INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly used in older adults, but tolerability among frail patients remains uncertain. This study examined immune-related adverse events (irAEs) and treatment ou...INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly used in older adults, but tolerability among frail patients remains uncertain. This study examined immune-related adverse events (irAEs) and treatment outcomes in frail and non-frail adults aged ≥65 years. MATERIALS AND METHODS: A retrospective single-centre review was conducted at Princess Alexandra Hospital (Queensland, Australia) of patients aged ≥65 who commenced at least one cycle of ICI between December 2021 and July 2023. Frailty was assessed using the Australian 58-item Frailty Index (FI) (non-frail <0.25, frail ≥0.25). The primary outcome was any irAE as defined by Common Terminology Criteria for Adverse Events (CTCAE v5). Secondary outcomes included treatment discontinuation, cycles, interruptions, and corticosteroid use. Univariable and multivariable logistic regression modelling was performed, adjusting for age, sex, cycles, tumour type, stage, concurrent therapy, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS). RESULTS: Of 122 adults (mean age 75.8 years, 66.4 % male), 51 (41.8 %) were frail. Twenty patients were still receiving ICIs and had not yet completed treatment at last census, leaving 102 records with evaluable outcomes for the final modelling. Any irAE occurred in 53 non-frail adults (74.7 %) and 28 frail adults (54.9 %) (adjusted OR 0.41, 95 % CI 0.19-0.89, p = 0.02). Non-frail adults had more grade 1 events (62.0 % vs 43.1 %, p = 0.045) and skin-related events (48 % vs 27 %, p = 0.04). Grade ≥ 3 events occurred in 11.3 % non-frail vs 11.8 % frail (OR 1.10, 95 % CI 0.38-3.17). Early discontinuation was 60.6 % in non-frail vs 74.5 % in frail (OR 1.90, 95 % CI 0.86-4.19, p = 0.12). Median cycles were 10 (IQR 4-16) in non-frail vs 6 (IQR 4-11) in frail (p = 0.04). DISCUSSION: Frailty (FI ≥0.25) was associated with fewer irAEs, but frail adults received fewer cycles. These findings are exploratory and should be interpreted cautiously as differences in exposure likely confound toxicity comparisons; time-to-event analyses are warranted.
INTRODUCTION: The world's population is aging rapidly and older adults carry a disproportionate cancer burden. Despite this, older patients remain underrepresented in clinical research. As a result, the evidence base inf...INTRODUCTION: The world's population is aging rapidly and older adults carry a disproportionate cancer burden. Despite this, older patients remain underrepresented in clinical research. As a result, the evidence base informing guideline development remains limited. Existing guidelines vary in methodological quality and applicability. We aimed to evaluate the quality and clinical applicability of established geriatric oncology guidelines using the Appraisal of Guidelines Research and Evaluation, version II (AGREE II) instrument. MATERIALS AND METHODS: A systematic search was conducted across PubMed, Embase, and the Cochrane Library, in addition to official oncology society websites (ASCO, NCCN, SoFOG, Japanese Geriatric Oncology Group). The search covered publications from January 2000 to May 2025 and was limited to English and to guidelines that specifically address cancer care in older adults and provide documented methodologies. Two reviewers independently appraised each guideline using the AGREE II tool across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. RESULTS: A total of 807 records were identified,out of which only 6 guidelines met the eligibility criteria. The AGREE II assessment revealed significant variability in guideline quality. Most guidelines scored high in clarity of presentation and scope and purpose, but showed moderate to low scores in stakeholder involvement and applicability. The recent ASCO guidelines demonstrated higher overall methodological rigor, whereas others lacked comprehensive documentation of evidence synthesis and user applicability. DISCUSSION: While several geriatric oncology guidelines demonstrate acceptable quality, inconsistencies remain, particularly in stakeholder engagement and practical implementation. Enhanced methodological rigor and inclusive development processes are essential for future guideline improvement and effective translation into geriatric oncology practice.
Hryniv S, Gilbride E, Consagra W
… +12 more, Mohile S, Yilmaz S, Kyi K, Kadambi S, Jensen-Battaglia M, Gilmore N, Whitehead M, Khatri J, Braiteh FS, Conlin A, Loh KP, Magnuson A
J Geriatr Oncol
· 2026 Mar · PMID 41389716
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INTRODUCTION: Exploring informational and decisional control preferences as well as examining concordance and patient-caregiver-physician factors associated with preferences in older adults with cancer and their caregive...INTRODUCTION: Exploring informational and decisional control preferences as well as examining concordance and patient-caregiver-physician factors associated with preferences in older adults with cancer and their caregivers may help to better understand the role of caregivers in supporting decision-making. MATERIALS AND METHODS: We utilized data from a national geriatric assessment (GA) cluster-randomized trial (NCT02054741; PI: Mohile) that recruited patients aged ≥70 with incurable cancer, their caregivers, and oncologists. Dyadic decision-making control preferences were measured by the Control Preferences Scale (CPS). Patients and caregivers were asked to describe patient's role in treatment decision-making (patient-role CPS); patients and caregivers were also asked to describe the caregiver's role in treatment decision-making (caregiver-role CPS). Matching patient-caregiver responses were considered concordant. Patients and caregivers were also asked about their information preferences regarding the amount of detail about the patients' illness using a scale from 1 (fewest detail) to 5 (the most detail). We used descriptive statistics to summarize CPS, informational preferences, and concordance in responses. We utilized logistic regression to assess dyads' sociodemographic information, patients' GA domain impairments, and physicians' practice characteristics associated with patient-caregiver CPS concordance. RESULTS: A total of 332 dyads participated; mean age (SD) of patients and caregivers was 76.6 (5.3) and 66.6 (12.2), respectively. Preferences for treatment decision-making varied, with some preferring shared decision-making and others preferring the doctor to make decisions. Concordance between patients and caregivers was observed in 46 % for patient-role CPS and 54 % for caregiver-role CPS. Baseline factors were not associated with dyad concordance. The majority of patients and caregivers preferred the most detailed information about the patient's illness. DISCUSSION: Clinicians should assess patients' and caregivers' informational and decisional control preferences for optimal support in decision-making.
INTRODUCTION: CDK4/6 inhibitors-abemaciclib, palbociclib, and ribociclib-are standard treatments for hormone receptor-positive, ERBB2 (HER2)-negative metastatic breast cancer. However, older adults are underrepresented i...INTRODUCTION: CDK4/6 inhibitors-abemaciclib, palbociclib, and ribociclib-are standard treatments for hormone receptor-positive, ERBB2 (HER2)-negative metastatic breast cancer. However, older adults are underrepresented in clinical trials, and age-related safety data remain limited in real-world settings. MATERIALS AND METHODS: We conducted a pharmacovigilance analysis using 44,100 individual case safety reports (ICSRs) from the FDA Adverse Event Reporting System (FAERS) involving patients aged ≥65 years treated with CDK4/6 inhibitors. Primary endpoints included serious adverse events (SAEs) and fatal outcomes. A secondary analysis compared adverse events between patients aged <65 and 65-85 years, calculating odds ratios (ORs) for selected toxicities, including death, disease progression, diarrhea, and myelosuppression. RESULTS: Among older patients, 71.2 % of reports involved SAEs and 5.3 % were fatal. Abemaciclib was linked to higher risk of death in those aged 65-85 compared to younger adults (OR 1.53; 95 % CI 1.18-1.99), but lower odds of myelosuppression (OR 0.37; 95 % CI 0.26-0.53). Palbociclib showed similar death risk across age groups (OR 0.98; 95 % CI 0.92-1.05) and reduced risk of disease progression in older adults (OR 0.72; 95 % CI 0.61-0.84). Ribociclib showed no significant age-related difference in fatality (OR 1.01; 95 % CI 0.87-1.17) but had the highest overall death risk (OR 9.14 vs palbociclib; 95 % CI 7.70-10.84). DISCUSSION: Real-world data reveal drug- and age-specific toxicity differences. Ribociclib and abemaciclib pose higher risks in older adults compared to palbociclib, supporting the need for personalized treatment and careful monitoring in older patients.
INTRODUCTION: Cancer in older adults is often associated with functional limitations, geriatric syndromes, poor self-rated health, vulnerability, and frailty, and these conditions might worsen treatment-related side effe...INTRODUCTION: Cancer in older adults is often associated with functional limitations, geriatric syndromes, poor self-rated health, vulnerability, and frailty, and these conditions might worsen treatment-related side effects. Recent guidelines for patients with cancer during and after treatment have documented the beneficial effects of exercise to counteract certain side effects; however, little is known about the role of exercise during cancer treatment in older adults. MATERIALS AND METHODS: This is a multicentre randomised controlled trial in which 200 participants will be allocated to a control group or an intervention group (the sample size has been calculated to detect a clinical difference of 1 point in Short Physical Performance Battery (SPPB) score, assuming an α error of 0.05, a β error of 0.20, and a 10 % loss rate). Patients aged ≥70 years, diagnosed with any type of solid cancer and candidates for systemic treatment are eligible. Subjects in the intervention group are invited to participate in a 12-week supervised multicomponent exercise programme in addition to receiving usual care. Study assessments are conducted at baseline and three months. The primary outcome measure is physical function as assessed by the SPPB. Secondary outcome measures include comprehensive geriatric assessment scores (including social situation, basic and instrumental activities of daily living, cognitive function, depression, nutritional status, polypharmacy, geriatric syndromes, pain, and emotional distress), anthropometric characteristics, frailty status, physical fitness, physical activity, cognitive function, quality of life, fatigue, and nutritional status. Study assessments also include analysis of inflammatory, endocrine, and nutritional mediators in serum and plasma as potential frailty biomarkers at mRNA and protein levels and multiparametric flow cytometric analysis to measure immunosenescence markers on T and NK cells. DISCUSSION: This study seeks to extend our knowledge on exercise interventions during systemic anticancer treatment in patients over 70 years of age. Results from this research will guide the management of older adults during systemic treatment in hospitals seeking to enhance the standard of care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05131113, November 11, 2021.
INTRODUCTION: Dizziness and balance impairments are underexplored symptoms in older adults with cancer. Age-related factors, comorbidities, and chemotherapy may contribute to its prevalence and severity, potentially affe...INTRODUCTION: Dizziness and balance impairments are underexplored symptoms in older adults with cancer. Age-related factors, comorbidities, and chemotherapy may contribute to its prevalence and severity, potentially affecting quality of life, increasing fall risk, and delaying treatment. Data on the incidence and prevalence of these symptoms are limited. This systematic review aimed to summarize the evidence and estimate the incidence and prevalence of dizziness or vertigo and impaired postural balance in patients with cancer ≥65 years receiving chemotherapy. MATERIALS AND METHODS: We searched PubMed, EMBASE, CENTRAL, and CINAHL in May 2025 without date or language restrictions. Cross sectional studies, cohort studies, randomized controlled trials, and mixed method studies investigating incidence and/or prevalence of dizziness or vertigo and impaired postural balance were included. Random-effects meta-analysis, employing the inverse-variance method, was applied. Certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach. RESULTS: From 15,614 title/abstracts screened, 14 studies (1259 participants) were included. Incidence could not be evaluated. Studies reporting prevalence across multiple chemotherapy regimens contributed separate estimates for each regimen. Meta-analysis included 25 prevalence estimates for dizziness and three for impaired postural balance. The pooled prevalence of dizziness was 15 % (95 % CI:10 %-22 %). Assessor-reported prevalence using the Common Terminology Criteria for Adverse Events (CTCAE) was 11 % (95 % CI: 8 %-16 %), while patient-reported prevalence rate using the European Organisation for Research and Treatment of Cancer Chemotherapy Induced Peripheral Neuropathy Questionnaire (EORTC QLQ-CIPN20), or a self-constructed questionnaire was 35 % (95 % CI: 20 %-53 %). Most studies demonstrated a high risk of bias, and certainty of evidence was very low due to unstructured assessor-reported measurement methods. Impaired postural balance prevalence from one study was 48 % (95 % CI: 39 %-57 %) with low certainty of evidence. Prevalence of dizziness and impaired postural balance did not differ significantly across chemotherapy regimens. DISCUSSION: Prevalence of dizziness and impaired postural balance in older patients receiving chemotherapy varied substantially depending on the measurement method, with higher rates in patient-reported outcomes. Certainty of evidence was low primarily due to limitations in outcome measures. Future studies should incorporate patient-reported outcome measures and a systematic objective baseline assessment for a comprehensive evaluation of these symptoms. TRIAL REGISTRATION: PROSPERO CRD42024585974.
INTRODUCTION: Limited tools exist to specifically predict the risk of chemotherapy toxicity and related events in older individuals with gastrointestinal (GI) cancers. MATERIALS AND METHODS: We evaluated patients aged ≥6...INTRODUCTION: Limited tools exist to specifically predict the risk of chemotherapy toxicity and related events in older individuals with gastrointestinal (GI) cancers. MATERIALS AND METHODS: We evaluated patients aged ≥60 years with GI cancers who underwent a comprehensive geriatric assessment comprising demographic, cancer variables, and geriatric domains (function, comorbidities, nutritional status, medications, cognition, psychological status, and social support). A Cancer and Aging Research Group (CARG) score was calculated in all patients. The occurrence of grade 3 to 5 adverse events, emergent hospitalizations, and sudden death without identifiable adverse events were defined as treatment related adverse events (TRAE) to form the new predictive model. Based on initial univariate analysis of factors predicting for TRAE and then multivariate analysis, a nomogram was developed to predict the probability TRAEs. The total score derived from the nomogram was categorized into low, moderate, and high-risk groups based on a recursive partitioning algorithm. RESULTS: In total, 701 patients with a median age of 67 years (range, 60 to 88 years) with predominantly stage IV cancers (58 %) were analysed. The distribution of GI cancers was gastric and esophageal cancers (n = 349, 50 %), hepatobiliary and pancreatic cancers (n = 241, 34 %), and colorectal cancers (n = 84, 12 %). TRAE occurred in 53 % of the patients. A predictive model for TRAE was developed using the Mobility-Tiredness (Mob-T) Scale, hearing, cancer stage, site of primary, and chemotherapy dosing (standard or reduced). A predictive score in which the median risk score was 22 (range, 0 to 40) and risk stratification identified older adults at low risk (0 to 13 points; 17 %), intermediate risk (14 to 21 points; 40 %), or high risk (>22 points; 71 %) of chemotherapy toxicity (P < 0.001). The new model outperformed the CARG score based on ROC analysis (0.75 vs 0.59, p < 0.001). DISCUSSION: A new and simpler risk score predicts for chemotherapy related adverse events in older patients with GI cancers and seems to be more accurate than the CARG score. The score requires validation in prospective studies.
INTRODUCTION: Due to the growth of the cancer survivor population, strategies to facilitate efficient delivery of survivorship care are critical to reduce the risk of adverse events associated with frailty. The objective...INTRODUCTION: Due to the growth of the cancer survivor population, strategies to facilitate efficient delivery of survivorship care are critical to reduce the risk of adverse events associated with frailty. The objective of this study was to develop a risk stratification tool to identify long-term survivors at the highest risk of becoming frail 5-10 years after cancer diagnosis. MATERIALS AND METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) dataset linked with Medicare data to identify patients with stage I-III breast, prostate, colon, or rectal cancers who lived at least five years from diagnosis and were not severely frail at year five post-diagnosis. Frailty was assessed using the claims-based Kim Frailty Index (FI) categorized by recommended thresholds. Restricted mean survival time (RMST) regression was used to identify clinical and demographic characteristics associated with frailty progression, defined as an increased category of the FI. Significant predictors were used to create clinical prediction rules and stratify survivors into low, intermediate, and high-risk groups. RESULTS: A total of 87,229 five-year survivors were included. At five years from diagnosis (time zero), 22 % of patients not frail at cancer diagnosis had new onset frailty and were mildly or moderately frail; at 10 years from diagnosis, 61 % had developed new or worsening frailty. Advanced age, comorbidities (RMST ratios ranging from 0.67 [95 % CI 0.65-0.70] to 0.80 [95 % CI 0.77-0.84], baseline moderate frailty at cancer diagnosis (RMST ratios ranging from 0.79 [95 % CI 0.76-0.83] to 0.86 [95 % CI 0.83-0.90]) and at five years post-diagnosis (RMST ratios ranging from 0.63 [95 % CI 0.62-0.64] to 0.71 [95 % CI 0.69-0.73]), living in a high poverty area (RMST ratios ranging from 0.91 [95 % CI 0.87-0.94] to 0.96, [95 % CI 0.93-0.99], and systemic treatments four to five years post-diagnosis (RMST ratios ranging from 0.77 [95 % CI: 0.70-0.84] to 0.86, [95 % CI: 0.84-0.89] were associated with less average time without frailty. DISCUSSION: Age, comorbidities, prior frailty, and late treatment were associated with frailty in older breast, prostate, colon, and rectal cancer survivors. This risk stratification model can be used by clinicians to assess cancer and age-related risk of frailty and facilitate timely intervention.
INTRODUCTION: Data on treatment preferences in older cancer patients are lacking. We aimed to identify their priorities. MATERIALS AND METHODS: We conducted a multicenter prospective cohort study on patients with cancer...INTRODUCTION: Data on treatment preferences in older cancer patients are lacking. We aimed to identify their priorities. MATERIALS AND METHODS: We conducted a multicenter prospective cohort study on patients with cancer aged ≥70 and 18-69, initiating first medical treatment. Patients and physicians prioritized eight aspects of care: treatment efficacy, life expectancy, autonomy, daily tasks, social activities, treatment burden, toxicity, and economic burden via self-completed questionnaires. The primary endpoint was the priorities of older patients. RESULTS: We included 233 older and 100 younger patients at eight sites. In the older patient cohort, median age was 79 (min-max: 70-97), breast cancer represented 34 % (N = 78) and lung 12 % (N = 27). Metastatic setting concerned 45 % of the patients. The most frequently rated top priority at treatment initiation was treatment efficacy in both older (73 %) and younger cohorts (79 %), followed by autonomy in the older cohort (13 %) and life expectancy in the younger cohort (14 %). Treatment efficacy was almost systematically cited in the top four priorities for both older (94 %) and younger patients (96 %), followed by autonomy (86 %) for older and life expectancy (82 %) for younger patients. These priorities were stable (>70 %) between initiation and three months for each cohort. Agreement rate for prioritization of aspects of care between older patients and physicians was 87 % for treatment efficacy and 64 % for autonomy. DISCUSSION: Autonomy was the second most cited priority among older patients, yet many physicians failed to recognize this, potentially affecting treatment decisions. These findings highlight the need for shared decision-making to align treatment choices with patient expectations.