Agyei KG, Malhotra A, Norton SA
… +4 more, Mohamed M, Juba KM, Mohile S, Ramsdale E
J Geriatr Oncol
· 2026 Apr · PMID 41785645
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INTRODUCTION: Polypharmacy affects up to 93% of older adults with cancer and increases risks of treatment toxicity, drug interactions, and adverse outcomes. Deprescribing, the planned discontinuation of potentially inapp...INTRODUCTION: Polypharmacy affects up to 93% of older adults with cancer and increases risks of treatment toxicity, drug interactions, and adverse outcomes. Deprescribing, the planned discontinuation of potentially inappropriate medications, can mitigate these risks. However, deprescribing interventions in oncology clinics remain understudied outside palliative care settings. This study aimed to identify barriers and facilitators to deprescribing in the oncology clinic across multiple stakeholder groups. MATERIALS AND METHODS: Between November 2020 and August 2021, virtual focus groups were conducted with five key informant groups: patients (n = 9), primary care physicians (n = 7), oncology pharmacists (n = 7), oncology nurses (n = 7), and oncologists (n = 6). Participants were recruited from the University of Rochester Wilmot Cancer Institute, affiliated sites, and a patient advisory board. Semi-structured interview guides explored topics including polypharmacy definitions, medication communication, workflows, and deprescribing strategies. Sessions were audio-recorded, transcribed verbatim, and analyzed using inductive content analysis with MAXQDA software. Two coders performed open coding and developed themes categorized at patient, healthcare provider, and system levels. RESULTS: At the patient level, barriers included resistance to change, lack of awareness, mistrust, and health complexity, while facilitators included education/empowerment, effective communication, and caregiver involvement. At the provider level, barriers encompassed knowledge gaps, scope of practice concerns, and time limitations, with facilitators including inter-provider communication, education, longitudinal approaches, and provider maturity. System-level barriers included care fragmentation, electronic health record limitations, and automated workflows, while facilitators emphasized team-based care, decision support tools, and pharmacist integration. Notably, all groups expressed consistent enthusiasm for pharmacist involvement in deprescribing interventions. DISCUSSION: This analysis revealed multilevel barriers and facilitators to deprescribing in older adults with cancer. Mismatches between provider perceptions and patient attitudes suggest opportunities for improved communication. Time constraints and scope of practice concerns were prominent provider barriers, addressable through longitudinal approaches and team-based models. The consistent enthusiasm across all stakeholder groups for pharmacist-led interventions informed the design of a subsequent cluster-randomized trial. These findings suggest scalable interventions leveraging pharmacist expertise and decision support tools to address polypharmacy in this vulnerable population.
Strohschein FJ, van der Wal-Huisman H, Hayden KA
… +11 more, Haase KR, Hannan M, Kenis C, Li J, Nikita N, Pilleron S, Ruegg T, Schmidt H, Steckelberg A, Vonnes C, Puts M
INTRODUCTION: Cancer treatment decision making (CTDM) presents important challenges among older adults due to variation in health and functional status, presence of comorbidities, differing goals/values, quality and quan...INTRODUCTION: Cancer treatment decision making (CTDM) presents important challenges among older adults due to variation in health and functional status, presence of comorbidities, differing goals/values, quality and quantity of life considerations, and limited inclusion in clinical trials. Nursing standards and guidelines call for competence in supporting CTDM and nurses advocate for greater involvement. However, clear understanding of the existing evidence to inform nursing practice is lacking. We aimed to map and synthesize evidence that provides insight into nursing practice in CTDM among older adults, with attention to nursing roles, required skills and competencies, potential barriers and facilitators, and outcomes studied. MATERIALS AND METHODS: Following JBI (formerly Joanna Briggs Institute) methodology for scoping reviews, we included empirical articles that describe nursing contribution, individually or as part of a multidisciplinary team (MDT), related to CTDM for active (curative or non-curative) treatment among adults aged ≥60 years diagnosed with cancer. Nine databases were searched systematically from inception to January 2024, no limits applied. Two independent reviewers screened identified records and full texts, then systematically extracted data from included articles. Basic qualitative content analysis was conducted on charted data. RESULTS: Of the 9582 records screened, 980 full texts were assessed for eligibility; 84 reports describing 78 studies were included. Conducted primarily in the United States or United Kingdom, studies described nursing interventions, nursing involvement in geriatric assessment and MDT meetings/clinics, and the perspectives of patients, family, and/or healthcare professionals. Although seldom the primary focus, researchers have highlighted the important roles of nurses in the CTDM process, before, during, and after consultations with physicians and MDT meetings, which require disease-specific knowledge and relational skills. MDT collaboration, training, dedicated time and space, adequate resources, and support from leadership are critical to promoting involvement, with potential impact on decision satisfaction and optimal treatment decisions. The value of nurses' involvement is endorsed by patients, family, and other healthcare professionals. DISCUSSION: Nurses play a vital role in CTDM among older adults, particularly in the MDT context. However, rigorous studies demonstrating the impact of nursing practice on CTDM outcomes among older adults are lacking. Further research is needed to inform nursing practice and interventions.
The average global life expectancy is predicted to increase to approximately 80 years by 2040 [1]. Cancer is an ageing-related disease, and its prevalence will also increase with this ageing of the population [2]. This r...The average global life expectancy is predicted to increase to approximately 80 years by 2040 [1]. Cancer is an ageing-related disease, and its prevalence will also increase with this ageing of the population [2]. This rise in older adults living with cancer will demand innovation in service delivery, multidisciplinary collaboration, and a renewed focus on compassionate, patient-centred care. We are therefore compelled to rethink how we approach cancer diagnosis, treatment, and survivorship. This white paper explores the potential realities and challenges through a multidimensional lens, addressing the intersection of demographic shifts, rapid technological advancements, and the evolving needs of older adults living with cancer. Key areas examined include the integration of precision medicine and digital health tools, the adaptation of healthcare delivery models, and the implications for workforce training and resource allocation. The discussion highlights disparities in care, the importance of personalised interventions, and strategies to enhance quality of life for older adults with cancer. By anticipating these developments, the paper offers critical insights for policymakers (who set the rules and goals and allocate funding), health system leaders (who manage the day-to-day operations), clinicians and allied health professionals (who are patient-facing), and patients and caregivers, aiming to promote equity, innovation, quality and resilience in the care of older adults with cancer as we approach the next decade. The paper seeks to consolidate and clarify the diverse issues and opportunities that will emerge as the global population ages and the burden of cancer among older adults rises. With average life expectancy predicted to approach 80 years by 2040, and cancer recognised as a disease closely linked to ageing [3], the paper brings together expert perspectives to provide a sector-wide synthesis of the impending challenges. Its purpose is not to offer a conventional systematic review, but rather to serve as a strategic resource for policymakers, health system leaders, clinicians, allied health professionals, patients, and caregivers, informing the response to demographic shifts, technological advances and evolving patient needs. By consolidating insights on disparities in care, the necessity for personalised interventions, and strategies to enhance quality of life, the paper aims to inform and inspire innovation, equity and resilience in geriatric oncology as we approach the next decade.
INTRODUCTION: Pulmonary lobectomy represents the primary curative treatment for lung cancer in older adults, yet frailty's impact on critical early postoperative outcomes remains inadequately characterized. This analysis...INTRODUCTION: Pulmonary lobectomy represents the primary curative treatment for lung cancer in older adults, yet frailty's impact on critical early postoperative outcomes remains inadequately characterized. This analysis examined the effect of preoperative frailty on early postoperative mortality and failure-to-rescue in a contemporary national cohort. MATERIALS AND METHODS: This retrospective cohort study analyzed older adults undergoing pulmonary lobectomy for lung cancer using the National Inpatient Sample (2016-2022). The Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator and Hospital Frailty Risk Score (HFRS) were used to identify frail patients. Multivariable logistic regression examined associations between frailty and failure-to-rescue (death after postoperative complications) and 14-day in-hospital mortality. RESULTS: Among 110,460 patients aged ≥65 years, frailty prevalence was 5.7% (n = 6290) by ACG indicator and 19.8% (n = 21,915) by HFRS (≥5). Among ACG-defined frail patients, the most common frailty-defining conditions were dementia (37.8% of frail patients), malnutrition (36.0%), and weight loss (11.6%). Overall complication rate was 39.3%, but frail patients (HFRS ≥5) experienced higher rates (69.0% versus 32.0%), higher hospitalization costs (median $104,446 versus $88,532), and reduced likelihood of home discharge (83.3% versus 95.5%; all p < 0.001). Overall 14-day mortality was 0.8%. Frail patients had higher rates of failure-to-rescue (ACG: 3.7% versus 1.7%; HFRS: 4.1% versus 0.8%) and mortality (ACG: 2.1% versus 0.7%; HFRS: 2.8% versus 0.3%; all p < 0.001) compared with non-frail patients. After multivariable adjustment, frailty remained associated with failure-to-rescue (ACG: OR 2.01, 95% CI 1.36-3.06; HFRS: OR 4.66, 95% CI 3.27-6.63) and 14-day mortality (ACG: OR 2.70, 95% CI 1.77-4.10; HFRS: OR 9.30, 95% CI 6.52-13.26). Frailty accounted for 68% of early deaths within the frail cohort and 11% of all cohort deaths. DISCUSSION: Preoperative frailty was associated with early postoperative mortality and failure-to-rescue rates following pulmonary lobectomy in older adults, emphasizing the need for systematic frailty assessment, enhanced perioperative surveillance, and targeted interventions for this population.
INTRODUCTION: Gait speed (GS) reflects an individual's physical capacity and is often used to assess the level of fitness in older individuals with cancer. Importantly, GS can be measured in various ways. This study exam...INTRODUCTION: Gait speed (GS) reflects an individual's physical capacity and is often used to assess the level of fitness in older individuals with cancer. Importantly, GS can be measured in various ways. This study examined the association between several GS measurements and one-year mortality in older patients with head and neck cancer. MATERIALS AND METHODS: This prospective cohort study included 227 patients. GS was measured at usual and fast pace using a 5-m walkway. GS reserve (fast-usual GS) and GS ratio (fast/usual GS) were calculated. GS measurements were analyzed both as continuous and categorical variables. For the categorical analyses, two categorical GS variables were created: '1 m/s' and '25th percentile.' Each variable included three categories: for '1 m/s': usual and fast GS <1 m/s, usual GS <1 m/s and fast GS ≥1 m/s, and usual and fast GS ≥1 m/s; for '25th-percentile': usual and fast GS < p25, usual GS < p25 and fast GS ≥ p25, and usual and fast GS ≥ p25. Cox regression survival analyses were performed. RESULTS: Median age was 76 [IQR 72-80] years, 71% were men and 51 patients died within one year. Mean usual and fast GS were 1.08 ± 0.27 and 1.41 ± 0.39 m/s, respectively. A higher usual (HR 0.23, 95%CI 0.07-0.76) or fast GS (HR 0.36, 95%CI 0.14-0.91) were associated with lower mortality. Patients with usual and fast GS <1 m/s (HR 2.66, 95%CI 1.29-5.50) had a higher mortality risk compared to patients with usual and fast GS >1 m/s. The association of 25th percentile group with mortality attenuated after adjustment for treatment (HR 2.07, 95%CI 0.91-4.73). Neither GS reserve nor GS ratio were associated with mortality. DISCUSSION: Lower usual and fast gait speeds are associated with higher one-year mortality in patients with head and neck cancer. A simple guideline is that patients with usual and fast GS <1 m/s or < p25 have a twofold higher risk of dying within one year compared to patients who walk faster.
INTRODUCTION: Family and/or unpaid caregivers play an important role in managing care for older adults with cancer (aged ≥65 years). Despite the development of theoretical models that emphasize the need for medical teams...INTRODUCTION: Family and/or unpaid caregivers play an important role in managing care for older adults with cancer (aged ≥65 years). Despite the development of theoretical models that emphasize the need for medical teams to assess caregiver abilities and integrate this assessment into patient care plans, little is known about what specific caregiver abilities should be prioritized for assessment and how such assessments should be conducted. MATERIALS AND METHODS: In this interpretive description qualitative study, we conducted individual, semi-structured interviews with healthcare professionals (HCPs) who are involved in caring for older adults with cancer. All participants were recruited from a single large academic medical center between June and September 2024. The interviews focused on: (1) the caregiver abilities of interest to HCPs, (2) how HCPs assess these abilities, and (3) how HCPs respond to caregiver-reported deficits in these abilities. All interviews were audio-recorded and transcribed. Two analysts analyzed the transcripts using inductive thematic analysis and open coding. RESULTS: We interviewed 19 HCPs from diverse specialties (mean age: 45 ± 1.7 years, 90% female, 90% White). HCPs expressed interest in various caregiver abilities, including physical or functional capacity, cognitive function, medical knowledge and skills, emotional ability to cope with cancer diagnosis, financial ability (e.g., accessing medications), and availability. HCPs reported assessing caregiver abilities based on interactions with caregivers or using informal direct questions. They also reported several challenges in this assessment such as time limitations in clinical settings and ambiguity regarding their responsibility in evaluating caregiver abilities. When responding to deficits in caregivers' abilities, HCPs usually encourage caregivers to seek available social support or connect them with relevant resources. If caregivers need to develop specific caregiving skills, HCPs use more deliberate methods (e.g., a teach-back approach) to evaluate their abilities and provide direct support, including helping simplify caregiving tasks, providing necessary supplies or equipment, and offering various learning methods. DISCUSSION: We did not identify a systematic approach among HCPs to assessing these abilities. Given HCP-reported challenges in this assessment, our study highlights the need for a formal caregiver ability assessment to identify caregiver challenges and inform patient care plan development.
Brauer ER, Lazaro S, Economou DR
… +3 more, Rapkin D, Wong DJ, St John MA
J Geriatr Oncol
· 2026 Mar · PMID 41702290
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INTRODUCTION: Frailty and malnutrition are strong predictors of adverse outcomes in patients with head and neck cancer, yet remain underassessed in routine clinical care. This project aimed to develop, implement, and eva...INTRODUCTION: Frailty and malnutrition are strong predictors of adverse outcomes in patients with head and neck cancer, yet remain underassessed in routine clinical care. This project aimed to develop, implement, and evaluate a standardized screening process for frailty and malnutrition in a multidisciplinary head and neck cancer program to identify high-risk patients and inform treatment planning. MATERIALS AND METHODS: Through a quality improvement initiative, a multidisciplinary team integrated the Risk Analysis Index for Cancer (RAI-C) for frailty and Malnutrition Screening Tool (MST) into routine intake for new referrals of patients with head and neck cancer. Implementation was evaluated across three domains: feasibility, measured through completion rates, acceptability, assessed using clinician feedback via a survey, and impact on patient outcomes, using survival analysis. RESULTS: Among 585 eligible patients, 488 (83.4%) were successfully screened. The cohort (mean age 63.1 years, 64% male) demonstrated high frailty prevalence with 57.2% categorized as frail (RAI-C score ≥ 37) and 14.3% at risk for malnutrition (MST score ≥ 2). In multivariable analysis adjusted for tumor site, treatment intensity, and comorbidities, frail patients had a more than 3-fold increased mortality risk compared to non-frail patients (adjusted HR 3.07, 95% CI 1.50-6.30, p = 0.002). Similarly, malnourished patients showed a 2.8-fold increased mortality risk compared to non-malnourished patients (adjusted HR 2.77, 95% CI 1.52-5.03, p < 0.001). Clinician feedback (n = 14) emphasized the value of screening in promoting "whole person" treatment planning, with suggestions for developing standardized pathways for interventions based on screening results. DISCUSSION: Implementing frailty and malnutrition screening in multidisciplinary head and neck cancer care is feasible, acceptable to clinicians, and identifies patients at significantly higher mortality risk. The strong association between screening results and survival validates these tools' clinical utility and supports their integration into routine practice. Future directions include developing a structured prehabilitation program targeted to modifiable risk factors identified through screening to potentially improve outcomes in this vulnerable population.
INTRODUCTION: There is a paucity of data with respect to optimal management of metastatic renal cell carcinoma (mRCC) in older patients. Real-world data may help close this knowledge gap and improve care in this understu...INTRODUCTION: There is a paucity of data with respect to optimal management of metastatic renal cell carcinoma (mRCC) in older patients. Real-world data may help close this knowledge gap and improve care in this understudied and growing patient population. MATERIALS AND METHODS: The Canadian Kidney Cancer information system (CKCis) was utilized to identify patients with mRCC, categorizing them as either older (defined as age ≥ 75 years) or younger (age < 75 years). Our primary objective was to identify if first line (1 L) mRCC management strategies differed by age. Secondary outcomes of interest were potential differences in treatment-related toxicities, overall survival (OS), progression free survival (PFS), and time to treatment discontinuation (TTD) by age. RESULTS: In total, 2585 patients were included (<75 years of age n = 2205; ≥ 75 years of age n = 380). Baseline demographics were comparable between cohorts, though older patients more often had five or more comorbidities (95% vs. 67%, p < 0.001) and more frequently had Karnofsky Performance Status ≤70% (19% vs. 13%, p = 0.002). Older patients underwent metastasectomy (15% vs. 24%, p < 0.001) and cytoreductive nephrectomy less frequently (2% vs. 7%, p = 0.047), and were less likely to be enrolled in clinical trials (10% vs. 23%, p < 0.001). Older patients received 1 L targeted monotherapy more frequently than immune checkpoint inhibitor (ICI)-based therapy in the post-ICI era (65% vs. 44%, p < 0.001). Older patients did not experience more treatment-related toxicities from ICI-based therapy. Older patients experienced shorter OS when controlling for International mRCC Database Consortium (IMDC) classification, comorbidities, and histology (HR 1.25, 95% CI 1.1-1.4, p = 0.003) in the overall cohort. DISCUSSION: Patients ≥75 years of age received 1 L targeted monotherapy more frequently than those <75 years of age, though when they received combination ICI-based therapy, they did not experience more treatment-related toxicities. Clinicians should individualize treatments for older patients not strictly based on age, but after discussion of available options in a patient-centered manner, considering comorbidities, disease burden, and patient preferences.
Fournier B, Russo C, Maire A
… +14 more, Buono R, Lebras L, Guillermin Y, Santana C, Rey P, Belhabri A, Michallet AS, Jauffret L, Pretet-Flamand E, Terret C, Michallet M, Fervers B, Nicolas-Virelizier E, Pérol O
INTRODUCTION: Older adults with hematologic malignancies are at high risk of treatment-related functional decline. Although physical activity (PA) may mitigate these effects, evidence in older adults with acute myeloid l...INTRODUCTION: Older adults with hematologic malignancies are at high risk of treatment-related functional decline. Although physical activity (PA) may mitigate these effects, evidence in older adults with acute myeloid leukemia (AML) and non-Hodgkin lymphoma (NHL) remains limited. We evaluated the feasibility and exploratory effects of a 6-month individualized PA program delivered during and after chemotherapy in this population. MATERIAL AND METHODS: The OncoGeriatric and Individualized Physical Activity (OCAPI) study is a single-arm, prospective feasibility study evaluating a 6-month individualized PA program in AML/NHL patients ≥65 years receiving chemotherapy ± immunotherapy. The PA program included supervised and unsupervised sessions, an activity tracker, and motivational phone calls. The primary outcome was progam adherence. Secondary outcomes were feasibility metrics (recruitment, retention, adherence, safety, and patient satisfaction) assessed throughout the study, and exploratory effectiveness measures (physical condition, PA behavior, and patient-reported and geriatric outcomes) evaluated at baseline, three, and six months. RESULTS: Forty-two participants were enrolled. Rates of recruitment and retention were 59% and 88%, respectively. Adherence was 66% for supervised sessions, and < 5% for unsupervised ones. Activity trackers were worn 63% of the prescribed time and 75% of scheduled calls were completed. No exercise-related adverse events occurred. Patient satisfaction was high (96%). Perceived usefulness was 91% for supervised sessions, 54% for unsupervised sessions, 84% for the activity tracker, and 86% for motivational calls. At three months, in the overall cohort, handgrip strength showed a decline and balance an improvement, but there were no changes in other performance, patient-reported, or geriatric outcomes. Changes in limb strength and walking endurance may varied by diagnosis, with NHL patients tending to improve, and AML ones tending to decline. At six months, among all participants, walking endurance improved significantly and clinically (+53 m in the 6-Minute Walk Test, p = 0.01), while left-hand grip strength declined. Nutritional status and quality of life also showed improvement, with no notable changes in other outcomes. DISCUSSION: The individualized PA program was feasible and safe for older patients with AML/NHL during chemotherapy. Exploratory effectivenness findings suggest that patients improved walking endurance and quality of life and diagnosis-specific functional trajectories. Larger multicenter trials are needed to confirm these preliminary observations.
INTRODUCTION: Cancer treatment puts older adults with cancer at increased risk for functional decline, impaired quality of life (QOL), and treatment-related toxicity. Geriatric co-management has been proposed as a strate...INTRODUCTION: Cancer treatment puts older adults with cancer at increased risk for functional decline, impaired quality of life (QOL), and treatment-related toxicity. Geriatric co-management has been proposed as a strategy to improve outcomes in this vulnerable population. MATERIALS AND METHODS: This prospective, randomized (1:1) trial evaluated the impact of geriatric co-management and intervention in patients aged ≥70 years with a G8 score < 15 initiating new systemic outpatient treatment. The aim was to assess the efficacy of targeted interventions versus standard care. Two primary endpoints were chosen: independence (no restrictions in instrumental activities of daily living (IADL)) and QOL (global health scale of the European Organisation for the Research and Treatment of Cancer questionnaire: EORTC QLQ-C30) at 12 weeks (T2). Secondary endpoint was "incidence of severe adverse events" (Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0, grade ≥ 3). A multiprofessional team performed the geriatric assessment and co-management in the intervention group (IG). RESULTS: A total of 217 patients were enrolled (207 in full analysis set; median age 75 (range 70-89) years; 42% female). For both primary endpoints, a tendency for improvement in the IG was observed: an adjusted odds ratio (OR) of 1.34 (97.5% CI 0.60-2.98; p = 0.42) for regaining independence, and an adjusted difference in global QOL T2 scores of 1.82 (CI -4.44-8.07; p = 0.51). Statistical significance could not be demonstrated. Geriatric co-management reduced grade ≥ 3 toxicities compared with standard care (15.5% vs 30.8% of patients, risk difference - 15.2%, 95% CI -26.5%; -3.9%) and lowered unplanned hospitalizations (21.4% vs 28.8% of patients, risk difference - 7.5%, 95% CI -19.3%; 4.3%). DISCUSSION: The interventions showed a consistent, yet statistically insignificant, impact on quality of life and independence. Importantly, it was associated with a reduction in severe toxicity and may have led to fewer unplanned hospitalizations. Findings support further integration of geriatric co-management into routine oncology care for older adults with cancer.
INTRODUCTION: Older adults with cancer have a higher risk of developing sarcopenia, which may contribute to a worse prognosis. This study aimed to verify if sarcopenia predicts early death in older adults with cancer at...INTRODUCTION: Older adults with cancer have a higher risk of developing sarcopenia, which may contribute to a worse prognosis. This study aimed to verify if sarcopenia predicts early death in older adults with cancer at the time of admission for outpatient treatment. MATERIALS AND METHODS: This prospective cohort study was based on secondary data analysis from individuals over 60 years old with cancer admitted to an oncogeriatric outpatient clinic from 2016 to 2020. Upon admission, sociodemographic data, clinical variables, nutritional, and physical assessment were evaluated. We considered probable sarcopenia (low hand grip strength [HGS], < 16 kg women and < 27 kg men), sarcopenia (low HGS and calf circumference [CC] < 31 cm), and severe sarcopenia (low HGS, decreased CC, and timed up and go test ≥20 s). The primary outcome was all-cause early death within 180 days from outpatient evaluation. A multivariate analysis using the Cox proportional hazards model was performed, and the survival curve was established according to the degrees of sarcopenia. RESULTS: Of the 403 individuals included, 44.2% (n = 178) had some degree of sarcopenia upon admission (25.1% had probable sarcopenia and 15.6% had sarcopenia). Eighty-seven (21.6%) individuals died within 180 days. All degrees of sarcopenia were associated with death; probable sarcopenia (hazard ratio [HR] 1.76; confidence interval of 95% [95% CI] 1.05 to 2.99; p = 0.03), sarcopenia (HR 2.00; 95% CI 1.11 to 3.62; p = 0.02), and severe sarcopenia (HR 3.15; 95% CI 1.35 to 7.32; p = 0.007). Low HGS was the only criterion for diagnosing sarcopenia associated with early death. The other risk factors associated with death were male sex, primary site of cancer, metastatic disease, reduced functionality, and polypharmacy. DISCUSSION: Identifying predictors of early death in older adults with cancer is clinically relevant and has a direct impact on therapeutic decision-making processes.
INTRODUCTION: We aimed to systematically analyze the risk factors for venous thromboembolism (VTE) in patients aged ≥60 years with malignant solid tumors to facilitate targeted prevention. MATERIALS AND METHODS: We searc...INTRODUCTION: We aimed to systematically analyze the risk factors for venous thromboembolism (VTE) in patients aged ≥60 years with malignant solid tumors to facilitate targeted prevention. MATERIALS AND METHODS: We searched Ovid MEDLINE, EMBASE, SCIE, and SCOPUS databases for articles from inception to April 24, 2024. Article quality was assessed via the Newcastle-Ottawa Scale, with data extracted independently by two reviewers and thematically categorized. RESULTS: Sixteen studies (n = 964,290 patients) were included. VTE incidence varied significantly by cancer type, ranging from 1.2% (prostate cancer) to 20.3% (colorectal cancer). Twenty-nine distinct risk factors were identified across five domains: (1) Treatment-related: chemotherapy (significant risk factor in 8/9 studies), radiotherapy, and targeted therapy. (2) Disease-related: advanced tumor stage (reported in 56% of studies) and high-risk cancer types (pancreatic and colorectal). (3) Comorbidity-related: cardiovascular disease (44% of studies), kidney disease, and a VTE history (strongest predictor, hazard ratio = 5.4-20.1). (4) Sociodemographic: Black race (highest risk), female sex (increased risk for colorectal/renal cancer), and older age. (5) Laboratory: elevated D-dimer level (≥600 μg/L) and low partial pressure of oxygen (<75 mmHg). An "age paradox" was observed: while age is a risk factor, the relative contribution of cancer to VTE diminished with age, and the observed VTE incidence decreased in very old individuals (≥85 years), likely due to competing mortality. DISCUSSION: The risk of VTE in older patients with solid tumors is multidimensional. Current risk models are inadequate. Future tools must integrate tumor characteristics, treatment exposures, geriatric-specific factors (comorbidities, frailty), and bleeding risk to optimize personalized thromboprophylaxis.
Mizutani T, Sato F, Uemura K
… +10 more, Shimizu Y, Iwatani T, Kobayashi S, Sawaki M, Tashiro S, Tsuji T, Yamamoto H, Ogawa A, Hamaguchi T, Geriatric Study Committee of the Japan Clinical Oncology Group, Japan
INTRODUCTION: Older adults represent a growing proportion of patients with cancer. However, confirmatory randomized controlled trials (RCTs) continue to rely primarily on tumor-based endpoints such as overall survival (O...INTRODUCTION: Older adults represent a growing proportion of patients with cancer. However, confirmatory randomized controlled trials (RCTs) continue to rely primarily on tumor-based endpoints such as overall survival (OS), which may overlook outcomes particularly important to older adults, including quality of life (QOL), functional status, and treatment tolerance. This review aimed to systematically characterize the primary endpoints used in confirmatory RCTs enrolling adults aged ≥65 years and to evaluate how novel endpoints reflecting patient priorities were defined and analyzed. MATERIALS AND METHODS: PubMed, CINAHL, and the Cochrane Library were searched for English-language confirmatory RCTs exclusively enrolling adults aged ≥65 years with cancer and reporting a primary endpoint (up to January 19, 2024). Endpoints were classified as conventional (tumor-based) or novel (non-tumor-based). Data were extracted on endpoint definitions, measurement tools, and statistical approaches. RESULTS: Of 822 records identified, 66 RCTs met the eligibility criteria, yielding 71 primary endpoints. Conventional outcomes predominated (n = 53; 74.6%), with OS being the most frequent, followed by progression-free survival and disease-free survival. Novel endpoints (n = 18; 25.3%) included health-related QOL (HR-QOL), toxicity, geriatric assessment-based measures, composite endpoints, and patient satisfaction. HR-QOL was most commonly assessed using the European Organization for Research and Treatment of Cancer QLQ-C30. Definitions of toxicity and functional decline varied across studies. Variance assumptions were rarely reported, and minimal clinically important differences were inconsistently applied. Additional endpoints, such as quality-adjusted survival, overall treatment utility, and disability-free survival, were infrequently reported. DISCUSSION: Survival remains the predominant endpoint in confirmatory RCTs involving older adults with cancer, while patient-relevant outcomes are inconsistently incorporated. Addressing these gaps may facilitate more patient-centered trial designs and improve the real-world applicability of research findings for the aging cancer population.