INTRODUCTION: Renal cell carcinoma (RCC) primarily affects older adults who often present with frailty, increasing their risk of surgical complications and delayed recovery. Prehabilitation, incorporating exercise, nutri...INTRODUCTION: Renal cell carcinoma (RCC) primarily affects older adults who often present with frailty, increasing their risk of surgical complications and delayed recovery. Prehabilitation, incorporating exercise, nutrition, and psychological support, may improve postoperative outcomes. However, no studies have investigated prehabilitation prior to surgery for RCC. The aim is to assess whether a one-month multimodal prehabilitation program including geriatric interventions improves recovery in patients with frailty undergoing surgery for localized RCC ≤ 7 cm. MATERIALS AND METHODS: 60 patients, aged ≥65, with a Clinical Frailty Scale (CFS) score of 3-6 are randomized 1:1 to standard care or prehabilitation involving home-based exercise, geriatric assessment with tailored interventions, and smoking cessation support. The primary outcome is change in Quality of Recovery-15 (QoR-15) 21 days postoperatively. Secondary outcomes include changes in QoR-15, health-related quality of life (EQ-5D-5L) and physical performance (30-s chair-stand test, handgrip strength) assessed preoperatively, 1, 21 and 90 days postoperatively. Postoperative complications will be evaluated using the Clavien-Dindo classification, alongside a cost-effectiveness analysis. Long-term outcomes include 1- and 5-year recurrence-free, cancer-specific, and overall survival. DISCUSSION: Pre-KiT explores if a pragmatic geriatric prehabilitation strategy is effective and feasible for older frail patients with RCC. The intervention is designed for easy implementation in clinical practice: administered by a single healthcare professional, requiring only one additional hospital visit, and consists of home-based exercises. This low-resource approach also aims to minimize financial costs, which is of importance for implementation possibilities. If successful, it could improve standard care and outcomes after surgery. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06745609. Prospectively registered December 12th, 2024.
INTRODUCTION: Improvements in supportive care strategies and growing evidence for benefit have led to increased use of autologous stem cell transplant (ASCT) in older patients with multiple myeloma (MM). However, the lac...INTRODUCTION: Improvements in supportive care strategies and growing evidence for benefit have led to increased use of autologous stem cell transplant (ASCT) in older patients with multiple myeloma (MM). However, the lack of standardized criteria for transplant eligibility often leaves the decision to the physician's clinical judgment. The roles of frailty/geriatric assessment tools, functional status, and comorbidity in selecting candidates and predicting transplant outcomes in older patients with MM remain uncertain. The purpose of this systematic review was to examine the measures of frailty, functional status, and comorbidity reported for older patients with MM who underwent ASCT and to evaluate their association with outcomes. MATERIALS AND METHODS: On April 11, 2024, MEDLINE, EMBASE, and the Cochrane Library were searched for articles that included older adults (>60 years) with MM addressing the use of ASCT or ASCT eligibility/ineligibility. We included retrospective and prospective studies that included (1) at least one measure of functional status and/or comorbidities and (2) at least one transplant-related outcome (response rate, transplant-related mortality). RESULTS: Twenty-five studies were included, four prospective and 21 retrospective. Of these, four studies utilized the International Myeloma Working Group (IMWG) frailty index, with some including frail patients. In one study utilizing a comprehensive geriatric assessment, >50 % of older adults who were considered transplant-eligible reported dependence on ≥1 Instrumental Activities of Daily Living (IADL), severe limitations in vigorous activities, and/or self-reported weight loss. Eighteen studies reported a measure of functional status, most commonly Eastern Cooperative Oncology Group Performance Status; 19 studies reported a comorbidity measure, most commonly Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI). The comorbidity scores were generally low in patients who underwent ASCT (<3). The 100-day treatment-related mortality ranged from 0 % to 6 %, with overall response rates were generally high across studies. DISCUSSION: There is wide variability in the tools used to assess characteristics of older adults who underwent ASCT across studies. The optimal tool for selecting older ASCT candidates remains undefined, but it is likely that no single measure can adequately capture overall health status. Prospective studies incorporating a multidimensional assessment are necessary to better define transplant eligibility in this population.
Older adults with cancer face disproportionately high rates of severe treatment-related toxicities, yet current prediction tools rarely incorporate biomarkers that capture physiological resilience. The hypothalamic-pitui...Older adults with cancer face disproportionately high rates of severe treatment-related toxicities, yet current prediction tools rarely incorporate biomarkers that capture physiological resilience. The hypothalamic-pituitary-adrenal (HPA) axis-central to stress adaptation, immune regulation, and tissue repair-undergoes pronounced age-related alterations, including elevated basal cortisol, reduced dehydroepiandrosterone (DHEA) and its sulphate form DHEAS, and an increased cortisol:DHEA(S) ratio. These changes may impair immune function, delay recovery, and exacerbate vulnerability to treatment toxicity. This narrative review synthesizes mechanistic and clinical evidence linking HPA-axis dysregulation to treatment tolerance in geriatric oncology. Common patterns include blunted diurnal cortisol slopes, elevated evening cortisol, and low DHEA(S), which are associated with fatigue, functional decline, and reduced survival across cancer types. However, their predictive value for acute treatment toxicities remains underexplored due to methodological heterogeneity, lack of age-specific reference ranges, and absence from existing geriatric toxicity models. This review proposes a translational roadmap that prioritizes (1) standardization of salivary cortisol/DHEA(S) protocols; (2) prospective, age-stratified validation studies using standardized toxicity endpoints; (3) interventional testing of behavioral or pharmacological strategies to modulate HPA function; and (4) integration into oncology workflows and electronic decision-support tools. Incorporating endocrine biomarkers into risk prediction could refine treatment stratification, enable targeted supportive care, and ultimately improve outcomes for older patients with cancer.
INTRODUCTION: Cancer primarily affects older adults, with a significant proportion also experiencing sarcopenia which is associated with poor clinical outcomes. In older adults with cancer, sarcopenia is not only age-rel...INTRODUCTION: Cancer primarily affects older adults, with a significant proportion also experiencing sarcopenia which is associated with poor clinical outcomes. In older adults with cancer, sarcopenia is not only age-related but also exacerbated by disease processes, inflammation, and the catabolic effects of treatments such as chemotherapy and radiotherapy. Its presence is linked to increased treatment toxicity, longer hospitalisations, reduced physical function, and poorer survival rates. However, diagnosing sarcopenia remains challenging due to inconsistent criteria and limited access to diagnostic tools. Emerging evidence suggests that nutritional interventions may help prevent or reverse sarcopenia. This review aims to evaluate the effectiveness of nutritional interventions in managing sarcopenia in older adults with cancer. MATERIALS AND METHODS: A systematic review was conducted using the PICO framework, targeting studies involving patients aged 65 and older with cancer and confirmed or likely sarcopenia. A total of 1439 studies were retrieved from databases and screened using Rayyan. Data extraction focused on outcomes related to body composition, physical performance, and nutritional intake. Risk of bias was assessed using RoB2, ROBINS-I, and ROBINS-E tools. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed using SWiM guidelines. Studies were grouped by design and intervention type, and the GRADE approach was applied to assess evidence certainty. RESULTS: Nine studies (2016-2024) met the inclusion criteria. Interventions included dietary supplements, nutritional counselling, enteral feeding, and multimodal strategies. Most studies showed improvements in sarcopenia-related outcomes. Protein supplementation notably improved lean body mass and skeletal muscle index in some randomised control trials (RCTs). Observational studies found associations between certain dietary patterns-such as high fish and fat intake-and reduced sarcopenia risk. DISCUSSION: Nutritional interventions show promise in managing sarcopenia among older adults with cancer. However, further large-scale, standardised research is needed. Meanwhile, promoting good nutrition and physical activity remains essential.
INTRODUCTION: Hematopoietic stem cell transplantation (SCT) is increasingly used to treat hematological conditions in patients 60 years and older. Graft vs host disease (GVHD), a complication of SCT, is a major cause of...INTRODUCTION: Hematopoietic stem cell transplantation (SCT) is increasingly used to treat hematological conditions in patients 60 years and older. Graft vs host disease (GVHD), a complication of SCT, is a major cause of morbidity, nonrelapse mortality, and interference with quality of life (QOL). Concern that older adults are at higher risk for developing GVHD has limited the use of SCT in this population. Older adults are also at higher risk for adverse events from the mainstay treatment of GVHD: corticosteroids. There is no standard of care for the management of GVHD in older adults, which may limit older adults' access to SCT. We aimed to review the literature on non-corticosteroid immune modulating agents used to prevent and treat GVHD for outcomes data specific to older adults. MATERIALS AND METHODS: We performed a scoping review using Pubmed, identifying 31 studies comparing immunosuppressive prophylaxis and treatment modalities for GVHD (acute, chronic, mixed, and corticosteroid refractory) within a 10-year span (February 13, 2013 - February 13, 2023). Articles exploring cutaneous GVHD only or corticosteroid treatments were excluded. Articles were reviewed for inclusion of patients 65+ years, response rate, mortality rate, adverse events, degree of corticosteroid sparing, and QOL scores before and after treatment. RESULTS: Seventeen articles met inclusion criteria, for a total of 2534 patients with GVHD. Two articles did not include patients 65+, ten did not specify the number of patients 65+, and five articles indicated the number of patients 65+ (n = 160). No articles specified response rate, mortality rate, or adverse events in patients 65+. Twelve articles indicated degree of corticosteroid sparing. Six articles included QOL scores, but did not assess impact of treatment on QOL scores or specify QOL scores in patients 65+. Overall, 3.5% of study participants were identified as aged 65+ and 4.7% aged 60 + . DISCUSSION: There is a lack of relevant outcomes data to guide best practice in the prevention and treatment of GVHD in older adults Understanding the risk of GVHD in older adults and identifying effective prophylactic and treatment strategies for GVHD in older adults may result in more older adults having access to SCT.
INTRODUCTION: With the growing population of older breast cancer survivors, understanding how chronic comorbidities evolve across treatment and toward the end-of-life (EOL) is increasingly important. We aimed to characte...INTRODUCTION: With the growing population of older breast cancer survivors, understanding how chronic comorbidities evolve across treatment and toward the end-of-life (EOL) is increasingly important. We aimed to characterize temporal and EOL patterns of comorbidity clusters before and after adjuvant endocrine therapy (AET) among women aged 66-79 years and ≥ 80 years with breast cancer. MATERIALS AND METHODS: We used the 2016-2019 SEER-Medicare data to identify women aged ≥66 years who initiated AET in 2017. Eligible patients had hormone receptor-positive, stage I-III breast cancer diagnosed within one year prior to AET initiation (index date). Comorbidities were defined using Clinical Classifications Software Refined (CCSR) codes. To identify comorbidity patterns, we applied agglomerative hierarchical clustering using Jaccard's dissimilarity index and Ward's minimum variance method to the top 50 CCSR categories across four periods: pre-index, post-year 1, post-year 2, and EOL. RESULTS: We identified 11,551 women, of whom 11,050 were alive at the end of follow-up and 501 died during follow-up. Among the patients who were alive, more than 50% had ≥2 chronic conditions across the observation windows. Cardiovascular diseases and their associated risk factors showed the largest increase over time. The most consistent and prevalent cluster across post-year 1, post-year 2, and EOL was "cardiovascular and pulmonary diseases," including hypertension, coronary atherosclerosis, with additional respiratory and kidney-related conditions emerging near EOL. DISCUSSION: Comorbidity clustering was common and persisted across observation windows, with cardiovascular and related conditions prominent and expanding near EOL. These patterns highlight the need for integrated cardio-oncology and geriatric co-management to address the complex care needs of older women receiving AET.
Lin YC, Kang D, Cao B
… +7 more, Hume E, Tabriz AA, Suneja G, Coghill AE, Jim H, Turner K, Islam JY
J Geriatr Oncol
· 2026 Mar · PMID 41558110
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INTRODUCTION: People with HIV (PWH) are more likely to die due to cancer compared to people without HIV. Disparities in cancer care, including access to palliative care, for PWH contribute to poor health-related quality...INTRODUCTION: People with HIV (PWH) are more likely to die due to cancer compared to people without HIV. Disparities in cancer care, including access to palliative care, for PWH contribute to poor health-related quality of life (HRQoL) and survival. However, limited research exists examining patient-reported HRQoL among PWH with cancer. We examined HRQoL among patients diagnosed with non-AIDS defining cancers with and without HIV. MATERIALS AND METHODS: We used the 2007-2017 Surveillance, Epidemiology, and End Results and the Medicare Health Outcomes Survey (SEER-MHOS) linkage data to assess HRQoL among patients (ages ≥18) diagnosed with breast, colorectal, gastrointestinal, head and neck, lung, lymphoma, and prostate cancers. HRQoL outcomes included the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and the eight scale scores of the Veterans RAND 12-Item Health Survey (VR-12), and the VR-6D health utility score. Higher HRQoL scores indicate better health status. Adjusting for patient characteristics, we computed mean HRQoL scores using multivariable linear regression models and the predictive margins method. The minimally important difference (MID) in HRQoL scores between patients with and without HIV by cancer types was assessed. RESULTS: The sample (N = 43,973) included 310 (0.7%) patients with HIV and had an average age at cancer diagnosis of 70.8 years. PWH reported lower scores in at least one HRQoL outcome compared to patients without HIV for all cancers examined. Differences in HRQoL for PWH compared to patients without HIV exceeded the MID for cancers of the breast (PCS: -2.7; MCS: -9.1; VR-6D: -0.08), colorectum (PCS: -2.3; MCS: -6.2; VR-6D: -0.06), gastrointestinal tract (MCS: -5.9; VR-6D: -0.04), head and neck (PCS: -4.1; MCS: -7.5; VR-6D: -0.07), lungs (PCS: -2.5; MCS: -6.3; VR-6D: -0.06), lymphatic system (PCS: -2.3; MCS: -2.6; VR-6D: -0.04), and prostate (MCS: -8.0; VR-6D: -0.07). DISCUSSION: Our findings demonstrated that PWH across all cancers examined reported substantially lower mental and/or physical HRQoL compared to patients without HIV. Future work can explore strategies for symptom monitoring and management among PWH.
INTRODUCTION: The treatment of stage III rectal cancer (RC) is complex and requires a multidisciplinary approach. Evidence-based guidelines (EBG) exist for the treatment of RC. We aimed to determine adherence to EBG in t...INTRODUCTION: The treatment of stage III rectal cancer (RC) is complex and requires a multidisciplinary approach. Evidence-based guidelines (EBG) exist for the treatment of RC. We aimed to determine adherence to EBG in the treatment of stage III RC and the impact on survival in older adults. MATERIALS AND METHODS: This is a retrospective study of patients within the Surveillance, Epidemiology, and End Results program (SEER). We included adults with stage III RC between 2007 and 2018 with one pathologically confirmed primary tumor. We defined guideline-based care as receipt of: chemoradiation within 6 months of date of diagnosis; surgery within 6 months of completion of chemoradiation; and chemotherapy after surgery. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method. Multivariable Cox regression was performed to determine factors associated with survival. RESULTS: We identified 3962 patients, and 1945 (49.1%) were female. There were 1707 (43.1%) with a Charlson Comorbidity Index of zero. Of the total, 994 (25.1%) received all guideline-based treatments. Factors associated with lack of guideline-based care included age, comorbidities, income, and geographic location. Guideline-based care was associated with increased OS (HR: 0.55, 95% CI: 0.49-0.60) and CSS (HR: 0.59, 95% CI: 0.48-0.73). DISCUSSION: Although 43.1% of the cohort had a comorbidity index of zero, only 25.1% received all guideline-based treatments. Deviation from guideline-based care had a significant impact on OS. Our data show that more efforts can be made to recommend multimodal RC treatment among older adults.
Radiotherapy (RT) is a vital and effective cancer treatment that contributes to over 40 % of cancer cures. RT is also fundamental to palliation and improving quality of life in almost all advanced malignancies. The speci...Radiotherapy (RT) is a vital and effective cancer treatment that contributes to over 40 % of cancer cures. RT is also fundamental to palliation and improving quality of life in almost all advanced malignancies. The specialty of radiation oncology has undergone dramatic technological advances over the past decade with increasing sophistication of treatment planning and delivery leading to improved cure rates and reduced side effects. For older adults with cancer, RT represents an excellent treatment option due to its effectiveness, limited systemic toxicity, convenience, and tolerability. Advanced techniques such as stereotactic body radiotherapy (SBRT) and hypofractionated regimens are highly effective non-invasive treatment options that may avoid the need for hospital admission, the potential mortality and morbidity of surgery and/or the toxicities of systemic therapy. Historically, the role of RT for older adults has not been comprehensively assessed or defined due to the limited recruitment of older adults to clinical trials. Fortunately, the increasing number of RT trials tailored to specifically explore outcomes for older people is expanding the body of evidence for this priority research area. This updated expert position paper from the SIOG (International Society of Geriatric Oncology) Task Force seeks to provide an overview of the current role of RT in the management of older adults with cancer. The position paper is informed by the geriatric radiation oncology clinical expertise of the SIOG Task Force and emerging evidence in the field since the publication of the original 2014 position paper. Topics covered include the fundamentals of geriatric oncology as applied to radiation oncology, options for dose fractionation schedules and techniques across pre-defined tumor sites and appropriate individualised modifications of regimens in the setting of frailty, discussion of expected tolerability and toxicity (if any) in older adults, and the unique perspectives of care around older adults requiring RT in low- and middle-income countries.
Surgical resection offers a curative treatment option for patients with colorectal cancer liver metastases (CRLM), but data on resection of CRLM among older patients is conflicting and sparse. The older population is het...Surgical resection offers a curative treatment option for patients with colorectal cancer liver metastases (CRLM), but data on resection of CRLM among older patients is conflicting and sparse. The older population is heterogenous, and no age-calibrated guidelines for management of surgically resectable CRLM exist. Age-related physiologic changes to the liver include impaired tissue growth, increased oxidative stress and inflammation, and dysregulated metabolic homeostasis. Cumulatively, these changes to the liver microenvironment lead to decreased regeneration ability of the liver and higher vulnerability to the stress of surgery. Systemic chemotherapy may also be associated with worse hepatotoxicity among older patients. Given the combination of age-related physiological changes and chemotherapy-associated hepatotoxicity, evaluating both the volume and the function of the future liver remnant (FLR) among older patients is critically important. Additionally, older patients may have higher risks for both medical and surgical postoperative complications including following CRLM resection. Liver-directed therapy, including transarterial chemoembolization (TACE), transarterial delivery of irinotecan-coated beads (DEBIRI), hepatic infusion chemotherapy (HAI), as well as radiation and ablation therapy are well-tolerated and may be offered to older patients. Discussions of CRLM resection and treatment options should be paired with goals of care conversations for older patients, including wishes surrounding both quantity and quality of life, and functional outcomes. Some older patients, including frail individuals or those with limited life expectancies, may benefit more from liver-directed therapy than from surgical management of CRLM. Shared-decision making tools may be helpful for discussing potential post-operative issues with older patients, including quality-adjusted life expectancy, the potential for loss of independent living, and stays in long-term care facilities following CRLM resection in addition to morbidity and mortality.
INTRODUCTION: Older adults (≥65 years) with triple-negative breast cancer (TNBC) have higher mortality rates than younger patients, due in part to greater comorbidity and lower rates of treatment. However, the impact of...INTRODUCTION: Older adults (≥65 years) with triple-negative breast cancer (TNBC) have higher mortality rates than younger patients, due in part to greater comorbidity and lower rates of treatment. However, the impact of hospital volume on survival outcomes in this population remains understudied. This study examined the relationship between hospital volume and survival among older adults (aged 65 years or older) diagnosed with TNBC. MATERIALS AND METHODS: The National Cancer Database was queried for women ages ≥65 years with stage I-III TNBC diagnosed between 2010 and 2020. Annual hospital volume was the facility-level average of breast cancer cases treated in the years before the year of diagnosis. Volumes were divided into quartiles, with the lowest quartile (≤136 cases/year) defined as low-volume and the remaining three quartiles combined as high-volume. Sociodemographic, clinical, and treatment characteristics were compared according to hospital volume status. Crude and adjusted mortality risk differences and relative risks were estimated using pooled logistic regression models. RESULTS: The study cohort comprised 37,538 older women with TNBC, of whom 25 % (n = 9388) were treated at low-volume hospitals. Patients treated at low-volume hospitals were slightly older (73 years [IQR: 68 to 79] vs. 72 years [IQR: 68 to 78 years]) and traveled a shorter distance to the hospitals (6.80 miles [IQR: 3.00 to 14.30] vs 8.60 miles [IQR: 4.30 to 18.00]) than those treated at high-volume hospitals (p < 0.001). On adjusted analysis, treatment at low-volume hospitals (Low-Value Risk: 0.607, 95 % CI: 0.579 to 0.638) was associated with a 5.5 % increased risk of all-cause mortality compared to treatment at high-volume hospitals (High-Volume Risk: 0.576, 95 % CI: 0.556 to 0.592) (RR: 1.055, 95 % CI: 1.003 to 1.121). Patients treated at low-volume hospitals had a 3.2 % excess adjusted risk of mortality compared to those treated at higher-volume hospitals (RD: 3.2 %, 95 % CI: 0.2 % to 6.9 %). DISCUSSION: Older adults treated at low-volume hospitals had modestly higher mortality than those at high-volume facilities. Future work should identify mechanisms underlying this relationship and assess whether referral patterns for older adults should consider hospital volume.
INTRODUCTION: Predicting survival in older women with early breast cancer can guide personalized care and improve outcomes. Aging is an individualized process that influences tumor characteristics and survival, with card...INTRODUCTION: Predicting survival in older women with early breast cancer can guide personalized care and improve outcomes. Aging is an individualized process that influences tumor characteristics and survival, with cardiovascular disease (CVD) being the leading non-cancer cause of death due to cardiovascular risk factors. This study aimed to develop and validate machine learning (ML) models to predict all-cause, breast cancer-related, and CVD-related mortality in older women with stage I-II, hormone receptor-positive breast cancer at the U.S. population level. To address the heterogeneity associated with aging, we created separate models for two age groups (66-79 and ≥ 80 years). MATERIALS AND METHODS: Using the 2006-2019 SEER-Medicare database, we identified women aged ≥66 years diagnosed with stage I-II breast cancer, representing early-stage invasive disease, who initiated adjuvant endocrine therapy (AET) between 2007 and 2009. The first date of AET use was defined as the index date. We assessed pre-existing comorbidities during the one year prior to the index date and followed patients for up to 10 years or until death. Outcomes included all-cause mortality, breast cancer-related mortality, and CVD-related mortality. We developed survival prediction models using the decision tree-based algorithms for the two age groups. Model performance was evaluated using the mean area under the receiver operating characteristic curve (AUROC), and model interpretability was enhanced using Shapley Additive Explanations. RESULTS: Among 10,104 women, all six models achieved a mean AUROC >0.7 using the random survival forest algorithm (RSF), indicating strong predictive performance. For all-cause mortality, key predictors in both age groups included age, screenings for suspected conditions (abnormal findings without diagnosis), and congestive heart failure. Tumor size, cancer stage, and secondary malignancies were most predictive of breast cancer-related mortality, while congestive heart failure, heart valve disorders, and other ill-defined heart diseases were critical for CVD-related mortality. DISCUSSION: We developed ML-based survival models across outcomes and age group using the decision tree-based algorithms to predict mortality in older women with stage I-II breast cancer. RSF demonstrated the best performance, with age, screenings for suspected conditions, and congestive heart failure consistently emerging as key predictors. Targeting these factors may enhance cardio-oncology care.