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Geriatric Oncology: Getting Even Better with Age

The aging of the population has created a demographic imperative impacting the field of geriatrics and each of its subspecialties. Geriatric oncology is no exception: a 67% increase in the number of new cancer cases in older adults is anticipated by 2030. The majority of patients treated by oncologists are older adults, and the majority of older adults have had their lives in some way touched by cancer. Further, with rapid advances in therapeutic options, the natural history of many cancers is changing, with increasing numbers of older adult cancer survivors and older adults living with advanced cancer as a chronic condition. Despite the incredible scientific advances in cancer care in recent years, the practice of “evidence-based medicine” for older patients, particularly those older than 75 years, is hindered by a lack of evidence. Guideline-based treatment recommendations routinely fail our older patients when the evidence on which they are based does not include representative older adults. Rosemary Yancik first brought attention to the issue of cancer and aging nearly 40 years ago. Due to the initiatives of many pioneers in the field and perhaps the realities of the demographic imperative, research and educational activities focused on cancer and aging have increased dramatically, particularly in the past 10 years. While the evidence base has improved, there is much work still to be done. Available evidence continues to demonstrate age-related disparities in screening, diagnosis, treatment, and outcomes. As of 2019, representation of older adults on cancer clinical trials remains low, only incrementally improved over decades. Study of cancer therapies in patients with multimorbidity or frailty is particularly challenging. Data focusing on treatment outcomes prioritized by older adults, such as quality of life and functional independence, are limited; and strategies to personalize care to older adults, accounting for vulnerabilities, goals, and values across the cancer care continuum, are needed. The Institute of Medicine, the American Society of Clinical Oncology, and the US Food and Drug Administration all recognize these needs and have called for expanding the evidence base. The field of geriatric oncology endeavors to translate the principles of geriatric medicine into the field of oncology. It is a collaborative, multidisciplinary field dedicated to the study of older patients with a core goal of improving the lives of older adults diagnosed with cancer, emphasizing personalized, patient-centric care. The field has grown on a foundation of observational data. Understanding age-related changes in tumor biology and the impact of age, agingassociated vulnerabilities, and frailty on treatment outcomes has been an important step to define the areas in greatest need of further study. The literature is now rich with studies demonstrating the value of assessment strategies that resemble a geriatrician’s assessment, rather than a typical oncology assessment. Geriatric assessment and geriatric screening tools can predict toxicity of chemotherapy, rehospitalization, functional decline after treatment, and survival. The strength of the evidence in support of geriatric assessment led the American Society of Clinical Oncology to recommend that all older adults with cancer undergo geriatric assessment prior to chemotherapy to identify vulnerabilities not routinely identified in oncology practice. Submissions in this Mini-Issue continue to strengthen the foundational evidence base and highlight a breadth of research aimed at filling gaps across the cancer care continuum. This issue further advances our understanding of factors associated with treatment and outcomes, including in older adults with colorectal cancer and multiple myeloma, in transplant clinics, and in a geriatric oncology clinic in Mexico. Maintenance of functional independence and cognition are outcomes that are prioritized by older adults with cancer, which remain poorly characterized in clinical trials. Several articles in this issue examine these outcomes in older adults with cancer, including characterization of functional resilience among older women who received chemotherapy. Two articles demonstrate the importance of attention to the quality of life of caregivers of older adults with cancer. As the evidence base develops, next steps will include providing data to support personalized management, developing novel trial designs, pioneering new approaches to care delivery, and ultimately implementing results into practice at the level of the individual and the healthcare system. Research presented in this issue highlights challenges and opportunities in effecting change, which includes implementing geriatric screening, testing rehabilitation for vulnerable older adults with cancer, and decreasing aggressive care at the end of life. Geriatric oncology is coming of age. Its success will continue to be fostered by the dedication of a passionate and collaborative national and international community of investigators, clinicians, educators, and advocates. The Cancer and Aging Research Group (CARG), despite the recent passing of our leader Arti Hurria, remains an instrumental force in advancing the science and mentoring the next generation of geriatric oncologists; William Dale and DOI: 10.1111/jgs.15947