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The worldwide population is ageing, alongside an increase in cancer incidence rates. Over the past 10 years, there has been huge progress in the field of oncology with earlier diagnosis and an expansion of treatment options, leading to a growing number of older people living with cancer. That has meant that caring for older patients with cancer is now part of day-to-day oncology practices. This cohort often has geriatric syndromes and a higher prevalence of frailty and complex needs and preparing our clinical services to optimise care for these patients is essential. Whilst it is widely accepted that comprehensive geriatric assessments are of benefit to patients, only a small proportion of patients can access these through specialised teams during their cancer care. In the past few years there has been significant progress in this field throughout the United Kingdom (UK). The goal of this review is to inform other health care systems how to learn from what has been done in the UK. This paper provides an update from our previous review in 2020, detailing the new services being implemented and made available to patients and an expansion in the number of new pilot teams and research projects/trials throughout the four nations of the UK., Competing Interests: Declaration of Competing Interest Mark Baxter reports a relationship with Servier Monde that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Mark Baxter reports a relationship with Ipsen that includes: speaking and lecture fees and travel reimbursement. Mark Baxter reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. Mark Baxter reports a relationship with Merck Sharp & Dohme UK Ltd. that includes: speaking and lecture fees. Kirsty Balachandran reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. Anne Barrell reports a relationship with Roche that includes: travel reimbursement. Anne Barrell reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. Anne Barrell reports a relationship with Novartis AG that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Pfizer Inc. that includes: board membership, speaking and lecture fees, and travel reimbursement. Nicolo Matteo Luca Battisti reports a relationship with Abbott that includes: board membership. Nicolo Matteo Luca Battisti reports a relationship with Sanofi that includes: board membership and speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Astellas Pharma Inc. that includes: board membership. Nicolo Matteo Luca Battisti reports a relationship with Exact Sciences Corporation that includes: travel reimbursement. Nicolo Matteo Luca Battisti reports a relationship with Eli Lilly and Company that includes: speaking and lecture fees and travel reimbursement. Nicolo Matteo Luca Battisti reports a relationship with AbbVie Inc. that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Roche that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Servier Monde that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Gilead Sciences Inc. that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees. Kwok-Leung Cheung reports a relationship with Roche that includes: consulting or advisory. Kwok-Leung Cheung reports a relationship with Cancers that includes: travel reimbursement. Helen Brown reports a relationship with Roche that includes: funding grants. Fabio Gomes reports a relationship with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees and travel reimbursement. Fabio Gomes reports a relationship with Roche that includes: speaking and lecture fees and travel reimbursement. Fabio Gomes reports a relationship with Boehringer Ingelheim GmbH that includes: speaking and lecture fees and travel reimbursement. Fabio Gomes reports a relationship with Pfizer Inc. that includes: speaking and lecture fees and travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The global population aged 80 years or older is expected to triple by 2050, leading to an increased cancer burden in the oldest population. This study describes the estimated cancer incidence and mortality in 2022 and projections for 2050 in the oldest old, analyzed globally and by world regions and World Bank income levels, for all sexes combined, as well as separately for males and females., Methods: Using GLOBOCAN 2022 estimates, we reported the estimated number of new cancer cases (excluding non-melanoma skin cancers), deaths, and truncated age-standardized incidence (ASIR) and mortality rates (ASMR) (per 100,000 individuals aged 80 years or older). We also presented the top five cancers by cases and deaths. Additionally, we projected the number of new cancer cases and deaths for each region in 2050, assuming no change in cancer incidence and death rates., Result: In 2022, an estimated 2.6 million new cancer cases (14 % of all cancer cases) and 2.1 million cancer deaths (22 % of all cancer deaths) occurred in the oldest old, with regional variations. Globally, lung, colorectal, and prostate cancers were the most common cancers diagnosed and leading causes of cancer death. ASIR ranged from 987 in Africa to 2044 per 100,000 in Northern America while ASMR ranged from 981 in Africa to 1769 per 100,000 in Oceania. In 2050, an estimated 7.4 million new cancer cases and 6 million cancer deaths are expected. The greatest increases are anticipated in China, India, and Africa, with increases exceeding 200 % compared to 2022 estimates., Conclusion: The growing cancer burden among the oldest old poses significant challenges to global healthcare systems, necessitating resource-tailored adaptations. These findings call for the inclusion of the oldest old in the development and implementation of cancer control policies and a better representation in cancer research., Competing Interests: Declaration of Competing Interest NMLB: Advisory board: Pfizer, Abbott, Sanofi, Astellas. Travel grants: Exact Sciences, Pfizer, Lilly, Novartis. Speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead, AstraZeneca, Lilly, Exact Sciences. VN has received institutional research funding from Astra Zeneca Pharma India Ltd, Glenmark, Nanobiotix SA, Novartis, and Roche Products (India) Pvt. Ltd. All research grants have been paid to the institution. EB: honoraria: AstraZeneca, Daiichi, Eli Lilly, Incyte, Pfizer, Seagen, Takeda; consultation fees: Daiichi, Menarini, Pfizer, Sandoz; travel supports: AstraZeneca, Daiichi, Gilead, Novartis, Pfizer. Other authors have no conflict to declare., (Copyright © 2024. Published by Elsevier Ltd.)

As the global population ages, so does the number of older people being diagnosed, treated and surviving cancer. Challenges to providing appropriate healthcare management stem from the heterogeneity common in this population. Although malnutrition is highly prevalent in older people with cancer, ranging between 30 % and 80 % according to some analyses, is associated with frailty, and has been shown to be a major risk factor for poor treatment response and worse overall survival, addressing nutrition status is not always a priority among oncology healthcare providers. Evaluation of nutritional status is a two-step process: screening identifies risk factors for reduced nutritional intake and deficits that require more in-depth assessment. Screening activities can be as simple as taking weight and BMI measurements or using short nutritional questionnaires and asking the patient about unintentional weight loss to identify potential nutritional risk. Using geriatric assessment, deficits in the nutritional domain as well as in others reveal potentially reversible geriatric and medical problems to guide specific therapeutic interventions. The authors of this paper are experts in the fields of geriatric medicine, oncology, and nutrition science and believe that there is not only substantial evidence to support regularly performing screening and assessment of nutritional status in older patients with cancer, but that these measures lead to the planning and implementation of patient-centered approaches to nutrition management and thus enhanced geriatric-oncology care. This paper presents rationale for systematic nutrition screening and assessment in older adults with cancer., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: J.M.B. - Advisor to the following companies: Nutricia DANONE; Nestlé ; Fresenius; Pfizer; Novartis; Rejuvenate Biomed. Lecturer for: Nutricia DANONE; Nestlé ; Fresenius; Pfizer; Novartis. All income from the above activities goes to the institution he is working for. M.P. - Boards & Committees: BDA Prehab Sub-Group Committee. Travel grants: BDA GET Fund, RMH Charity, SIOG. Speaker fees: Fresenius Kabi, SPCC & SIOG. Research grants: Nutricia. R.B. – has participated to Advisory Boards for Nutricia Research, Eli Lilly, Novo Nordisk, Pfizer. N.M.L.B. – Advisory board: Pfizer, Abbott, Sanofi, Astellas; Travel grants: Exact Sciences, Pfizer, Lilly, Novartis; Speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead, AstraZeneca, Lilly. E.S-P-D-C. – Speaker fees: Amgen, Synapsis. F.S. – BMS, Sanofi, Roche, MSD, Prostrakan, Leo pharma, Janssen, Pfizer, Amgen, Pierre Fabre Oncologie, Pharmanovia, Vifor Pharma, GSK, Viatris, Helsinn. P.S. – BMS: Member of Advisory Board on cancer in the elderly (2018–2019), GSK: Conference with honoraria (2020), EISAI: Member of Advisory Board on Management of older patients with thyroid cancer (2021), AbbVie: Member of Advisory Board on Geriatric oncology in hematological malignancies (2023). The other authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Immune checkpoint inhibitors (ICI) have transformed the management of cancer, particularly for older adults, who constitute a majority of the global cancer patient population. This study aimed to assess the inclusion, characteristics, and reporting of older adults enrolled in Food and Drug Administration (FDA) registration clinical trials of ICI between 2018 and 2022. Clinical trials of ICI leading to an FDA approval in solid tumor oncology between 2018 and 2022 were included. Primary study reports and all available secondary publications were assessed. The availability and completeness of older subgroup data for protocol-defined clinical efficacy endpoints, health-related quality of life (HRQOL) and toxicity outcomes, and baseline characteristics were assessed according to predefined criteria which categorized reporting completeness hierarchically in relation to the availability of published data, including effect size, sample size, and measures of precision. 53 registration trials were included, involving a total of 37,094 participants. Most trials (64.2%) were of ICI combination therapy. 42.3% of patients were aged≥65 years; 11.1% were aged≥75. No trials specified an upper age limit for eligibility. 98.1% of trials excluded patients with European Cooperative Oncology Group performance status>1. 87.2% of primary efficacy endpoints and 17.9% of secondary efficacy endpoints were reported completely for older adults. Five studies (9.4%) reported baseline characteristics, three (6.1%) reported HRQOL assessments, and four (7.5%) reported toxicity outcomes completely among older subgroups. No trials conducted baseline geriatric assessments or reported geriatric-specific symptoms or quality of life scales. This analysis highlights significant deficits in the enrollment and reporting of older subgroups in pivotal trials of ICI therapy. The findings highlight an urgent need for improved reporting and inclusion standards in clinical trials of ICI to better inform treatment decisions for older adults., Competing Interests: Competing interests: CME: None. RP: None. CS: None. MR: None. NMG-S: None. DW: None. NMLB: Advisory board: Pfizer, Abbott, Sanofi, Astellas; Travel grants: Exact Sciences, Pfizer, Lilly, Novartis; Speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead, AstraZeneca, Lilly., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Many patients with early breast cancer (eBC) undergoing neoadjuvant chemotherapy do not achieve pathological complete response (pCR), which is a prognostic factor. We examined the role of HER2-low expression in predicting pCR and prognosis in HER2-negative eBC., Methods: We evaluated patients with stage I-III HER2-negative BC, treated between 2013 and 2023 at The Royal Marsden NHS Foundation Trust, London. Tumors were classified based on estrogen receptor (ER) status and into HER2-low and HER2-zero subgroups. We analyzed pCR rates, relapse-free survival (RFS) and overall survival (OS)., Results: 754 patients were included in the analysis. pCR rate was 8.9% in the ER+ /HER2-low, 16.5% in the ER+ /HER2-zero, 38.9% in the ER- ER-/HER2-low and 35.9% in the ER-/HER2-zero eBC (p < 0.001). Multivariable analysis showed a significantly lower pCR rate in HER2-low compared to HER2-zero BC in the ER+ subgroup. At a median follow-up of 63.8 months (59.9-67.4), we observed longer OS in HER2-low compared to HER2-zero patients in the overall and in the ER+ population. There was no predictive or prognostic impact of HER2-low status in the ER- population., Conclusion: This study supports the interpretation of HER2 status as a possible prognostic and predictive biomarker for HER2-negative eBC, especially among patients with ER+ disease., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Despite significant evidence supporting the benefits of comprehensive oncogeriatric assessment in the management of older patients with cancer, the adoption of specialised geriatric oncology programs in the United Kingdom remains limited. Descriptions of clinic structure and models, patient demographics and baseline characteristics, resource utilisation, and predictors of resource utilisation are lacking in this population, which may complicate or impede the planning, resourcing, and development of further services in this subspecialty on a national and regional basis., Materials and Methods: Between November 2021 and April 2023, 244 patients commencing systemic anticancer treatment at the Royal Marsden Hospital, London underwent geriatric screening using the Senior Adult Oncology Programme-3 (SAOP3) screening tool. Baseline clinical factors (sex, age, Charlson Comorbidity Index score, Cumulative Illness Rating Scale-Geriatric [CIRS-G] score, Katz Index score, Barthel Index score, treatment intent, and Eastern Cooperative Oncology Group Performance Status [ECOG-PS]) were assessed as predictors of geriatric impairments and need for multidisciplinary referral and intervention using a negative binomial regression analysis. Referral rates to multidisciplinary teams were assessed against ECOG-PS score using point-biserial correlation, as well as against a historical control using descriptive statistics., Results: The median age of participants was 77; 75.8% were female. Breast cancer was the most prevalent diagnosis (61.9%). Most patients (67.6%) were undergoing treatment in the palliative setting. Two hundred eleven (86.5%) patients were identified as having at least one geriatric impairment. Six hundred forty-nine multidisciplinary referrals were made, of which 583 (86.7%) were accepted by the referred patient. Higher ECOG PS was positively associated with geriatric impairments in physiotherapy, occupational therapy, dietetics, pharmacy, and welfare rights domains, as well as with the overall number of geriatric impairments., Discussion: The Royal Marsden Senior Adult Oncology Programme represents the first geriatric oncology service in a tertiary cancer centre in the United Kingdom. Following implementation of SAOP3 screening, we observed a substantial increase in referrals to all multidisciplinary teams, suggestive of previously underrecognized needs among this population. The need for multidisciplinary intervention was strongly correlated with baseline ECOG-PS score, but not with other measured clinical variables, including comorbidity or functional indices., Competing Interests: Declaration of Competing Interest Colm Mac Eochagain: None. Annie Barrell: Speaker Fees: Novartis. Vanya Slavova-Boneva: Speaker Fees: Novartis. Jane Murphy: None. Megan Pattwell: None. Jacqueline Cumming: None. Amanda Edmondson: None. Maureen McGinn: None. Emma Kipps: None. Martine Milton: None. Jo Jethwa: None. Alistair Ring: Honoraria for consultancy and talks: Novartis, Astra-Zeneca, Roche, Pfizer, Lilly, Gilead, Daiichi-Sankyo, Seagen, Stemline, MSD and Zuellig-Pharma. Nicolò Matteo Luca Battisti: Advisory board: Pfizer, Abbott, Sanofi, Astellas; Travel grants: Exact Sciences, Pfizer, Lilly; Speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Competing Interests: Declaration of Competing Interest CME, AB, JM, MP, JC, VS, AE: None. NB: Advisory board: Pfizer, Abbott, Sanofi, Astellas. Travel grants: Exact Sciences, Pfizer, Lilly, Novartis. Speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead, AstraZeneca. AR: Honoraria for consultancy and talks: Novartis, Astra-Zeneca, Roche, Pfizer, Lilly, Gilead, Daiichi-Sankyo, Seagen, Stemline, MSD and Zuellig-Pharma.

Introduction: Adequate reporting of data specific to older populations enrolled to breast cancer trials is critical, given the high incidence of the disease among this demographic. This study aimed to examine the completeness of reporting of older subgroups among patients recruited to registration clinical trials investigating systemic treatments for breast cancer., Methods: Clinical trials leading to a US food and drug administration (FDA) approval in breast cancer between 2012 and 2021 were included. Primary study reports and and all available secondary publications were systematically and objectively assessed with regard to the availability of data regarding efficacy, baseline characteristics, safety, and health-related quality of life (HRQOL) outcomes among older subgroups., Results: 27 trials and 216 publications were assessed. 20.3% of patients were aged ≥65. 70.0% of patients had an eastern cooperative oncology group (ECOG) performance status of 0. Although complete reporting of primary endpoints was adequate (72.7%), most protocol-defined primary endpoints were surrogate endpoints (84.8%). Overall survival data among older populations was unavailable in 50.0% of studies. Reporting was poor for secondary efficacy endpoints (81.8% unreported), baseline characteristics (70.4% unreported), toxicity (55.6% unreported), and health-related quality of life outcomes (87.5% unreported)., Conclusion: The findings underline significant deficits in the reporting of age-specific data in breast cancer registration trials. The underreporting of key efficacy, safety, and HRQOL outcomes highlights the need for mandatory reporting standards and a dedicated emphasis on older populations' priorities and needs in the reporting of registration clinical trials., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Most cancers occur in older people and the burden in this age group is increasing. Over the past two decades the evidence on how best to treat this population has increased rapidly. However, implementation of new best practices has been slow and needs involvement of policymakers. This perspective paper explains why older people with cancer have different needs than the wider population. An overview is given of the recommended approach for older people with cancer and its benefits on clinical outcomes and cost-effectiveness. In older patients, the geriatric assessment (GA) is the gold standard to measure level of fitness and to determine treatment tolerability. The GA, with multiple domains of physical health, functional status, psychological health and socio-environmental factors, prevents initiation of inappropriate oncologic treatment and recommends geriatric interventions to optimize the patient's general health and thus resilience for receiving treatments. Multiple studies have proven its benefits such as reduced toxicity, better quality of life, better patient-centred communication and lower healthcare use. Although GA might require investment of time and resources, this is relatively small compared to the improved outcomes, possible cost-savings and compared to the large cost of oncologic treatments as a whole., (© 2023. Wuhan University Global Health Institute.)

Competing Interests: Declaration of Competing Interest NMLB and LMB reported relevant activities outside the submitted work: NMLB has served on advisory boards for Pfizer, Abbot, and Sanofi; received travel grants from Exact Sciences, Pfizer, and Lilly; and received speaker fees from Pfizer and AbbVie. LMB has served as a consultant for Pfizer, AstraZeneca, EMD Serono, and Merck.

Competing Interests: Declaration of Competing Interest Dr. Battisti reports receiving travel grants from Exact Sciences, Pfizer, and Lilly; speaker fees from AbbVie, Roche, Sanofi, and Novartis; and serving on advisory boards of Pfizer, Abbott, and Sanofi. Dr. Loh reports receiving honoraria from Pfizer and acting as a consultant to Seattle Genetics. Dr. Kanesvaran reports receiving honoraria for advisory boards and speaking engagements from BMS, MSD, Astellas, J&J, Eisai, Ipsen, Pfizer, Merk, AstraZaneca, Novartis.

In order to tailor treatment to their needs, cancer patients are encouraged to be more active and engaged in their care decisions and to be autonomous yet collaborative with their healthcare professionals when it comes to aspects of their treatment in order to get better results. However, this can only happen after providing them with accurate information about cancer and the different treatment alternatives and their potential side effects. However, sharing robust data-based information is often hindered by exposure to misleading information through different media and online platform, where patients might come across unscientifically founded health practices. Increasing health literacy and cancer-specific literacy is essential to fight this negative trend. The idea is that more knowledgeable patients will be able to debunk more easily misinformation they encounter. This is also related to inequalities among cancer patients. Not only levels of cancer literacy within Europe are uneven across and within countries, but there are social groups that, due to specific social determinants, are systematically less informed and skilled regarding cancer care. In this paper an overview of gaps in addressing literacy issues, and the importance of health literacy to empower patients in their journey through treatment is delineated, concluding with some recommendations to improve cancer literacy in Europe., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Frailty negatively affects the outcomes of patients with cancer, and its assessment might vary widely in the real world. The objective of this study was to explore awareness and use of frailty screening tools among the ONCOassist healthcare professionals (HCPs) users., Materials and Methods: We sent 2 emails with a cross-sectional 15-item survey in a 3-week interval between April and May 2021. Differences in the awareness and use of tools according to respondents' continents, country income, and job types were investigated., Results: Seven hundred thirty-seven HCPs from 91 countries (81% physicians, 13% nurses, and 5% other HCPs) completed the survey. Three hundred and eighty-five (52%) reported assessing all or the majority of their patients; 518 (70%) at baseline and before starting a new treatment. Three hundred and four (43%) HCPs were aware of performance status (PS) scores only, 309 (42%) age/frailty/comorbidity (AFC) screening, and 102 (14%) chemotoxicity predictive tools. Five hundred and thirty-seven (73%) reported using tools; 423 (57%) just PS, 237 (32%) AFC, and 60 (8%) chemotoxicity ones. Reasons for tools non-use (485 responders) were awareness (70%), time constraints (28%), and uselessness (2%). There were significant differences in awareness and use of screening tools among different continents, country income, job types, and medical specialties (P < .001 for all comparisons)., Conclusion: Among selected oncology HCPs, there is still a worldwide lack of knowledge and usage of frailty screening tools, which may differ according to their geography, country income, and education. Targeted initiatives to raise awareness and education are needed to implement frailty assessment in managing patients with cancer., (© The Author(s) 2022. Published by Oxford University Press.)

Competing Interests: Nicolo Matteo Luca BattistiConsulting or Advisory Role: Pfizer, Sanofi, Abbott NutritionSpeakers' Bureau: Pfizer, AbbVie, SanofiTravel, Accommodations, Expenses: Pfizer, Genomic Health, Lilly Mark LawlerHonoraria: Pfizer, Roche, Bayer Health, NovartisTravel, Accommodations, Expenses: Pfizer, Roche Katie RizviHonoraria: Roche Robert GreeneConsulting or Advisory Role: GlaxoSmithKline Kathy OliverConsulting or Advisory Role: Bristol Myers Squibb (Inst), Seattle Genetics (Inst), Novartis Italy (Inst), Sanofi/Regeneron (Inst), Novocure (Inst), Eisai (Inst)Other Relationship: Bristol Myers Squibb (Inst), Novocure (Inst), Photonamic (Inst), Bayer (Inst), Northwest Biotherapeutics (Inst), Novartis (Inst), Elekta (Inst), Medac (Inst), GW Pharmaceuticals (Inst), Pfizer (Inst), Karyopharm Therapeutics (Inst), Apogenix (Inst)No other potential conflicts of interest were reported.

Competing Interests: NMLB wishes to acknowledge the support of the Royal Marsden National Institute for Health and Care Research Biomedical Research Centre for Cancer. NMLB has received travel grants from Exact Sciences, Pfizer, and Lilly; advisory board fees from Abbott, Sanofi, and Pfizer; and speaker fees from Pfizer, Roche, Sanofi, and AbbVie, outside of the submitted work. JH declares no competing interests.

Late recurrences are a key challenge for patients with early-stage oestrogen receptor-positive breast cancer, with the risk of disease relapse continuing steadily from 5 to more than 20 years after diagnosis. Five years of adjuvant endocrine therapy with tamoxifen or an aromatase inhibitor was shown many years ago to improve survival. More recently, the trials of extended adjuvant endocrine therapy for more than 5 years have shown a further small gain, but with an associated small risk of increased long-term toxicity including bone loss, cardiovascular impairment and impaired quality of life. This review describes the efficacy and safety of extended endocrine therapy, the optimal selection criteria for patient benefit and the potential for novel agents to improve long-term outcomes., Competing Interests: Conflict of interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: NMLB has received advisory fees from Pfizer, Abbott and Sanofi, speaker fees from Pfizer, AbbVie, Roche and Sanofi and travel grants from Pfizer, Lilly and Exact Sciences. IES declares no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The benefit of chemotherapy for older patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (EBC) is a key area of debate. Gene expression profiling (GEP) may identify patients deriving benefit, but their predictive role has not been established for older adults. We summarise evidence on efficacy, safety, and quality-of-life impacts of chemotherapy and on GEP use and impact in older HR-positive, HER2-negative EBC patients., Methods: We conducted a literature search of PubMed and Embase on publications describing prospective studies evaluating chemotherapy in older adults with HR-positive, HER2-negative EBC and on publications describing retrospective and prospective studies evaluating GEP in older adults., Results: Eight publications on chemotherapy use, including 2,035 older patients with EBC were selected. Only one trial evaluated chemotherapy survival benefits in older adults, showing no benefit. Of four studies comparing different regimens, only one showed the superiority of taxanes versus anthracyclines alone. Those investigating alternative regimens did not show improvements over standard regimens despite significant limitations. Five publications on GEP, including 445,323 older patients, were included and investigated Oncotype DX. Limited evidence shows that GEP aids treatment decisions in this population. GEP was offered less frequently to older versus younger patients. Higher Recurrence Score was prognostic for distant recurrence, but chemotherapy did not improve prognosis., Conclusions: In older patients with HR-positive, HER2-negative, chemotherapy survival benefits EBC are unclear and GEP is less used. Although its prognostic role is well established, its predictive role remains unknown., Competing Interests: Conflict of interest statement The authors declare the following financial interests/personal relationships, which may be considered as potential competing interests: NMLB has received advisory fees from Pfizer and Sanofi, speaker fees from Pfizer, Sanofi, Roche and AbbVie and travel grants from Pfizer, Lilly and Genomic Health. AR has received advisory board and speaker fees from Roche, AZ, Seagen, Novartis, Pfizer, MSD and Lilly. MB has received speaker fees from Lilly, and travel grants from Pfizer. LB has received advisory board and speaker fees from AstraZeneca, Daiichi-Sankyo, Celgene, Eisai, Genomic Health, Ipsen, Lilly, Novartis, Pfizer, Pierre Fabre, Puma Biotechnology, Roche, Takeda. HW's institution received financial compensation on his behalf for advisory boards and lecture fees from Immutep Pty, MSD, AstraZeneca Ireland, Daiichi, AbbVie, Lilly, PSI CRO AG, KCE, EISAI, AstraZeneca, Roche, Congres care, Pfizer, ARIEZ, Sirtex, TRM Oncology, ORION Corporation, Novartis, Biocartes and Puma Biotech. HW's institution received an unrestricted research grant on his behalf from Roche and he received travel support from Pfizer and Roche. EB has received travel supports from AstraZeneca, Novartis, Pfizer, Pierre Fabre, Roche, Sandoz, honoraria or consultation fees from BMS, Eli Lilly, G1 Therapeutics, Pfizer, Sandoz and Seagen. KLC has received advisory fees from Genomic Health and consulting fees from Roche. SML is supported by the NCI Cancer Center Support Grant (P30CA008748). The remaining authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer., Objectives: We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence., Methods: The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined., Results: Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients., Conclusions: There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes., Competing Interests: This study was funded by a joint research grant from the British Heart Foundation (SP/16/5/32415) and Cancer Research UK (C53325/A21134). The funders did not have any involvement in producing the report. Dr Battisti has received advisory board fees from Pfizer, Abbott and Sanofi; has received travel grants from Exact Sciences, Eli Lilly and Pfizer; and has received speaker fees from Pfizer and Abbvie. Dr Ring has received advisory board and speaker fees from Roche, Novartis, Pfizer, Merck Sharpe & Dohme, AstraZeneca, Seagen, Daiichi Sankyo, and Eli Lilly. Dr Adlam has received research funding and in-kind support from AstraZeneca for unrelated research; has received educational funding from Abbott Vascular to support a clinical research fellow; and has conducted consultancy for General Electric to support general research funds. Mr Sweeting is a full-time employee of AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Breast cancer is the most common type of cancer affecting women worldwide and its risk increases with age. Compared with other breast cancer subtypes, triple negative breast cancer (TNBC) behaves more aggressively, with earlier relapses and poorer survival outcomes. Although the incidence of TNBC decreases with age, it still affects about 10% of older women with breast cancer. The management of TNBC in older patients is particularly challenging as chemotherapy is the main treatment choice in both early and advanced diseases and older patients are often prone to increased treatment-related toxicities. This review highlights the specific considerations in this vulnerable group of patients and summarizes the current evidence for TNBC management in older adults from early to late stage of disease., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Competing Interests: Declaration of competing interest No conflicts of interest or disclosures.

Competing Interests: Dr Nicolò Matteo Luca Battisti has received travel grants from Exact Sciences, Pfizer and Lilly, advisory board fees from Abbott, Sanofi and Pfizer and speaker fees from Pfizer, Roche, Sanofi and AbbVie. The other authors have no conflict of interest to disclose.

Purpose of Review: In this review, we describe the evidence on the efficacy and the safety of systemic treatments for the management of early breast cancer (EBC) in older individuals., Recent Findings: Chemotherapy has a temporary impact on quality of life (QoL) for older EBC patients and improves survival outcomes for those with oestrogen receptor (ER)-negative disease. Benefits were seen also in the context of comorbidities, although these may be influenced by selection bias. The Cancer and Aging Research Group-Breast Cancer tool can predict the risk of severe toxicities on chemotherapy in older patients. Gene expression profiling is less frequently used in older adults although it holds promise to better inform patient selection also in this age group.Postneoadjuvant systemic therapy and novel agents remain poorly described in older patients with EBC. No disease-free survival benefits were seen in older patients receiving abemaciclib plus adjuvant endocrine therapy., Summary: Chemotherapy is beneficial for selected older patients with high-risk, ER-negative EBC. Although its impact on QoL is temporary, preferences, higher risk of toxicity and competing risks need to be carefully considered. Open questions remain on novel therapeutic approaches and gene expression profile in older EBC patients and more real-world evidence is warranted., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Over a third of breast cancers are diagnosed in patients ≥70 years. With the ageing of the population, the number of older breast cancer patients will continue to rise. Older patients are under-represented in clinical studies underpinning breast cancer therapy, and frequently do not receive guideline-concordant care. This review outlines the evidence on the efficacy and the safety of systemic treatment options for the management of early-stage breast cancer (EBC) in older adults and identifies where critical data gaps exist. Chemotherapy is beneficial for older patients with oestrogen receptor (ER)-negative EBC, whilst the benefit for those with ER-positive disease is less certain. Careful consideration should be given to the side-effect profile of the treatment regimen chosen, owing to the risks of myelosuppression and cardiac damage, as well as toxicities, such as neuropathy, that may impact independence. The impact of chemotherapy on quality of life (QOL) outcomes appears significant but reversible in this population. Gene expression profiling, benefit and chemotherapy toxicity prediction tools integrating global health considerations hold promise to better inform chemotherapy decisions in this population. Benefits on targeted anti-human epidermal growth factor receptor 2 (HER2) agents is maintained in older EBC patients with a favourable safety profile. Endocrine therapy including aromatase inhibitors is the standard of care in this population, and extended treatment decisions should consider effects on bone health and life expectancy. More trials recruiting older adults with pragmatic designs and meaningful endpoints for this population are warranted to better inform systemic treatment decisions and discussion with patients., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Radiotherapy reduces in-breast recurrence risk in early breast cancer (EBC) in older women. This benefit may be small and should be balanced against treatment effect and holistic patient assessment. This study described treatment patterns according to fitness and impact on health-related quality-of-life (HRQoL)., Methods: A multicentre, observational study of EBC patients aged ≥ 70 years, undergoing breast-conserving surgery (BCS) or mastectomy, was undertaken. Associations between radiotherapy use, surgery, clinico-pathological parameters, fitness based on geriatric parameters and treatment centre were determined. HRQoL was measured using the European Organisation for the Research and Treatment of Cancer (EORTC) questionnaires., Results: In 2013-2018 2811 women in 56 UK study centres underwent surgery with a median follow-up of 52 months. On multivariable analysis, age and tumour risk predicted radiotherapy use. Among healthier patients (based on geriatric assessments) with high-risk tumours, 534/613 (87.1%) having BCS and 185/341 (54.2%) having mastectomy received radiotherapy. In less fit individuals with low-risk tumours undergoing BCS, 149/207 (72.0%) received radiotherapy. Radiotherapy effects on HRQoL domains, including breast symptoms and fatigue were seen, resolving by 18 months., Conclusion: Radiotherapy use in EBC patients ≥ 70 years is affected by age and recurrence risk, whereas geriatric parameters have limited impact regardless of type of surgery. There was geographical variation in treatment, with some fit older women with high-risk tumours not receiving radiotherapy, and some older, low-risk, EBC patients receiving radiotherapy after BCS despite evidence of limited benefit. The impact on HRQoL is transient., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Breast cancer is increasingly prevalent in older adults and is a substantial part of routine oncology practice. However, management of breast cancer in this population is challenging because the disease is highly heterogeneous and there is insufficient evidence specific to older adults. Decision making should not be driven by age alone but should involve geriatric assessments plus careful consideration of life expectancy, competing risks of mortality, and patient preferences. A multidisciplinary taskforce, including members of the European Society of Breast Cancer Specialists and International Society of Geriatric Oncology, gathered to expand and update the previous 2012 evidence-based recommendations for the management of breast cancer in older individuals with the endorsement of the European Cancer Organisation. These guidelines were expanded to include chemotherapy toxicity prediction calculators, cultural and social considerations, surveillance imaging, genetic screening, gene expression profiles, neoadjuvant systemic treatment options, bone-modifying drugs, targeted therapies, and supportive care. Recommendations on geriatric assessment, ductal carcinoma in situ, screening, primary endocrine therapy, surgery, radiotherapy, adjuvant systemic therapy, and secondary breast cancer were updated., Competing Interests: Declaration of interests LB reports personal fees from AstraZeneca, Eisai, Lilly, Pierre Fabre, and Daiichi Sankyo; grants, personal fees, and non-financial support from Celgene, Ipsen, and Pfizer; grants and personal fees from Genomic Health and Novartis; and personal fees and non-financial support from Roche, outside the submitted work. NLMB reports grants and personal fees from Pfizer and grants from Genomic Health, outside the submitted work. HW reports that his institution (University Hospitals Leuven, Leuven, Belgium) received consulting fees and honoraria from AstraZeneca, Biocartis, Lilly, Novartis, Pfizer, PUMA Biotechnology, Roche, Sirtex, and Daiiji; the institution received unrestricted research grants from Roche and Novartis; and HW received travel support from Roche and Pfizer. MSA reports personal fees and non-financial support from the Multinational Association for Supportive Care in Cancer, European Society of Medical Oncology, and European CanCer Organisation; grants and personal fees from Helsinn, Sandoz; and personal fees from Tesaro, Merck, Vifor, Pfizer, Taiho, and Kyowa Kirin, outside the submitted work. EGCB reports personal fees from Pfizer, Roche, Samsung, Pierre Fabre, Novartis, AstraZeneca, TLC PharmaChem, Clinigen, Mylan, and G1 Therapeutics; and grants and personal fees from Bristol Myers Squibb, outside the submitted work. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy., Methods: A multicentre, prospective, observational study was performed to determine chemotherapy (±trastuzumab) usage and survival and quality-of-life outcomes in EBC patients aged ≥70 years. Propensity score-matching adjusted for variation in baseline age, fitness and tumour stage., Results: Three thousands four hundred sixteen women were recruited from 56 UK centres between 2013 and 2018. Two thousands eight hundred eleven (82%) had surgery. 1520/2811 (54%) had high-risk EBC and 2059/2811 (73%) were fit. Chemotherapy was given to 306/1100 (27.8%) fit patients with high-risk EBC. Unmatched comparison of chemotherapy versus no chemotherapy demonstrated reduced metastatic recurrence risk in high-risk patients(hazard ratio [HR] 0.36 [95% CI 0.19-0.68]) and in 541 age, stage and fitness-matched patients(adjusted HR 0.43 [95% CI 0.20-0.92]) but no benefit to overall survival (OS) or breast cancer-specific survival (BCSS) in either group. Chemotherapy improved survival in women with oestrogen receptor (ER)-negative cancer (OS: HR 0.20 [95% CI 0.08-0.49];BCSS: HR 0.12 [95% CI 0.03-0.44]).Transient negative quality-of-life impacts were observed., Conclusions: Chemotherapy was associated with reduced risk of metastatic recurrence, but survival benefits were only seen in patients with ER-negative cancer. Quality-of-life impacts were significant but transient., Trial Registration: ISRCTN 46099296., (© 2021. The Author(s).)

Purpose: Trastuzumab improves survival in patients with HER2+ early breast cancer. However, cardiotoxicity remains a concern, particularly in the curative setting, and there are limited data on its incidence outside of clinical trials. We retrospectively evaluated the cardiotoxicity rates [left ventricular ejection fraction (LVEF) decline, congestive heart failure (CHF), cardiac death or trastuzumab discontinuation] and assessed the performance of a proposed model to predict cardiotoxicity in routine clinical practice., Methods: Patients receiving curative trastuzumab between 2011 and 2018 were identified. Demographics, treatments, assessments and toxicities were recorded. Fisher's exact test, Chi-squared and logistic regression were used., Results: 931 patients were included in the analysis. Median age was 54 years (range 24-83) and Charlson comorbidity index 0 (0-6), with 195 patients (20.9%) aged 65 or older. 228 (24.5%) were smokers. Anthracyclines were given in 608 (65.3%). Median number of trastuzumab doses was 18 (1-18). The HFA-ICOS cardiovascular risk was low in 401 patients (43.1%), medium in 454 (48.8%), high in 70 (7.5%) and very high in 6 (0.6%). Overall, 155 (16.6%) patients experienced cardiotoxicity: LVEF decline ≥ 10% in 141 (15.1%), falling below 50% in 55 (5.9%), CHF NYHA class II in 42 (4.5%) and class III-IV in 5 (0.5%) and discontinuation due to cardiac reasons in 35 (3.8%). No deaths were observed. Cardiotoxicity rates increased with HFA-ICOS score (14.0% low, 16.7% medium, 30.3% high/very high; p = 0.002)., Conclusions: Cardiotoxicity was relatively common (16.6%), but symptomatic heart failure on trastuzumab was rare in our cohort. The HFA-ICOS score identifies patients at high risk of cardiotoxicity.

Most adults with cancer are over 65 years of age, and this cohort is expected to grow exponentially. Older adults have an increased burden of comorbidities and risk of experiencing adverse events on anticancer treatments, including functional decline. Functional impairment is a predictor of increased risk of chemotherapy toxicity and shorter survival in this population. Healthcare professionals caring for older adults with cancer should be familiar with the concept of functional status and its implications because of the significant interplay between function, cancer, anticancer treatments, and patient-reported outcomes. In this narrative review, we provide an overview of functional status among older patients with cancer including predictors, screening, and assessment tools. We also discuss the impact of functional impairment on patient outcomes, and describe the role of individual members of an interprofessional team in addressing functional impairment in this population, including the use of a collaborative approach aiming to preserve function., Competing Interests: Declaration of Competing Interest Dr. Puts is supported as a Canada Research Chair in the Care for Frail Older Adults. Dr. Battisti has received travel grants from Genomic Health and Pfizer and speaker fees from Pfizer. Dr. Loh is supported by the National Cancer Institute at the National Institute of Health (K99CA237744) and Wilmot Research Fellowship Award and has served as a consultant to Pfizer and Seattle Genetics. Dr. Pergolotti receives a salary from ReVital Cancer Rehabilitation, Select Medical, Inc., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Competing Interests: KPL has served as a consultant to Pfizer and Seattle Genetics. NMLB has received travel grants from Pfizer, Lilly, and Genomic Health; and reports speaker fees from Pfizer and AbbVie. All other authors declare no competing interests. The work was supported by the National Cancer Institute at the National Institute of Health (K99CA237744 awarded to KPL) and the Wilmot Research Fellowship Award (awarded to KPL).

Competing Interests: Declaration of Competing Interest Dr. Magnuson reports National Institute on Aging K76 Career Development Award, National Cancer Institute Loan Repayment Award, and honoraria for an educational lecture provided at the American Society of Radiation Oncology 2020 annual meeting. Dr. Battisti has received speaker fees from AbbVie and Pfizer and travel grants from Pfizer, Lilly and Genomic Health. Dr. Sedrak reports grants from National Institute of Aging (NIA R03AG064377), National Cancer Institute (NCI K12CA001727), Waisman Innovation Fund, Circle 1500 (USA), Pfizer (USA), Eli Lilly (USA), Novartis (CH), and Seattle Genetics (USA), outside the submitted work. All other authors declare no conflict of interest. All authors contributed to the conception, writing, and approval of this paper.

Purpose of Review: Cancer is a disease of older adults, where fitness and frailty are a continuum. This aspect poses unique challenges to the management of cancer in this population. In this article, we review the biological aspects influencing the efficacy and safety of systemic anticancer treatments., Recent Findings: The organ function decline associated with the ageing process affects multiple systems, including liver, kidney, bone marrow, heart, muscles and central nervous system. These can have a significant impact on the pharmacokinetics and pharmacodynamics of systemic anticancer agents. Comorbidities also represent a key aspect to consider in decision-making. Renal disease, liver conditions and cardiovascular risk factors are prevalent in this age group and may impact the risk of adverse outcomes in this setting., Summary: The systematic integration of geriatrics principles in the routine management of older adults with cancer is a unique opportunity to address the complexity of this population and is standard of care based on a wide range of benefits. This approach should be multidisciplinary and involve careful discussion with hospital pharmacists., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in older patients enrolled in the Bridging the Age Gap study., Materials and Methods: A prospective, multicentre, observational study of EBC patients ≥70 years old was conducted in 2013-2018 at 56 UK hospitals. Demographics, patient, tumour characteristics, treatments and adverse events were recorded. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires (EORTC-QLQ) C30, BR23 and ELD 15 plus the Euroqol-5D (eq-5d) over 24 months and analysed at each time point using baseline adjusted linear regression analysis and propensity score-matching., Results: Three thousand and four hundred sixteen patients were enrolled in the study; 1520 patients undergoing surgery and who had high-risk EBC were included in this analysis. 376/1520 (24.7%) received chemotherapy. At 6 months, chemotherapy had a significant negative impact in several EORTC-QLQ-C30 domains, including global health score, physical, role, social functioning, cognition, fatigue, nausea/vomiting, dyspnoea, appetite loss, diarrhoea and constipation. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). Its impact was no longer significant at 18-24 months in unmatched and matched cohorts., Conclusions: The negative impact of chemotherapy on quality-of-life is clinically and statistically significant at 6 months but resolves by 18 months, which is crucial to inform decision-making for older patients contemplating chemotherapy., Trial Registration Number Isrctn: 46099296., Competing Interests: Conflict of interest statement The authors declare no conflict of interest. Professors Stephen Walters and Thompson Robinson are National Institute for Health Research (NIHR) Senior Investigators; Jenna Morgan is a NIHR Clinical Lecturer; and Kate Lifford is funded by the NIHR as part of this project. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Breast cancer (BC) is the most common female cancer and the second cause of death among women worldwide. The 5-year relative survival rate recently improved up to 90% due to increased population coverage and women's attendance to organised mammography screening as well as to advances in therapies, especially systemic treatments. Screening attendance is associated with a mortality reduction of at least 30% and a 40% lower risk of advanced disease. The stage at diagnosis remains the strongest predictor of recurrences. Systemic treatments evolved dramatically over the last 20 years: aromatase inhibitors improved the treatment of early-stage luminal BC; targeted monoclonal antibodies changed the natural history of anti-human epidermal growth factor receptor 2-positive (HER2) disease; immunotherapy is currently investigated in patients with triple-negative BC; gene expression profiling is now used with the aim of personalising systemic treatments. In the era of precision medicine, it is a challenging task to define the relative contribution of early diagnosis by screening mammography and systemic treatments in determining BC survival. Estimated contributions before 2000 were 46% for screening and 54% for treatment advances and after 2000, 37% and 63%, respectively. A model showed that the 10-year recurrence rate would be 30% and 25% using respectively chemotherapy or novel treatments in the absence of screening, but would drop to 19% and 15% respectively if associated with mammography screening. Early detection per se has not a curative intent and systemic treatment has limited benefit on advanced stages. Both screening mammography and systemic therapies continue to positively contribute to BC prognosis.

The ongoing coronavirus disease 2019 (COVID-19) pandemic has affected millions of people in over 180 territories, causing a significant impact on healthcare systems globally. Older adults, as well as people living with cancer, appear to be particularly vulnerable to COVID-19 related morbidity and mortality, which means that older adults with cancer are an especially high-risk population. This has led to significant changes in the way geriatric oncologists provide care to older patients, including the implementation of novel methods for clinical visits, interruptions or delays in procedures, and modification of therapeutic strategies, both in the curative and palliative settings. In this manuscript, we provide a global overview of the perspectives of geriatric oncology providers from countries across Europe, America, and Asia, regarding the adaptive strategies utilized to continue providing high quality care for older patients with cancer during the COVID-19 pandemic. Through these perspectives, we attempt to show that, although each country and setting has specific issues, we all face similar challenges when providing care for our older patients with cancer during these difficult times., Competing Interests: Declaration of Competing Interest Dr. Battisti has received travel grants and speaker fees from Pfizer and travel grants from Genomic Health. Dr. Loh serves as a consultant to Pfizer and Seattle Genetics. Dr. Loh is supported by the Wilmot Research Fellowship Award and National Cancer Institute (K99CA237744). Dr. Neuendorff has received honoraria and travel support by Janssen-Cilag, Medac, and Jazz Pharmazeutical. Dr. Mian reports Honoraria/Consultancy fees from Amgen, Celgene, Takeda, Janssen, Sanofi. All other authors have no financial conflicts of interest to disclose., (Copyright © 2020. Published by Elsevier Ltd.)

Immunotherapy with checkpoint inhibitors against programmed cell death receptor (PD-1) and programmed cell death ligand (PD-L1) has been implemented in the treatment pathway of patients with non-small cell lung cancer (NSCLC) from locally advanced disease to the metastatic setting. This approach has resulted in improved survival and a more favourable toxicity profile when compared with chemotherapy. Following the successful introduction of single-agent immunotherapy, current clinical trials are focusing on combination treatments with chemotherapy or radiotherapy or even other immunotherapeutic agents. However, most of the data available from these trials are derived from, and therefore might be more applicable to younger and fitter patients rather than older and often frail lung cancer real-world patients. This article provides a detailed review of these immunotherapy agents with a focus on the data available regarding older NSCLC patients and makes recommendations to fill evidence gaps in this patient population.

Purpose of Review: Decision-making for systemic treatments in older patients with cancer is difficult because of concerns for decreased organ function, risk of toxicity, limited life expectancy due to comorbidities and the lack of evidence available to guide its management in this population. Here, we review the data on the role of systemic agents for the treatment of common malignancies in this age group., Recent Findings: Evidence on the use of systemic treatments for older patients with cancer is increasing, especially for newer options including immune checkpoint inhibitors and targeted agents that provide comparable benefit in older and younger patients. Nonetheless, the risks for short- and long-term toxicities need to be considered. More research is warranted and represents a unique opportunity to increase the knowledge on cancer treatment for older adults. Healthy, older individuals should be considered for standard systemic treatment options, whereas those at risk based on geriatric assessments require adjusted plans. Geriatric assessments are key for decision-making.

Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Older adults with cancer have increasing needs in physical, cognitive, and emotional domains, and they can experience decline in all domains with the diagnosis and treatment of cancer. Social support plays a key role in supporting these patients, mitigating negative effects of diagnosis and treatment of cancer, and improving cancer outcomes. We review the importance of social support in older adults with cancer, describe the different components of social support and how they are measured, discuss current interventions that are available to improve social support in older adults, and describe burdens on caregivers. We also highlight Dr. Arti Hurria's contributions to recognizing the integral role of social support to caring for older adults with cancer., Competing Interests: Declaration of Competing Interest, (Copyright © 2019 Elsevier Inc. All rights reserved.)