Geriatric oncology is gaining increasing momentum as a subspecialty ensuring comprehensive care for older adults with cancer. A number of factors need to be considered while managing their unique needs, such as physical and psychological ageing, underlying comorbidities, social and family support, polypharmacy, nutritional problems and cognitive impairment and their life expectancy. These principles play a crucial role in the oncological therapeutic decision-making process. Ideally, a thorough initial evaluation of older patients with cancer should involve a Comprehensive Geriatric Assessment (CGA) i.e., a multi-dimensional diagnostic and therapeutic process evaluating the functional, psychological and nutritional status, comorbidities, medications used, and social support, of the patient. This process has several benefits, including predicting toxicities on anticancer treatments, aiding therapeutic decisions, estimating prognosis, improving quality of life & well-being, reducing the rate of hospital admissions due to treatment side effects and reducing the risk of complications on systemic therapeutic approaches.
Nonetheless, there are several challenges to the implementation of integrated oncogeriatric care in routine practice, mainly owing to the shortage of geriatricians, the lack of training of cancer specialists in the principles of geriatrics, the fact that these assessments are frequently deemed to be time consuming and the prevalence of cancer in the older age group. In most countries there is a significant lack of opportunities for geriatric oncology training. In an online survey conducted amongst 69 medical oncology trainees in the United Kingdom, almost two-thirds of the respondents had not received formal training in geriatric oncology, with only about one-third of them being confident in treating older cancer patients. On the other hand, in the United States dual training in hematology/oncology and geriatrics can be pursued in multiple institutions across the country.