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Rationale & Objective: β 2 -Microglobulin (B2M) and β-trace protein (BTP) are novel endogenous filtration markers that may improve the accuracy of estimated glomerular filtration rate (eGFR) beyond creatinine and cystatin C (eGFR cr-cys ), but they have not been assessed in patients with cancer., Study Design: Cross-sectional analysis., Setting & Participants: Prospective cohort of 1,200 patients with active solid tumors recruited between April 2015 and September 2017., Exposure: CKD-EPI equations without race combining B2M and/or BTP with creatinine with or without cystatin C (2-, 3-, or 4-marker panel eGFR)., Outcome: Performance of equations compared with eGFR cr-cys and non-GFR determinants of serum B2M and BTP (S B2M , and S BTP , respectively). Measured GFR (mGFR) was determined using the plasma clearance of chromium-51 labeled ethylenediamine tetraacetic acid ( 51 Cr-EDTA)., Analytical Approach: Bias was defined as the median of the differences between mGFR and eGFR, and 1-P 30 was defined as the percentage of estimates that differed by more than 30% from the mGFR (1-P 30 ). Linear regression was used to assess association of clinical and laboratory variables with S B2M , and S BTP after adjustment for mGFR., Results: Mean age and mGFR were 58.8±13.2 SD years and 78.4±21.7 SD mL/min/1.73m 2 , respectively. Performance of the 3-marker and 4-marker panel equations was better than eGFR cr-cys (lesser bias and 1-P 30 ). Performance of 2-marker panel equations was as good as eGFR cr-cys (lesser bias and similar 1-P 30 ). S B2M and S BTP were not strongly influenced by cancer site., Limitations: Participants may have had better clinical performance status than the general population of patients with solid tumors., Conclusions: B2M and BTP can improve the accuracy of eGFR and may be useful as confirmatory tests in patients with solid tumors, either by inclusion in a multimarker panel equation with creatinine and cystatin C, or by substituting for cystatin C in combination with creatinine., Plain-Language Summary: The most accurate method to assess estimate kidney function is estimated glomerular filtration rate (eGFR) using creatinine and cystatin C (eGFR cr-cys ). We studied whether using β2-microglobulin (B2M) and/or β-trace protein (BTP) with creatinine with or without cystatin C (2-, 3-, or 4-marker panel eGFR) might be useful in patients with active solid tumors. The performance of the 3-marker and 4-marker panel equations was better than eGFR cr-cys . Performance of 2-marker panel equations was as good as eGFR cr-cys . We conclude that B2M and BTP can improve the accuracy of eGFR and may be useful as a confirmatory test in patients with solid tumors either by inclusion in multimarker panel equation with creatinine and cystatin C or by substituting for cystatin C in combination with creatinine., (Copyright © 2024 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

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.

Cancer is predominantly a disease of aging, and older adults represent the majority of cancer diagnoses and deaths. Older adults with cancer differ significantly from younger patients, leading to important distinctions in cancer treatment planning and decision-making. As a consequence, the field of geriatric oncology has blossomed and evolved over recent decades, as the need to bring personalized cancer care to older adults has been increasingly recognized and a focus of study. The geriatric assessment (GA) has become the cornerstone of geriatric oncology research, and the past year has yielded promising results regarding the implementation of GA into routine cancer treatment decisions and outcomes for older adults. In this article, we provide an overview of the field of geriatric oncology and highlight recent breakthroughs with the use of GA in cancer care. Further work is needed to continue to provide personalized, evidence-based care for each older adult with cancer., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Current guidelines recommend estimating glomerular filtration rate (eGFR) using creatinine (eGFRcr) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation as the first test for GFR evaluation, but the Cockcroft-Gault (CG) equation is still commonly used in oncology practice and clinical trials despite increasing evidence of its inaccuracy compared to measured GFR (mGFR). Guidelines recommend eGFR using cystatin C (eGFRcys) or both markers (eGFRcr-cys) as a confirmatory test, but neither was carefully evaluated in cancer patients. Therefore, we compared performance of the CKD-EPI equations and others to the CG equation in adults with a variety of solid tumors. The mGFR was determined by plasma clearance of 51 Cr-EDTA. Bias was defined as the median of the differences between mGFR and eGFR while accuracy was defined as the percentage of estimates that differed by more than 30% from the measured GFR (1-P30). We prospectively recruited 1,200 patients between April 2015 and September 2017 with a mean age and mGFR of 58.8 years and 78.4 ml/min/1.73m 2 , respectively. Bias among eGFRcr equations varied from -8.1 to +6.1 ml/min/1.73 m 2 . CG was the least accurate, 1-P30 (95% confidence interval) was 24.9 (22.4- 27.3)%; CKD-EPI had 1-P30 of 19.1 (16.8-21.2)% while eGFRcr-cys had the best performance: bias -2.0 (-2.6 to -1.1) ml/min/1.73m 2 and 1-P30 7.8 (6.3-9.4)%. Thus, the CG equation should not be preferred over CKD-EPI equation, and eGFRcr-cys can be used as a confirmatory test in adults with solid tumors. Hence, a major policy implication would be to adopt general practice guideline-recommended methods for GFR evaluation in oncology practice and clinical trials., (Copyright © 2022 International Society of Nephrology. Published by Elsevier Inc. 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.)

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.)