As a powerful, objective marker of frailty, 4-m gait speed (4MGS) can predict morbidity and mortality in various populations including cardiac surgery and oncology patients. Its role in thoracic surgery is understudied. This study aimed to evaluate associations between preoperative 4MGS and outcomes after pulmonary resection.

A cohort study analyzed patients undergoing pulmonary resections at a high-volume surgical center from January 2021 to October 2023. Preoperative 4MGS was prospectively collected by medical assistants as part of routine vital sign assessments in clinic. Uni- and multivariable analyses were performed to evaluate the associations of preoperative 4MGS with postoperative length of stay, adverse events, and discharge disposition, controlling for lung function (FEV1), extent of resection, comorbidity, and other covariates.

Overall, 401 patients were included (median age, 69 years; interquartile range, 61-75 years): 123 (31%) lobectomy and 278 (69%) sublobar resection patients. After controlling for covariates, each decrease of 0.1 m/s in 4MGS was associated with average longer length of stay (beta, 0.12; 95% confidence interval [CI], 0.01-0.23) and increased odds of adverse events (odds ratio [OR], 1.10; 95% CI 1.00-1.25). These associations were largely maintained when analyses were repeated within the lobar and sublobar cohorts. Among the sublobar resections, decreases in 0.1 m/s of 4MGS was associated with increased odds of discharge to home requiring home services or to a rehabilitation facility (OR, 1.10; 95% CI 1.00-1.22).

Preoperative 4MGS is independently associated with important surgical outcomes after lung resection. The 4MGS marker can complement other preoperative measures used to risk-stratify patients undergoing lung resection.

Older adults (OA) with DLBCL are a heterogenous population with suboptimal outcomes. In this review, we identify and address the unique challenges encountered in the care of OA with DLBCL. We elaborate on the role and limitations of current geriatric assessment (GA) tools and ways to incorporate fitness in therapeutic decision making. We suggest best practices to implement GA in routine practice and clinical trials. The most widely used tool is simplified GA (sGA) which categorizes patients into fit, unfit and frail groups. Patients who are fit benefit from full dose/curative approach, whereas consideration should be made to reduce the intensity of chemotherapy for unfit patients. Frail patients with DLBCL are a major unmet need without any satisfactory treatment options. Ongoing investigations combining novel therapies into chemotherapy-free regimens are underway with promising early results. In the relapsed/refractory (R/R) setting, anti-CD19 CAR-T cell therapy (CART) is now the standard of care for primary refractory disease or relapse within 12 months of completing therapy. Autologous stem cell transplant is still a consideration for fit OA with relapse >12 months after completing therapy. The recent approval of bispecific antibodies is a welcome advance that will greatly benefit OA not eligible for CART. Other regimens available for patients ineligible for CART or for those who experience progression post-CART include polatuzumab-rituximab±bendamustine, tafasitamab-lenalidomide, loncastuximab or chemotherapy-based approaches such as rituximab-gemcitabine-oxaliplatin. We discuss the changing paradigm in R/R DLBCL and spotlight emerging data from recent congresses that can improve outcomes in this vulnerable population.

Postoperative adjuvant chemotherapy is known to enhance cure rates and is thus recommended for stages pII to pIII. However, specific guidelines for such treatment in elderly gastric cancer (GC) patients are currently lacking. This study examines the impact of adjuvant chemotherapy on the postoperative survival of these patients.

We reviewed a total of 7749 patients with GC who underwent radical gastrectomy at Zhejiang Cancer Hospital and Fujian Cancer Hospital from January 2007 to December 2019. We conducted univariate and multivariate Cox regression analyses to investigate the impact of clinicopathological factors on overall survival (OS) and cancer-specific survival (CSS) in these patients. Additionally, we created a meta-analysis forest plot and employed propensity score matching (PSM) to mitigate confounding bias.

Age and adjuvant chemotherapy were independent risk factors for OS and CSS. Stratified analysis based on chemotherapy use revealed a statistically significant difference in OS and CSS between younger patients who did and did not receive adjuvant chemotherapy. In contrast, no significant differences in OS and CSS were observed between older patients with or without adjuvant chemotherapy. These findings remained consistent after propensity score matching (PSM).

Age and adjuvant chemotherapy are independent risk factors for OS and CSS in patients with stage II/III GC; for patients with stage II/III gastric cancer aged ≥ 75 years, shared decision-making should be made taking into account functional status and comorbidities, rather than conventional adjuvant chemotherapy.

Bladder cancer is uncommon in individuals under the age of 45, and its clinical and molecular characteristics in this population differ significantly from those observed in older patients. This systematic review aims to evaluate recurrence, progression, survival outcomes, and molecular profiles of bladder cancer in young adults.

A systematic search was conducted in MEDLINE, Embase, Scopus, and CENTRAL databases for studies published between 1998 and 2024. Eligible studies included patients aged ≤ 40 years and reported outcomes such as recurrence-free survival (RFS), progression, and overall survival (OS). A total of 18 studies were included. Risk of bias was assessed using the ROBINS-I tool, and pooled estimates were calculated using random-effects meta-analysis models.

Bladder cancer in young adults is predominantly non-muscle-invasive and low-grade, with high survival rates. Recurrence rates varied across studies, ranging from 0 to 35.9%, while disease progression was rare. Several studies reported 100% RFS and OS in pediatric and young adult populations. The molecular profile of tumors in younger patients differed from that of older adults, with lower rates of TP53 and FGFR3 mutations. Meta-analysis revealed favorable long-term outcomes, particularly in patients diagnosed at early stages.

Bladder cancer in young adults presents a distinct clinical and molecular entity with excellent prognosis, minimal progression, and high survival. Despite this, recurrence remains a concern, highlighting the need for age-specific surveillance strategies and further research into molecular drivers of the disease in this age group.

The Hippocratic principle primum non nocere, or "first, do no harm", serves as a vital lens through which to re-evaluate modern oncology practices. While recent advances such as immunotherapy, targeted agents, and precision medicine have transformed cancer care, these treatments are not without risk. Even with improved tolerability, they may still lead to substantial toxicities, particularly in frail patients with advanced cancer. The pursuit of survival often overshadows the patient's quality of life, with aggressive interventions frequently continuing beyond the point of meaningful benefit. This perspective article argues for a more individualized and ethically grounded approach to cancer treatment, emphasizing the careful assessment of each patient's clinical status, values, and goals. By integrating geriatric and palliative assessments, improving shared decision making, and moving away from a default treatment-at-all-costs mindset, clinicians can better align care with what truly matters to patients. Honoring primum non nocere in oncology means not only extending life when appropriate but ensuring that life remains worth living.

Recent studies have shown that intermuscular adipose tissue (IMAT) is a significant prognostic factor for breast cancer. To date, no clinical studies have investigated whether IMAT can be used to predict chemotherapy toxicity in older adult patients with early-stage breast cancer.

We included 304 patients diagnosed with stage I-III breast cancer between January 2020 and December 2022 in Harbin Medical University Cancer Hospital. All patients were aged ≥ 65 years and treated with neoadjuvant or adjuvant chemotherapy. IMAT within the pectoralis muscle was measured using computed tomography imaging. Logistic regression analysis was used to identify independent predictors of chemotherapy toxicity. A nomogram was built, and the model performance was assessed using accuracy, discrimination, and clinical benefits. The net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to evaluate changes in model performance after the addition of adipose tissue.

Of the 304 patients (184 in the training cohort and 120 in the validation cohort), 30.3% developed grade 3-5 chemotherapy toxicities. Three independent predictors were identified in the multivariate analysis: hemoglobin level, IMAT area, and primary prophylaxis with granulocyte colony-stimulating factor. The nomogram demonstrated area under the receiver operating characteristic curve values of 0.708 (95% confidence interval [CI], 0.616-0.801) and 0.751 (95% CI, 0.655-0.846) in the training and validation cohorts, respectively. The nomogram showed good calibration (Hosmer-Lemeshow test, p > 0.05), and incorporating IMAT improved nomogram performance in both cohorts (all NRI and IDI > 0, p < 0.05). Decision curve analysis revealed that the nomogram was clinically useful.

A nomogram including IMAT may be useful for predicting the individual probability of chemotherapy toxicity and guiding therapy in older adults with early-stage breast cancer.

Canada's aging population is leading to an increased number of older adults being diagnosed with cancer. This population faces unique challenges, including frailty, comorbidities, polypharmacy, and malnutrition, which can negatively affect treatment outcomes. The role of registered dietitians (RDs) in managing nutrition-related issues in this population is well-documented, but there is limited research on their integration into geriatric oncology clinics. We evaluated the impact of integrating a registered dietitian (RD) into the Older Adult with Cancer Clinic (OACC) at the Princess Margaret Cancer Centre, Toronto, Canada.

A retrospective chart review was conducted of older adult cancer patients seen at the OACC, comparing outcomes before and after the RD's integration. The focus was on weight characteristics and change, malnutrition screening/identification, and management. The two-item Canadian Nutrition Screening Tool (CNST) was introduced during the RD's integration and was also examined to see its usefulness in identifying malnutrition risk. Chi-squared tests and t-tests were used for data analysis.

The pre-cohort (n = 140) had a mean age of 80.2 years, 48.6% female, and 77.9% vulnerable (Vulnerable Elders Survey (VES-13) ≥ 3). The post-cohort (n = 117) had a mean age of 81.4 years, 59.8% female, and 80.3% vulnerable (VES-13 ≥ 3). Weight change within 3 ± 1 months after the initial OACC consult was similar between pre and post groups with -1.4 kg and -1.2 kg, respectively (p = 0.77). Patients at nutritional risk, as determined by the OACC team, generated significantly more referrals to the RD in the post group (100% vs. 36.4%, p < 0.001). Among patients who had CNST screening and saw the RD, there was a higher rate of high nutrition risk among CNST-positive compared to CNST-negative patients (67.2% versus 44.4%, respectively). After the integration of the RD, a greater number of patients at nutritional risk received nutritional education and referrals to other healthcare professionals (43 versus 1).

The integration of an RD into the OACC led to improved referral rates, nutritional education, and referrals to other healthcare professionals. Moreover, patients who were CNST positive were more likely to have high nutritional risk.

The Alzheimer's Disease in Older Adults with Chronic Conditions (ADACC) Network is funded by the National Institute on Aging as a U24 cooperative agreement. ADACC is an inclusive, multidisciplinary group across multiple institutions that is charged with the task of developing evidence-based strategies for the use and implementation of Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) biomarkers among older adults with cognitive impairment and multiple chronic conditions (MCCs). This report summarizes highlights of the First Annual Symposium of ADACC, which was held in Winston-Salem, North Carolina, in April 2024. An overview of the ADACC Network and goals were initially described, followed by a state of the science integrating biomarkers, AD/ADRD, and MCCs. Multiple presentations on a variety of topics were featured, including the significance of MCCs in AD/ADRD, the effects of MCCs on Alzheimer's blood-based biomarkers, the incorporation of AD/ADRD biomarkers into cancer care, the need to address racial and biomarker disparities, clinician and patient perspectives on plasma AD/ADRD biomarker testing, and ethical considerations. ADACC emphasized the importance of supporting emerging researchers and fostering a collaborative environment.

Treatment of pancreatic cancer often entails multiple modalities (e.g., chemotherapy, surgery, radiation) that vary in intensity, timing, and toxicity profiles. Some treatment options are only recommended for medically 'fit' patients regardless of age, yet formal fitness measures (such as the geriatric assessment [GA]) and patient preferences are seldom utilized during treatment decision-making.

The INtegrating Systematic PatIent-Reported Evaluations into Multi-Disciplinary Tumor Board (INSPIRE-MDTB) intervention involves the presentation of GA and treatment preferences data during tumor board discussions of older patients with stage I-IV pancreatic adenocarcinoma. This qualitative study recorded, transcribed, and inductively analyzed historical (November 2021-February 2022) and intervention (September 2022-June 2023) MDTBs using NVivo software. A constant comparative method was used to establish a grounded scheme representative of clinicians' characterization of patients' fitness and preferences during decision-making.

Recordings of the primary MDTB presentation of 31 historical and 49 intervention patients with similar sex (52 %; 53 % female), age (m = 68.1; 72.3), race (65 %; 59 % White), and cancer stage (26 %; 22 % stage IV) were included. Although GA was captured for all included patients, it was not discussed in any historical cases, but was in 94 % of intervention cases. When compared to historical controls, INSPIRE patients had more frequent discussions of (1) cancer-related factors (e.g., size, location, rate of progression; 35 % vs. 43 %), (2) individual risk factors (e.g., age, comorbidities, tolerance; 90 % vs 98 %), and (3) psychosocial factors (e.g., health literacy, social support, substance use; 19 % vs 33 %). Identified preference domains were discussed in 39 % of historical and 80 % of intervention patients, with notably higher rates of discussion of patients' concerns regarding physical (0 %; 35 %) and mental/emotional (0 %; 20 %) side effects, ability to work (0 %; 10 %), and the logistics and convenience of treatment (6 %; 14 %).

The INSPIRE intervention enhanced MDTB discussion of patient fitness and preferences and represents a promising approach for fostering consistent and systematic presentation and discussion of patient-reported data, such as the GA and treatment preferences. This adds to our previous findings that INSPIRE was feasible, acceptable, appropriate, and time-effective according to patients and provider participants.

Older cancer survivors live with more comorbidities and have a higher mortality rate compared to the general older population. A high-quality diet that adheres to evidence based dietary recommendations and guidelines may help mitigate these issues. This can be assessed using dietary quality indices (DQIs), which objectively summarize scores for selected dietary components.

Identify the DQIs available in the literature for older cancer survivors, and their associations with health outcomes.

Five databases were searched to identify peer-reviewed articles in English, from inception to 12th November 2024. Two researchers independently screened 3,145 studies, extracted and qualitatively assessed data from 28 included reports from 16 studies.

12 DQIs and 40 unique components within these indices were identified and summarised narratively. Total vegetables (n = 8), total fruits (n = 8), whole grains (n = 6), saturated fat (n = 8), and salt/sodium (n = 8) were the most frequently incorporated components within a DQI. All DQIs were derived from evidence-based dietary guidelines. Only three DQIs were specifically designed for oncology population. Higher diet quality was associated with higher HR-QoL in breast, prostate, and colorectal cancer survivors in all but one study. The associations between mortality and diet quality were inconsistent, depending on the type of cancer and the mortality type i.e., cancer-specific or other causes.

DQIs are associated with important health outcomes. A major knowledge gap exists in DQIs suitable for older cancer survivors. Future research should develop DQIs to better assess how high-quality diets enhance health outcomes in older cancer survivors.

Acute myeloid leukemia (AML) is a bone marrow stem cell cancer that is often fatal despite available treatments. Diagnosis, risk assessment, monitoring, and therapeutic management of AML have changed dramatically in the last decade due to increased pathophysiologic understanding, improved assessment technology, and the addition of at least 12 approved therapies.

The diagnosis is based on the presence of immature leukemia cells in the blood, and/or bone marrow or less often in extra-medullary tissues. New biological insights have been integrated into recent classification systems.

The European Leukemia Network has published risk classification algorithms for both intensively and non-intensively treated patients based on cytogenetic and on molecular findings. Prognostic factors may differ based on the therapeutic approach.

Our increasing ability to quantify lower levels of measurable residual disease (MRD) potentially allows better response assessment, as well as dynamic monitoring of disease status. The incorporation of MRD findings into therapeutic decision-making is rapidly evolving.

The availability of 12 newly approved agents has been welcomed; however, optimal strategies incorporating newer agents into therapeutic algorithms are debated. The overarching approach integrates patient and caregiver goals of care, comorbidities, and disease characteristics.

Aging in humans is a heterogeneous process influenced by both biological and chronological factors. Biological age reflects an individual's physiological reserve and functional status. Increasing evidence suggests that cancer and its therapies accelerate biological aging. Many biomarkers have been evaluated to assess the biological age of patients with cancer. These biomarkers are emerging as potential tools to predict cancer-related toxicity and an individual's functional capacity as well as to individualize treatment.

This review summarizes the current literature on aging biomarkers in cancer patients, with a focus on markers of cellular senescence and epigenetic modification. We evaluate the existing evidence supporting their use as predictors of toxicity in patients undergoing chemotherapy and radiation therapy.

Biomarkers such as interleukin-6 (IL-6), leukocyte telomere length (LTL), and DNA methylation age show potential for assessing biological age, frailty, and functional reserve. The expression of p16INK4A has demonstrated promise in predicting therapy-induced toxicity and making treating decisions. However, additional confirmatory studies are necessary to further validate these biomarkers before they can be utilized as decision aids.

Aging biomarkers hold promise for individualizing cancer therapy and predicting treatment-related toxicity. However, further studies are essential to validate their reliability and support their integration into clinical practice.

The decline in physical fitness during neoadjuvant chemotherapy (NAC) impacts postoperative pneumonia and survival in older patients with locally advanced esophageal cancer (LAEC). However, information is lacking on the clinical mechanisms underlying the decline in physical fitness during NAC in older patients. This study investigated the factors responsible for the decline in physical fitness during NAC in older patients with LAEC.

This was a single-center exploratory prospective cohort study. A total of 80 patients with LAEC aged ≥ 65 years who were scheduled for curative esophagectomy after NAC were consecutively enrolled between October 2021 and December 2023. The decline in the incremental shuttle walking test (ΔISWT; ΔISWT = pre-NAC (m) - post-NAC (m)) was calculated to assess physical fitness. Significant factors responsible for ΔISWT were detected using a multivariate regression model. Statistical significance was two-tailed at p < 0.05.

A total of 69 patients (mean age, 72.9 years) were analyzed. The mean ISWT distances before and after NAC were 418.7 m and 353.5 m, respectively; the mean ΔISWT was 65.2 m. Significant responding factors for the decline in physical fitness during NAC were changes in skeletal muscle mass index (SMI; adjusted coefficient - 14.239 cm2/m2, 95% confidence interval - 19.690 to - 8.788, p < 0.001) and decreased hemoglobin (Hb; vs. non-decreased Hb, adjusted coefficient 33.907, 95% confidence interval 9.913 to 64.288, p = 0.008) during NAC.

This prospective cohort study found that the significant factors for the decline in physical fitness during NAC were loss of skeletal muscle mass and decreased Hb during NAC in older patients with LAEC.

The incidence of cancer among patients aged over 90 is increasing, but this population is poorly described in literature. This underrepresentation complicates decision-making for cancer treatments, despite the contribution of comprehensive geriatric assessment (CGA). This study aimed to describe early failure of specific anti-cancer treatments in a population of nonagenarians treated in a Comprehensive Cancer Center after undergoing a CGA.

This retrospective, monocentric cohort study included patients aged over 90 referred to an oncogeriatric team for CGA between 2019 and 2023, regardless of cancer type or planned treatment. The primary endpoint was the early treatment failure rate within 3 months of the initiation of treatment, defined as unplanned discontinuation, progression, or death.

119 patients were included, with a median age of 91 years (range: 90-99 years), 53 % were men. The most common cancers were skin (30 %), head and neck (24 %), genito-urinary (12 %), and breast cancers (11 %). Most patients were independent for activities of daily living with a median ADL score of 6/6 and IADL score of 3/4. They had an average of 1.3 severe comorbidities. Half of them suffered from undernutrition. The geriatric oncology team recommended 53.8 % treatment modifications (94.5 % de-escalation). The most common treatments received were radiotherapy (27 %), surgery (18 %), hormonal therapy (10 %) and chemotherapy (9 %). A quarter of the patients received exclusive supportive care. Among patients receiving specific treatment, early failure occurred in 22.7 % (20/88). The 6-month survival probability from initiation of treatment was 69.2 % (95 % CI: 60.3 %, 76.8 %), varying significantly by treatment intent: 93.9 % (95 % CI: 80.4 %, 98.3 %) for curative treatments, 77.4 % (95 % CI: 64.5 %, 86.6 %) for palliative treatments, and 26.8 % (95 % CI: 14.3 %, 44.6 %) for exclusive supportive care.

In this population of nonagenarians, who benefit from a CGA to identify and manage patient frailties, anti-cancer treatments were carried out with few early treatment failures.

We aimed to assess the prevalence of financial toxicity in older Indian patients with cancer and evaluate the association with quality of life (QoL), distress, vulnerabilities in the geriatric assessment, and factors impacting financial toxicity.

This was a prospective observational study at the Tata Memorial Center (Mumbai, India) in patients aged 60 years and over, planned for cancer-directed therapy. We used the COST-FACIT and CFPB Financial Well-Being Scales to assess financial toxicity. QoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 questionnaire, and distress with the NCCN distress thermometer.

Between June 2022 and September 2023, we enrolled 953 patients. The median age was 66 (IQR 63-72) years; 277 patients (29.1%) were over 70 years old, 737 (77.3%) were male, and 135 (14.2%) had health insurance. Therapy was planned with palliative intent in 607 (63.7%) patients. The prevalence of financial toxicity was 73.7% as per the COST-FACIT scale (n = 703), and 66% as per the CFPB (n = 629). Higher financial toxicity on the COST-FACIT scale was associated with poor financial well-being on the CFPB scale. Financial toxicity was associated with poor QoL and higher distress. Factors associated with significantly greater financial toxicity included history of tobacco chewing, monthly family income less than ₹50,000, lack of health insurance, illiteracy, depression, and cognitive impairment.

Identifying the factors contributing to financial toxicity will help make the cancer treatment journey smoother, more accessible and improve compliance to therapy for older patients.

ClinicalTrials.gov Identifier: CTRI/2020/04/024675.

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.

Background/Objectives: Few large cohorts with relatively uniform treatment approaches and long-term follow-up are available for assessing clinical outcomes for breast cancer (BC) patients. The Institut Català d'Oncologia (ICO) Breast Cancer Cohort was designed to well characterize treatment patterns and overall survival outcomes at 5 and 10 years, with a particular focus on patients < 40 and ≥70 years old, age groups often underrepresented in clinical trials. Methods: In this retrospective, observational study, we included all pathologically confirmed invasive BC patients diagnosed and treated between 2010 and 2014 at ICO, a Spanish reference cancer center, with a follow-up until November 2023. We collected comprehensive real-world data on clinicopathologic characteristics and treatment modalities. Overall survival (OS) was estimated using the Kaplan-Meier technique and was reported stratified by prognostic factors for the age groups of ≤40, 41-69 and ≥70. The Multivariate Cox model was used to estimate the risk of death for subgroups of age, adjusting for subtype, stage and grade. Results: Overall, 3451 patients with stage I to IV BC were diagnosed and treated, with a mean age of 58 years (range 19-98); 371 (10.8%) were diagnosed ≤40 years, and 756 (21.9%) were ≥70 years. With a mean follow-up of 9.9 years (SD = 3.5), the 5- and 10-year OS were 89% (95% CI: 86-92%) and 85% (95% CI: 81-88%) for patients ≤ 40, respectively; for those aged 41-69 years, 91% (95% CI: 90-92%) and 85% (95% CI: 83-86%), respectively; and 70% (95% CI: 66-73%) and 50% (95% CI: 47-54%) for those ≥70 years, respectively. The 5- and 10-year relative survival (RS) were 92% and 88% for patients < 70 years, respectively, and 82% and 77% for those ≥70 years, respectively. The Multivariate Cox model identified a HR of 4.90 (95% CI: 3.44-6.97, p < 0.001) for patients ≥ 70 years compared to those between 41 and 69 years. Conclusions: The ICO Breast Cancer Cohort, as far as we know, the largest in Spain with long-term follow-up, underscores the critical role of age and subtype in determining overall survival outcomes in patients with breast cancer.

The global burden of colorectal cancer (CRC) continues to rise, with elderly populations disproportionately affected. Despite oxaliplatin's established role in first-line metastatic CRC (mCRC) therapy, its clinical utility in older adults remains debated due to concerns over efficacy, toxicity, and survival outcomes. This meta-analysis evaluates the therapeutic benefits and risks of oxaliplatin-based regimens in elderly patients with mCRC, with emphasis on tumor response, survival endpoints, and treatment-related toxicities.

We systematically reviewed PubMed, Web of Science, Cochrane Library, and Chinese databases (CNKI, Wan Fang) through November 2024 for randomized controlled trials (RCTs) comparing oxaliplatin-based chemotherapy to non-oxaliplatin regimens in patients aged ≥65 with mCRC. Outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), complete response (CR), partial response (PR), disease control rate (DCR), and grade 3-4 adverse events. Data were pooled using random- or fixed-effects models in STATA 14.0 based on heterogeneity (I² statistic). Subgroup analyses explored heterogeneity sources, including chemotherapy combinations (e.g., bevacizumab, panitumumab).

Seven RCTs (1,839 patients) met inclusion criteria. Oxaliplatin significantly improved tumor response rates versus control regimens: ORR (OR 2.18, 95% CI 1.75-2.72; P<0.001), CR (OR 2.57, 1.11-5.97; P=0.028), and PR (OR 1.69, 1.28-2.22; P<0.001). No significant survival benefit was observed for OS (HR 0.97, 0.86-1.08; P=0.58) or PFS (HR 0.90, 0.79-1.01; P=0.07), though trends favored oxaliplatin. Grade 3-4 neutropenia (RR 1.84, 1.32-2.57), diarrhea (RR 2.01, 1.45-2.78), and sensory neuropathy (RR 3.12, 1.98-4.91) were more frequent with oxaliplatin. Subgroup analysis attributed DCR heterogeneity (I²=66%) to regimen differences, with reduced variability in bevacizumab/pantiumumab-combined subgroups.

This analysis demonstrates oxaliplatin's capacity to enhance tumor response in elderly mCRC patients, potentially alleviating symptoms and improving quality of life. However, the absence of significant survival gains underscores the complex interplay between tumor biology and therapeutic resistance. Mechanistically, chemotherapy-driven clonal selection may favor residual resistant subpopulations, as evidenced by liquid biopsy studies linking tumor evolution to disease progression. While toxicity profiles were manageable, the elevated risk of neurotoxicity and myelosuppression necessitates vigilant monitoring in this vulnerable cohort.

Oxaliplatin-based first-line therapy provides clinically meaningful tumor response improvements in elderly mCRC patients, though survival advantages remain elusive. Treatment decisions should balance response benefits against toxicity risks, prioritizing individualized strategies informed by geriatric assessments and molecular profiling. Future trials must integrate biomarker-driven approaches (e.g., ctDNA monitoring, RAS/RAF stratification) to optimize therapeutic precision in aging populations.

Frail older adults receiving cancer treatment are at heightened risk of adverse outcomes. Despite the known benefits of exercise during cancer treatment to improve well-being, few exercise studies focus on frail older adults receiving cancer treatment and their support person. Geriatric assessment (GA) is often recommended prior to the start of treatment for frail adults with cancer, but combining the GA with a planned exercise regimen remains unexplored. This study aims to determine the feasibility and acceptability of implementing geriatric assessment and management (GAM) in combination with virtual chair-based exercise (CBE) and health education for frail older adults with cancer and their support persons.

This phase 2 randomized controlled trial will include patients aged 70 years and above with a lung, gastrointestinal, or genitourinary cancer referred for first- or second-line chemotherapy, immunotherapy, or targeted therapy. Patients must be frail (≥3 on the Vulnerable Elders Survey), sedentary on the Godin Leisure Time Activity Questionnaire (<90 min of moderate/intense activity per week), have English proficiency with ability to consent, a physician-estimated life expectancy of at least six months, and deemed safe to exercise. Each older adult will be invited to bring a support person to participate in the study. Patients will be randomized 1:1 to GAM combined with online CBE and health education for 12 weeks or waitlist control. Participating support persons will follow the same intervention group. Primary endpoints for feasibility and acceptability will be recruitment rate, retention, adherence, and data collection. Outcome measures include physical activity, function, fatigability, quality of life, treatment toxicity, and unplanned hospital visits. Outcome measures will be used to obtain estimates of the effect size and feasibility analysis needed for designing a phase 3 study. The study will take place at two hospitals in Toronto, Canada.

This study will investigate the feasibility, acceptability, and obtain preliminary estimates of the outcomes of GAM plus CBE and health education in preventing functional decline and improving quality of life in frail older adults receiving cancer treatment and their support persons. The results will help to design a definitive phase 3 randomized controlled trial.

The trial is registered at ClinicalTrials.gov (Registration Number: NCT05509751).

Breast cancer remains a leading cause of cancer-related mortality worldwide, with elderly patients (aged >65 years) comprising a substantial portion of those affected. The treatment of breast cancer in this population is often complicated by frailty, comorbidities and polypharmacy. This review explores the application of antibody-drug conjugates (ADCs), such as trastuzumab emtansine (T-DM1), trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG), in treating breast cancer among elderly populations. The underrepresentation of older patients in clinical trials complicates efficacy and safety assessments in this group. Current evidence indicates that ADCs are both effective and tolerable in elderly patients, demonstrating improved progression-free survival (PFS) and overall survival (OS) alongside a manageable safety profile. Data from several trials like the EMILIA, TH3RESA and DestinyBreast studies demonstrate that T-DM1 and T-DXd maintained benefit in PFS and OS for HER2-positive breast cancer in older patients, despite a slight increase in adverse events. The ASCENT and TROPiCS-02 trials further confirm that SG provides significant improvements in PFS and OS in elderly patients at the cost of an increase in some toxicity. Emerging ADCs, including datopotamab deruxtecan and ARX-788, show promise but lack extensive geriatric-specific data. While the ADCs offer encouraging results in terms of efficacy and safety, with appropriate dose adjustments, further research is needed to optimize their use in elderly patients with breast cancer.

Evidence from randomized trials regarding adjuvant chemotherapy and its impact on survival in older patients with resected breast cancer is limited. This study evaluates the current evidence on the use of adjuvant chemotherapy and its effects on overall mortality and breast cancer-specific mortality in older patients. A systematic review and meta-analysis were conducted on the impact of adjuvant chemotherapy in elderly patients with HER2-negative breast cancer. Searches in PubMed, Embase, and The Cochrane Library up to May 2024 included terms such as "breast cancer," "adjuvant," "chemotherapy," "elderly," and "HER2-negative." Eligible studies involved women aged 65 years or older with HER2-negative breast cancer, comparing those receiving adjuvant chemotherapy versus those who did not. Excluded were studies on neoadjuvant therapy, HER2-positive disease, or non-English publications. The primary outcome was overall mortality. Among 2345 articles, 35 studies met the inclusion criteria, comprising 376,900 patients. Adjuvant chemotherapy significantly reduced overall mortality (hazard ratio [HR] = 0.73; 95% CI: 0.68-0.78) and breast cancer-specific mortality (HR = 0.81; 95% CI: 0.73-0.9), with the most pronounced benefit in triple-negative breast cancer (HR = 0.63; 95% CI: 0.60-0.67). Adjuvant chemotherapy reduces overall mortality and breast cancer-specific mortality in older patients, particularly those with triple-negative breast cancer. However, the evidence is predominantly based on retrospective or observational studies, highlighting inherent limitations. Comprehensive geriatric evaluations are crucial for patient selection, and dedicated clinical trials focused on older populations are urgently needed.

The grip strength test is often used during geriatric assessment (GA) to assess muscle strength in older adults. However, it is unclear which grip strength cutoffs are most relevant to older adults in the context of GA. Physical performance during GA is often assessed via the Short Physical Performance Battery (SPPB). Whether the SPPB is superior to two of its individual components (4-m gait speed and the 5-chair stand test) for identifying GA abnormalities is unknown. The objectives of this study were (i) to identify which grip strength thresholds are associated with impairments in GA domains and with an abnormal GA overall and (ii) to examine whether total SPPB score is a stronger indicator of an abnormal GA and each of its domains than 4-m gait speed and the 5-chair stand test.

This was a retrospective cohort study of older adults with cancer aged ≥65 years who had undergone a GA prior to treatment. Grip strength and the SPPB were completed during GA. We examined three different grip strength cutoffs: (i) European Working Group on Sarcopenia in Older People 2 (EWGSOP2); (ii) the Foundation for the National Institutes of Health (FNIH); and (iii) the Sarcopenia Definitions and Outcomes Consortium (SDOC). Low SPPB was defined as a score of ≤9 out of 12 points. A score of ≤3 out of 4 points was used to identify abnormalities in the 4-m gait speed and 5-chair stand test. Multivariable logistic regression was used to address the study objectives.

A total of 475 participants (mean age: 80.7 years, 42.9 % female) were included. The FNIH grip strength criteria had a higher discriminative ability of an abnormal GA (area under the curve [AUC] = 0.646) than the EWGSOP2 and the SDOC criteria. Compared to the SPPB and the 5-chair stand test, the 4-m gait speed was the strongest indicator of an abnormal GA (AUC = 0.737). The addition of low grip strength improved the performance of the SPPB (AUC Δ = +0.05) and gait speed (AUC Δ = +0.04) for identifying an abnormal GA.

Low grip strength per the FNIH and slow gait speed are of clinical relevance during GA.

The aim was to analyze the implementation of the Onco-Geriatrics model in a remote ultramarine territory: West-French Guiana. The population is socially precarious in terms of income, social coverage and administrative status, and most often speaks a non-French language and has a non-Western culture.

Narrative description of the implementation and retrospective study of anonymized data from the database of older patients managed for cancer between September 2014 and December 2020.

A total of 574 new patients were managed. Of these, 107 were aged 70 and over; 78 (73 %) had a G8 test. Forty-two patients had a multidimensional geriatric assessment (MGA). More than half the patients had dependency criteria, malnutrition and a high number of severe comorbidities. Difficulties encountered were language, level of education, clinical context (in 18 patients), but also insufficient involvement of health professional and the consequences of health organization and gradual implementation.

Implementation was impacted by the fact that quality criteria for implementation were not sufficient. Studies in high-middle-income countries in South America suggest that initial implementation of the MGA may be preferable, that frailty screening tests and the MGA procedure can be adapted to non-Western populations, and that the use of new technologies can improve the management of older patients in this context.

It is estimated that 60% of new rectal cancer cases will be diagnosed in patients ≥ 65 years old. The geriatric patient is heterogeneous and underrepresented in clinical trials, and oncologic therapies are often tailored with little evidence. We describe a cohort of patients diagnosed with locally advanced rectal cancer in geriatric and non-geriatric patients.

Retrospective and descriptive analysis of 137 patients, 44 (32.1%) ≥ 75 years old and 93 (67.9%) ≤ 75 years old, with diagnosis of locally advanced rectal cancer. All patients received neoadjuvant chemoradiotherapy (nCRT), followed by total mesorectal excision (TME) and adjuvant chemotherapy.

Mean age was 79.5 for ≥ 75 years and 62.7 for ≤ 75 years, tumor location was: upper rectum (16.1% and 11.3%), middle rectum (60.2% and 47.7%) and lower rectum (23.7% and 41%), using the Eastern Cooperative Oncology Group (ECOG) 0: 74.1% and 81.8%, ECOG 1: 25.9% and 18.2%. Pathological complete response was 21.5% and 22.7%, partial response, 57% and 59% and no response, 21.5% and 18.3%, respectively. Tumor shrinkage in both groups after neoadjuvant treatment was 34.5% and 35.46%. Local recurrence was 2.2% and 3.2% and distance recurrence, 11.3% and 8.6%, respectively.

The study shows similar outcomes in both groups following radical treatment, with similar rates of pathological complete response. However, it has notable limitations, including a small sample size and the absence of a comprehensive geriatric assessment. To enhance these findings, future research should involve larger patient cohorts with comparative analysis and clinical trials specifically focused on the geriatric population.

In the first-line treatment of elderly patients with advanced-stage non-small cell lung cancer (NSCLC) with high programmed death-ligand 1 (PD-L1) expression (tumor proportion score ≥ 50%), this study aimed to determine whether pembrolizumab monotherapy (MONO) or pembrolizumab plus platinum-based chemotherapy (COMB) should be selected.

We performed a retrospective multicenter study (sub-analysis of the HOT/NJLCG2001 trial) of 299 patients with NSCLC with high PD-L1 expression who received MONO or COMB as the first-line treatment between December 2018 and January 2020. We selected patients aged 75 years and older and assessed the clinical efficacy and toxicity.

In total, 81 (median age: 79 years) and 19 (median age: 76 years) patients received MONO and COMB, respectively. Twenty patients with a performance status (PS) score of 2-3 were enrolled in the MONO group. The median progression-free survival (PFS) was 7.8 and 8.9 months in the MONO and COMB groups, respectively. The median overall survival (OS) was 14.6 and 20.3 months, and the 2-year survival rates were 38.8 and 49.9%, respectively. Furthermore, 29.6% and 26.3% of patients discontinued treatment due to adverse events, respectively. In MONO, patients with PS 0-1 had a longer PFS (10.5 months) and OS (21.7 months) than those with PS 2-3 (0.7 and 1.6 months, respectively).

Some elderly patients with NSCLC and high PD-L1 expression might benefit from COMB; however, MONO is considered the preferred treatment. MONO may not be an effective or feasible treatment for patients with PS 2-3, even with high PD-L1 expression.

Concurrent chemoradiotherapy (cCRT) is the standard treatment for locally advanced and unresectable non-small-cell lung cancer. Population is aging, and Geriatric assessment (GA) has demonstrated its paper to select fit patients for active treatment and vulnerable, frail patients for interventions and/or palliative care in many histologies. Its role in locally advanced, unresectable non-small-cell lung cancer has been less explored.

To assess the capability of GA to detect frail patients not suitable for active treatment, we developed this exploratory non-interventional prospective study. All patients ≥ 70 years diagnosed with stage locally advanced and unresectable non-small-cell lung cancer were invited to undergo geriatric assessment. Secondary aims were description of population, exploring GA as prognostic factor, determination of toxicity profile and look for a frailty biomarker.

From June 2017 to June 2020, 51 patients were included, of whom 35% (n:18) were classified as frail. Frail patients had less overall survival and more grade 3-4 toxicity. Exploratory results for frailty phenotype are described in the text.

With the results of our study, we confirm that GA can detect frail patients unsuitable for treatment, with a higher risk of toxicity and less overall survival. A trend toward blood-test results for phenotype frailty can be hypothesis generation.

The treatment landscape for patients with advanced urothelial carcinoma (UC) has evolved rapidly in recent years. In current guidelines, combination treatment with enfortumab vedotin plus pembrolizumab is the first-line (1L) standard of care, and other recommended 1L treatment options are platinum-based chemotherapy followed by avelumab as switch-maintenance treatment in patients without progression, or combination treatment with nivolumab, cisplatin, and gemcitabine for cisplatin-eligible patients only. Individual patients differ in terms of their health status, disease characteristics, expected toxicities, and treatment preferences; thus, a "one-size-fits-all" approach to treatment is unlikely to be optimal. The availability of several treatment options creates the potential for individualized treatment. In this review, we discuss factors that may be considered when selecting 1L treatment for patients with advanced UC, including efficacy and safety data from phase 3 trials and real-world studies, quality of life, patient priorities for treatment, patient and disease characteristics, treatment sequencing, biomarkers, and treatment access and cost. Patients and physicians should discuss the benefit-risk balance of all available 1L options to enable shared decision-making. Longer follow-up from clinical trials and additional real-world studies are needed to further inform treatment selection.

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.

Opioids and benzodiazepines are commonly prescribed for cancer symptoms. In combination, they can increase the risk of adverse events, particularly for older adults with multimorbidity, who represent most patients with cancer. We aimed to understand cancer care providers' practices for opioid and benzodiazepine coprescribing and mitigating potential harms.

We interviewed oncology and palliative care providers from two health systems. Interviews focused on attitudes about and current practices for coprescribing opioids and benzodiazepines. We analyzed interview transcripts using a staged approach to thematic analysis.

Twenty providers (10 oncology, 10 palliative care) participated. We identified three key themes. (1) Reluctance to prescribe benzodiazepines: providers reported rarely coprescribing because they do not routinely prescribe benzodiazepines, which were viewed as having a poor safety profile. (2) Medication safety precautions: these included starting at a low dose and titrating up slowly, consolidating prescriptions under one provider whenever possible, and providing patient and caregiver education around side effects, overdose, and naloxone. Compared to oncologists, palliative care providers more often described providing naloxone to patients and caregivers. (3) Risk assessment and monitoring: most providers mentioned checking state Prescription Drug Monitoring Program databases and conducting chart reviews to identify evidence of substance misuse history. Several oncologists expressed discomfort in asking about substance misuse history due to concerns about stigma. Providers described sometimes relying on their perception of a patient's trustworthiness, with some acknowledging the potential for bias.

We highlight opportunities to improve medication review and reconciliation practices in oncology, increase uptake of naloxone in oncology practice, systematize efforts to screen patients for substance misuse, and strengthen integration of addiction and psychiatry services into oncology and palliative care settings. Regular use of geriatric assessment in oncology would also address many of the safety concerns we observed.

In the past, certain oncological therapies were not offered to frail older patients. However, the advancement of geriatric oncology, tailored chemotherapy regimens, the introduction of new treatments, and the optimization of supportive care have contributed to enhancing the therapeutic margin. We aimed to evaluate the benefit of systemic treatment among older adults by assessing the three-month survival of older frail patients with metastatic cancer.

This retrospective cohort study included patients aged 70 and over with metastatic cancer who underwent pre-therapeutic geriatric assessment at Gustave Roussy Hospital between May 2020 and May 2022 and were categorized as "frail" according to the SIOG-1 classification, whether they received systemic treatment (ST group) or exclusive supportive care (SC group).

The ST group included 77 patients, and the SC group included 44 patients. Patients in the ST group had a median age of 80.6 years (82.7 years in SC group). The three-month overall survival rate was 81.8 % [95 % Confidence Interval (CI) 71.8; 88.9] in the ST group. The median survival rate was 10.6 months [95 % CI 6.3; 12.6] in the ST group. In multivariate analysis within the ST group, loss of autonomy assessed by activity of daily living (ADL) (HR 2.16 [1.09; 4.28]) and more frailty factors (HR 1.40 [1.01; 1.95]) were associated with lower three-month survival.

Older frail patients with metastatic cancer may benefit from systemic oncologic treatment. The introduction of such treatment for patients with loss of autonomy in ADL or cumulative frailty factors should be considered only with caution.

Nursing care for older people with advanced cancer who live alone during outpatient chemotherapy should address their difficulties while respecting their lives. However, their lived experiences remain underexplored. Therefore, we conducted a descriptive qualitative study to explore and describe their lives. The participants were purposively sampled, older patients (≥ 65 years) with advanced cancer who lived alone and were receiving outpatient cancer chemotherapy. Semi-structured interviews were conducted using an interview guide, and thematic analysis was applied. There were 12 participants. Nine categories and 49 subcategories were extracted. The core category was "Getting by through endurance, ingenuity, and effort in one's increasingly fragile 'own vessel,' in order to survive a little longer and fulfill one's life." Effective support should not only address their challenges, but also respect their convictions, leverage their strengths, and enhance their self-efficacy. Further, early implementation of advance care planning (ACP) is crucial to proactively identify the needs of these patients, who rarely express their concerns. This approach facilitates their transition from full independence to autonomy, enabling them to choose and integrate necessary support into their daily lives.

Population aging and increased cancer incidence have made the treatment of cancer in older individuals an increasingly important issue. Geriatric 8 (G8) is a screening tool developed to identify patients who would benefit most from a comprehensive geriatric assessment (GA). Previous G8 studies have involved older patients, but the age-related significance and usefulness of G8 is unknown. In this study, G8 screening was administered to patients who were 30 years of age or over with cancer to examine a G8 score in each 10 years age group and its correlation with other GA tools.

The study was conducted at Fukuoka University Hospital from January 2020 to March 2022 and enrolled 715 patients aged ≥ 30 years undergoing surgery for primary gastrointestinal cancer or malignant disease. The relationship between age, G8, instrumental activities of daily living (IADL), activities of daily living (ADL), and the Charlson Comorbidity Index (CCI) was investigated.

The median age of the patients was 69 years (34-98 years). Functional disability in ADLs was present in 43 patients (6%) and in IADLs in 72 patients (10.1%). The mean G8 score by age group was 13.7, 13.1, 13.3, 13.3, 12.4, 11.3, and 9.25 for ages 30-39, 40-49, 50-59, 60-69, 70-79, 80-89, and 90-100 years, respectively. For each of the ADL/IADL items, the group with functional disability had significantly lower G8 scores than the group without functional disability (p < 0.001). The relationship between the G8 score and CCI by age group showed that the G8 score decreased as the CCI score increased. Assessments divided into age groups of 65, 70, and 75 years showed significant differences between groups for most ADL/IADL items and G8 scores, even when divided by age 65.

G8 scores were lower in patients with ADL/IADL disabilities and decreased with age in both the presence and absence of disabilities. The G8 total score decreased significantly after the age of 70 years. Performing G8 in patients < 65 years of age does not decrease sensitivity; however, the functional decline is so slight that it appears reasonable to restrict G8 screening to patients ≥ 65 years of age.

Ototoxicity is among the adverse events related to cancer treatment that can have far-reaching consequences and negative impacts on quality-of-life for cancer patients and survivors of all ages. Ototoxicity management (OtoM) comprises the prevention, diagnosis, monitoring, and treatment, including rehabilitation and therapeutic intervention, of individuals who experience hearing loss, tinnitus, or balance/vestibular difficulties following exposures to ototoxic agents, including platinum chemotherapy (cisplatin, carboplatin) and cranial radiation. Despite the well-established physical, socioeconomic, and psychological consequences of hearing and balance dysfunction, there are no widely adopted standards for clinical management of cancer treatment-related ototoxicity. Consensus recommendations and a roadmap are needed to guide development of effective and feasible OtoM programs, direct research efforts, address the needs of caregivers and patients at all stages of cancer care and survivorship. Here we review current evidence and propose near-term to longer-term goals to advance OtoM in five strategic areas: (1) beneficiary awareness, empowerment, and engagement, (2) workforce enhancement, (3) program development, (4) policy, funding, and sustainability, and (5) research and evaluation. The goal is to identify needs and establish a roadmap to guide worldwide adoption of standardized OtoM for cancer treatment and improved outcomes for patients and survivors.