating geriatric patients, what they focused on when evaluating geriatric patients, and what they thought about their training and preparedness for approaching geriatric patients. The questionnaire was sent online to radiation and medical oncologists, and the link was published on the Turkish Society of Radiation Oncology and the Turkish Society of Medical Oncology websites.

Two hundred and three physicians participated in the survey, 131 of whom were women. The median age was 41.66 years (24-69 years). One hundred and fifty-six physicians (76.1%) received specialty education at the university hospital. One hundred and three of them were radiation oncologists, and 80 were medical oncologists. Of the physicians, 19.7% received education in geriatrics before they specialized in oncology, and 6.9% said they were educated after specialization. When determining suitability for radiotherapy, 10.7% of radiation oncologists said that they use geriatric assessment tools. Similarly, 13.8% of medical oncologists claimed that they used geriatric assessment tools in determining suitability for chemotherapy. Of the physicians, 177 (86.3%) thought that geriatric evaluation could independently increase patient survival rate. Furthermore, patient cognitive status, functional status, physiological age, polypharmacy, geriatric specialist recommendations, inpatient services, patient relatives, and similar factors were found to be useful in treatment decisions. Finally, 92.7% of the participants believed that receiving education would have changed their perspectives on treating geriatric patients.

Our results provide perspectives on developing knowledge on and skills in geriatric training among oncologists. Learning new approaches is necessary for oncologists who more frequently confront geriatric patients with cancer.

The aim of this study was to analyze four pre-operative physical frailty indicators from a geriatric assessment (GA) independently and combined in a physical frailty index, in their ability to predict postoperative 30 d-complications.

In this secondary analysis of data from the published PERATECS study (ClinicalTrials.gov: NCT01278537), the predictive value of four physical frailty indicators from a defined GA battery was examined with univariable and multivariate logistic regression models in a sample of 493 onco-geriatric surgical patients. The primary endpoint was incidence of major (Clavien-Dindo ≥ grade 2 [CD ≥ 2]) complications within 30 postoperative days. Predictors of the first model included self-reported exhaustion (SRE), body mass index (BMI), Timed Up-and-Go (TUG) and handgrip strength (HGS) independently, and a second model combined these four items as a Physical Frailty Index (4i-PFI). Both regression models were adjusted for age, gender, American Society of Anesthesiologists (ASA) status, tumor sites, duration of surgery time and Mini Nutritional Assessment (MNA) score.

A total of 233 patients (47 %) developed CD ≥ 2 complications. In addition to ASA score, length of surgery, and gynecological and upper gastrointestinal tumor sites, the first model showed that SRE (OR 1.866) predicted CD ≥ 2 complications, but not TUG, BMI and HGS. In the second model, the 4i-PFI predicted CD ≥ 2 complications (OR pre-frail = 1.808, frail = 3.787).

Physical frailty indicators as SRE revealed a better ability to predict CD ≥ 2 complications than BMI, TUG and HGS. However, prediction of CD ≥ 2 complications was enhanced when these parameters were combined in a novel 4i-PFI.

In urologic oncology, which often involves older patients, it is important to consider how to manage their care appropriately. Geriatric assessment (GA) is a method that can address the specific needs of older cancer patients. The GA encompasses various assessment domains, but these domains exhibit variations across the literature. Some of the common items include functional ability, nutrition, comorbidities, cognitive ability, psychosocial disorders, polypharmacy, social and financial support, falls/imbalance, and vision/hearing. Despite the diversity of domains, there is limited consensus on reliable measurement methods. This review discusses the role of GA in managing urologic cancer in unique scenarios, such as those necessitating temporary or permanent urinary catheters or stomas due to urinary diversion. A comprehensive GA is time and human-resource-intensive in real-world clinical practice. Hence, simpler tools such as the Geriatric-8 (G8), capable of identifying high-risk patients requiring a detailed GA, are also under investigation in various contexts. Therefore, we conducted a systematic literature review on the G8. Our findings indicate that patients with low G8 scores encounter difficulties with stoma self-care after urinary diversion and have higher risks of urinary tract infections and ileus after radical cystectomy. The utilization of G8 as a screening tool for urologic cancer patients may facilitate the delivery of appropriate and personalized treatment and care.

Though cancer is more prevalent in the older population, this patient group are underrepresented in phase I oncology trials.

We evaluated the use of a geriatric screening tool (SAOP3) in patients of 70 years of age or older who attended a Phase I Clinical Trials Unit, with the aim of assessing the feasibility of the tool and identifying potential unmet needs in this patient group.

Twenty-two patients over the age of 70 completed the SAOP3 questionnaire. Geriatric impairments and needs were analysed with descriptive statistics. Qualitative responses were grouped in themes using structured thematic analysis.

All of patients triggered at least 1 geriatric domain, most commonly mobility. Six core themes were identified as being important to the patient including family, friends and positivity. On cognition assessment over 20% of patients triggered as requiring further cognitive assessment. The group had a relatively high screen fail risk.

In conclusion, routine geriatric screening withSAOP3 was feasible and identified areas of patient need. Results highlight the prevalence of psychological distress and cognitive impairment. Geriatric screening offers an opportunity for prehabilitation prior to trial and support during trial participation to optimise safety and improve trial access.

It is unclear whether the Geriatric-8 (G8) has the accuracy to preselect patients for complete geriatric assessment, and has the ability to predict adverse outcomes in patients with colorectal cancer (CRC). We therefore aimed to determine whether the G8, or other variables present in the medical record, are applicable in predicting 30-day adverse outcomes in older patients undergoing surgery for CRC.

We performed a retrospective cohort study involving patients ≥70 years who had surgery for CRC between 2018 and 2020 in a general hospital in the Netherlands. The primary outcome was adverse outcome(s), which is a composite of surgical and non-surgical complications, readmission and mortality, all within 30 days of surgery. The secondary endpoints were the individual components, such as delirium, infection and ileus. We explored potential prognostic factors using multivariable logistic regression analysis. Data were collected from the Dutch ColoRectal Audit (DRCA) and medical records.

The study included 200 patients (mean age 78.9 years: 50% female), with 36.5% having adverse outcomes in the first 30 days of surgery. In neither univariate nor multivariable analysis were G8 scores associated with adverse outcomes. Factors with higher odds of adverse outcomes were male gender, and having cognitive decline or previous delirium.

This study confirms that G8 scores have no prognostic value for adverse outcomes, complications and mortality within 30 days of surgery among older adults with CRC. Therefore, the G8 should not be the tool for short-term risk prediction of adverse outcomes in these patients.

Recognizing that receiving healthcare can be time intensive and burdensome, time toxicity has been conceptualized as the time spent by patients seeking healthcare. This study investigates the association between age at diagnosis and time toxicity for patients with Metastatic Breast Cancer (MBC) and identifies major components of care that confer the greatest time toxicity.

We conducted a retrospective cohort study among patients with MBC aged 67 or older using the SEER-Medicare database. We assessed time toxicity using the number of encounter days patients interacted with the healthcare system per 100 days, within the first year of starting cancer treatment. We used a Poisson model to analyze the association between age and encounter days, adjusting for clinical and sociodemographic factors. We stratified the mean encounter days for each age cohort by treatment types.

The final sample included 2949 patients; 51.4% were between 70 and 79 years old, and 81.3% were white. Although unadjusted analysis showed an association between older age and more encounter days (Rate Ratio (RR) 1.12; 95% CI 1.02, 1.22), there was no significant association after adjusting for comorbidities and treatment type. Patients with more than three comorbidities had significantly higher encounter days compared to those without comorbidities [RR 1.36 (95% CI 1.26, 1.46)]. Receipt of radiotherapy [RR: 1.45 95% CI (1.37, 1.54)] was associated with more encounter days compared to not receiving radiotherapy, while receipt of bone-modifying agents was associated with fewer encounter days compared to not using Bone modifying agents [RR 0.75 (95% CI 0.70, 0.79)].

Our study identified comorbidities and cancer treatment modality, including radiotherapy, as the factors affecting time toxicity in older patients with MBC. Assessment of an individual's comorbid medical conditions and types of treatment planned are crucial to understanding age-related impacts on encounter days and to support shared decision making in older patients.

The purpose of this study was to evaluate the safety and efficacy of preoperative concurrent chemoradiotherapy (preCRT) for locally advanced rectal cancer in older people who were classified as "fit" by comprehensive geriatric assessment (CGA).

A single-arm, multicenter, phase II trial was designed. Patients were eligible for this study if they were aged 70 years or above and met the standards of "fit" (SIOG1) as evaluated by CGA and of the locally advanced risk category. The primary endpoint was 2-year disease-free survival (DFS). Patients were scheduled to receive preCRT (50 Gy) with raltitrexed (3 mg/m2 on days 1 and 22).

One hundred and nine patients were evaluated by CGA, of whom eighty-six, eleven and twelve were classified into the fit, intermediate and frail category. Sixty-eight fit patients with a median age of 74 years were enrolled. Sixty-four patients (94.1%) finished radiotherapy without dose reduction. Fifty-four (79.3%) patients finished the prescribed raltitrexed therapy as planned. Serious toxicity (grade 3 or above) was observed in twenty-four patients (35.3%), and fourteen patients (20.6%) experienced non-hematological side effects. Within a median follow-up time of 36.0 months (range: 5.9-63.1 months), the 2-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) rates were 89.6% (95% CI: 82.3-96.9), 92.4% (95% CI: 85.9-98.9) and 75.6% (95% CI: 65.2-86.0), respectively. Forty-eight patients (70.6%) underwent surgery (R0 resection 95.8%, R1 resection 4.2%), the corresponding R0 resection rate among the patients with positive mesorectal fascia status was 76.6% (36/47).

This phase II trial suggests that preCRT is efficient with tolerable toxicities in older rectal cancer patients who were evaluated as fit based on CGA.

The registration number on ClinicalTrials.gov was NCT02992886 (14/12/2016).

Immune checkpoint inhibitors (ICIs) became a treatment option in most tumor types and improved survival in patients with cancer in the last decade. Older patients with cancer are underrepresented in the pivotal clinical trials with ICIs. Older patients with cancer often have significant comorbidities and geriatric syndromes like frailty, which can complicate cancer care and treatment decisions. Frailty is among the most prevalent geriatric syndromes in patients with cancer and could lead to inferior survival and a higher risk of complications in patients treated with chemotherapy. However, the effect of frailty on the efficacy and safety of ICIs is understudied. This review focuses on the available evidence regarding the association between frailty and ICI efficacy and safety. Although the survival benefits of ICIs have generally been shown to be independent of age, the available real-world data has generally suggested higher rates of immune-related adverse events (irAEs) and treatment discontinuation in older patients. While international organizations recommend conducting a comprehensive geriatric assessment CGA to assess and address frailty before the start of anti-cancer therapies, an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or higher is frequently used in clinical practice as synonymous with frailty, albeit with significant limitations. The available data has generally demonstrated diminished ICI efficacy in patients with an ECOG 2 or higher compared to patients with better performance status, while the incidence of high-grade irAEs were similar. Whilst evidence regarding outcomes with ICI in older patients and in those with sub-optimal performance status is growing, there is very limited data specifically evaluating the role of frailty with ICIs. These studies found a shortened overall survival, yet no evidence of a lower response rate to ICIs. These patients experienced more AEs, but they did not necessarily have a higher incidence of irAEs.