Study finds that national policies fall short of addressing the complexities of geriatric oncology – often due to a lack of clinical trial data involving older patients
Older adults are under-represented in cancer care guidelines across Europe, a new study has found.
A scoping review of 187 health strategies across the continent highlighted significant gaps which overlook the care of older people with cancer.
The findings call for urgent action to improve guidance and support for geriatric oncology as populations age.
The study was conducted by the Luxembourg Institute of Health (LIH) with the International Society of Geriatric Oncology, and involved 31 countries including Ireland. It focussed on guidelines around five of the most common cancers – breast, prostate, colorectal, lung, and urinary/bladder.
Despite the growing cancer burden among older adults, the study found that specific guidance for this demographic group remains underdeveloped, inconsistent, and highly dependent on geographic and disease-specific factors.
“Older adults make up the majority of cancer patients, yet many of the policies meant to guide their care are not equipped for this,” said LIH postdoctoral researcher Dr India Pinker.
“Our study shows that we lack dedicated, evidence-based recommendations for older adults, which poses a risk that the needs of this complex and heterogeneous group will go unmet.”
Key findings indicate that countries such as France, Germany, and Sweden are making strides with age-specific recommendations, while others – particularly in Eastern Europe – lag due to constraints hindering the update or creation of national guidelines.
These recommendations acknowledged the limited available evidence, while emphasising the importance of considering individual health and functional status when planning treatment. Indeed, many existing guidelines fall short of addressing the complexities of geriatric oncology, often due to a lack of clinical trial data involving older patients.
The review points to several root causes behind these shortcomings: limited inclusion of older adults in randomised clinical trials, slower adoption of new treatments in less affluent countries, and a lack of communication between oncologists and geriatric specialists to guide cancer care. These challenges, combined with ageing populations, highlight a growing public health concern that European cancer strategies must urgently address.
The research also advocates for broader adoption of such as a comprehensive geriatric assessment together with personalised interventions to tailor treatment decisions, which should not be based on chronological age only. Additionally, it recommends strengthening collaboration between oncologists and geriatricians to develop inclusive, actionable guidelines at both national and international levels.
“Cancer care must evolve to reflect the realities of our ageing societies,” Dr Pinker added. “We hope this work highlights the importance of generating and using evidence and geriatric expertise in shaping national cancer care guidelines. These measures will help to reduce age related disparities in cancer outcomes and ensure care is able to effectively respond to demographic realities.”
The full paper was published in the ESMO Open Journal under the title ‘Representation of geriatric oncology in cancer care guidelines in Europe: a scoping review by the International Society of Geriatric Oncology (SIOG)’.
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