The goal of the COVID-19 Working Group is to provide guidance for the management of cancer in older adults in the context of the COVID-19 pandemic and to facilitate the conduct of research on this topic.

Activities and responsibilities

  • To provide guidance to healthcare professionals on the management of older patients with cancer in the context of the COVID-19 pandemic
  • To issue advice on the prioritisation of anticancer treatments
  • To raise awareness on the challenges of managing cancer in older adults in the context of the outbreak
  • To generate opportunities for conducting research on these topics

COVID-19 is affecting the whole world, but older persons with cancer are among the highest risk groups for suffering more than others. Both older persons and patients with cancer are at increased risk of obtaining COVID-19 and dying from it, and the 2 risk factors add on. Moreover, older persons with cancer are at highest risk of being excluded from intensive care support for COVID-19 infection and/or adequate cancer treatment if resources are limited.

SIOG therefore wants to make some concrete statements and practical recommendations for all health care workers dealing with older persons with cancer. It should be clearly acknowledged that these are empirical considerations, not based on solid science, which doesn’t exist yet unfortunately.

  • More than ever, for every individual patient, physicians should search strategies to avoid undertreatment of the cancer while also avoiding overtreatment and useless hospital visits where patients potentially come in contact with the COVID-19. We need to protect older persons with cancer both from COVID-19 and from their cancer.
  • Chronological age is NOT a good parameter to omit visits or oncological treatments that provide true benefits for older patients. Some kind of geriatric or frailty evaluation can help to evaluate the global health status and propose individualized treatment plans.
  • Minimize face-to-face appointments by using tele-consultations, cutting of non-essential follow-up visits, reduce dwell time in services, home delivery of oral systemic therapy.
    – Many options are available to optimally support and treat older persons with cancer;
    – Timing and indications of surgery should be discussed multidisciplinary and with patient and caregivers, and in some situation, alternative bridging strategies may be useful;
    – Radiotherapy indications and timing need to be balanced well and put in context with the risks of frequent hospital visits;
    – Concerning systemic therapies, many different strategies can be considered such as subcutaneous home administrations instead of intravenous in hospital administrations, dispensing longer periods for oral medications, having oral drugs delivered at home by courier, increasing intervals between treatments or treatment breaks, separate rooms in the hospital for vulnerable patients in order to avoid contact with other patients;
  • Don’t forget that the patients’ opinion is also crucial in any decision. Treatment goals should be clearly defined and communicated, and it is ultimately the patient who decides after being well informed.

Position papers, research letters, hospital guidelines concerning older patients with cancer have been produced rapidly since the COVID-19 crisis appeared in the month of March. It is SIOG’s mission to diffuse all this important work through its website and network in order to increase visibility as much as possible. If you are aware of new papers, letters, guidelines on COVID-19 and older persons with cancer coming out in the next weeks/months, please send them to the SIOG office (info@siog.org), so the information can be added to this website. We aim to mention only information specifically directed to older persons with cancer, since many cancer organizations have already provided guidelines on cancer patients in general.

Concrete recent manuscripts are shown here:

In the meantime, we receive messages that research projects (retrospective and prospective) are starting to learn about what has happened or is happening with COVID-19 and older persons with cancer. SIOG also aims to collect information on starting or ongoing projects in order to facilitate collaboration. SIOG has already started a COVID-19 Working Group to deal with this issue. Please send information to the SIOG office (info@siog.org), so these can be added to this website.

Prof. Hans Wildiers
SIOG President (2018-2020)
On behalf of the SIOG Board of Directors and the SIOG COVID-19 Working Group

Co-Chairs
Nicolò Matteo Luca Battisti, United Kingdom
Anna Mislang, Australia

Members
Riccardo Audisio (Sweden); Mahmood Alam (Australia); Etienne Brain (France); Clarito Cairo Jr (Philippines); Kwok Leung Cheung (United Kingdom); Giuseppe Colloca (Italy); Lisa Cooper (USA); Luiz Antonio Gil Jr (Brazil); Regina Gironés Sarrió (Spain);   Michael Jaklitsch (USA); Kumud Kantilal (United Kingdom); Stuart Lichtman (USA); Anita O’Donovan (Ireland); Shane O’Hanlon (Ireland); Chiara Russo (France); Schroder Sattar (Canada); Enrique Soto (Mexico); Reinhard Stauder (Austria); Hans Wildiers (Belgium); Grant Williams (USA).

March 2021 – The following guideline “The SIOG COVID-19 Working Group Recommendations on the Rollout of COVID-19 Vaccines among Older Adults with Cancer” was published in the Journal of Geriatric Oncology (JGO).
July 2020 – The following guideline “Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group” was published in the Journal of Geriatric Oncology (JGO).

Treating elderly cancer patients during the COVID-19 pandemic
Dr Anna Mislang speaks to ecancer about the SIOG COVID-19 working group’s report and discussion of ethical issues revolving around treatment of cancer patients during the COVID-19 pandemic. Dr Mislang initially talks about the aims and objectives of the working group and then explains in detail their report. She covers all the aspects of cancer care and treatment and how they need to be changed in certain ways to meet the challenges created by the COVID-19 situation.
Dr Mislang winds it up in the end by talking about the future of geriatric oncology in terms of the “new normal” and says that SIOG is committed to improving the care of older adults with cancer.

Anna Mislang, co-chair of the COVID-19 Working Group, spoke for ESMO covering the implications of the COVID-19 pandemic on the management of cancer in older adults. In this video, Anna Mislang outlines that COVID-19 is an additional competing factor of mortality and morbidity to be considered in decision-making for this population and a number of strategies to mitigate risks when pursuing systemic and local treatments. Anna Mislang also discusses the need for international collaborative research to elucidate outcomes in this population during the pandemic.