Europe’s Cancer Care for Older Patients Is a Patchwork, Landmark Survey Reveals

Older adults are the fastest-growing group of people with cancer in Europe, yet the specialist care designed specifically for them remains a strikingly uneven patchwork across the continent. That is the central finding of the first Europe-wide survey of geriatric oncology practice, published in European Geriatric Medicine, which asked geriatricians in 37 countries how their institutions organize cancer care for older adults. The results reveal a discipline that has matured impressively in some health systems while remaining virtually absent in others, leaving the quality of care an older patient receives dependent to a remarkable degree on where they happen to live.

The survey, conducted by researchers affiliated with the European Geriatric Medicine Society’s special interest groups in gero-oncology and perioperative geriatric medicine, was distributed between April 10 and May 23, 2025. An anonymous 35-item questionnaire reached 11,189 professionals via international and national geriatric societies, generating 2,160 responses from 37 countries. After excluding incomplete or ineligible responses, the analysis focused on 395 geriatricians and internal medicine physicians with at least 26 percent survey completion across 34 countries. Most respondents were consultants in general hospitals, and more than half worked in university-affiliated academic centers, giving the dataset a strong institutional footprint, although the authors caution that the anonymous design and overlapping distribution networks prevent country-level results from being treated as nationally representative estimates.

The technical heart of geriatric oncology is the comprehensive geriatric assessment, or CGA, a multidimensional evaluation performed by a geriatrician-led team that maps medical, functional, psychological, and social vulnerabilities and converts them into a coordinated care plan. Because chronological age is a poor proxy for physiological resilience, international bodies including the International Society of Geriatric Oncology and the American Society of Clinical Oncology recommend CGA or an abbreviated geriatric assessment to guide treatment selection in older patients. The survey found that implementation of this principle varies enormously. Nineteen percent of respondents reported no formal geriatric oncology model at all, meaning older patients are simply not referred for geriatric evaluation. The two dominant approaches elsewhere were referral based on the referring physician’s clinical judgment, reported by 43 percent, and a structured two-step pathway in which patients are first screened for frailty and those at risk receive a full CGA, reported by 42 percent.

Even where screening exists, the tools and triggers differ from country to country. Frailty screening guided referral in 63 percent of practices, with the G8 questionnaire the most popular instrument at 50 percent, followed by the Clinical Frailty Scale at 32 percent and the Eastern Cooperative Oncology Group performance status at 10 percent. The national contrasts are telling: the G8 was nearly universal in France, used by 94 percent of respondents, and dominant in the Netherlands and Spain, while the United Kingdom relied predominantly on the Clinical Frailty Scale. Referral criteria based purely on chronological age, an approach geriatricians widely regard as outdated, persisted in 39 percent of practices, particularly in Italy and France and in several smaller Eastern European systems. Most referrals occurred at diagnosis or at the start of oncological treatment, and the CGA itself was carried out by geriatricians in 70 percent of settings, with nurse specialists contributing in 22 percent.

Perhaps the survey’s most consequential finding concerns the multidisciplinary team meeting, the tumor board where oncologists, surgeons, radiologists, and pathologists jointly plan treatment. Only 30 percent of respondents routinely attended these meetings, and just 20 percent were involved in treatment decisions on a routine basis, although another 49 percent participated case by case. The exploratory statistical analysis, adjusted for country group, institution type, and years of experience, showed that routine multidisciplinary team participation was associated with a sixfold increase in the odds of active involvement in treatment decision-making, an adjusted odds ratio of 6.01. It was also associated with a nearly sixfold increase in the odds of producing CGA-based recommendations that address both geriatric optimization and the oncological treatment itself, rather than generic conclusions filed in the patient record. Among geriatricians who regularly sat at the tumor board table, 47 percent actively shaped treatment decisions; among those who did not, the figure was just 11 percent.

Collaboration also appeared to change how the wider cancer team views geriatric input. Seventy-four percent of routine multidisciplinary team participants reported positive feedback from oncology and surgery colleagues, compared with only 31 percent of non-attendees, and participation remained independently associated with positive feedback after adjustment. The authors are careful to stress that these are cross-sectional associations and cannot prove causation; it may be that engaged geriatricians seek out tumor boards rather than the reverse. Still, the pattern aligns with prior evidence that multidisciplinary discussion incorporating functional status, comorbidity, and patient priorities helps avoid both overtreatment and undertreatment in older adults, and it identifies tumor board membership as a plausible and testable target for improving integrated cancer care.

If medical geriatric oncology is a patchwork, geriatric surgical oncology emerges as the discipline’s most underdeveloped frontier. Only 39 percent of respondents were involved in the care of hospitalized patients undergoing cancer surgery, and more than half reported no structural collaboration with surgical services whatsoever. The prevailing arrangement was a liaison model, in which geriatricians are consulted for specific problems such as delirium or preoperative assessment, reported by 37 percent, while a formal co-management model with geriatricians structurally embedded on the surgical ward existed in only 9 percent of settings. This stands in sharp contrast to orthogeriatrics, where co-management of hip fracture patients is well established and has demonstrably improved outcomes. Involvement concentrated in colorectal, upper gastrointestinal, and bladder cancers, and the Netherlands, Portugal, Belgium, and Denmark led in overall engagement. Just over half of respondents offered prehabilitation programs for surgical oncology patients, most commonly combining exercise training and nutritional support.

The survey also exposed systemic weaknesses in education and guidance. Nearly half of respondents, 48 percent, reported having no structured educational system in geriatric oncology in their country, and 23 percent said their nation lacked specific treatment guidelines for older patients with cancer. In several smaller countries, every respondent reported the absence of both. The barriers cited most often were a lack of engagement from other specialists, reported by 47 percent, a shortage of geriatricians at 44 percent, and insufficient education at 42 percent, with limited funding, staffing, and communication compounding the problem. Respondents’ proposed remedies were strikingly convergent: 45 to 50 percent supported dual training or fellowship programs combining geriatrics with oncology, around 42 percent backed regulatory measures, and 40 percent called for advocacy toward policymakers. More than 80 percent said they would attend a masterclass in perioperative geriatric medicine if one were established, signaling substantial pent-up demand for training.

The survey’s authors situate their findings within two decades of European development. France pioneered formal geriatric oncology with its Pilot Oncogeriatric Coordination Units, created by the National Cancer Institute in 2005, and unsurprisingly reported some of the highest integration in the current survey, with referral at diagnosis in 87 percent of cases and strong G8 uptake. Belgium and the Netherlands have repeatedly documented barriers such as workload and staffing, and a Spanish national questionnaire found older patients often routed to palliative care rather than geriatricians. An interview study of five European cancer centers published in 2024 reached similar conclusions despite unanimous agreement on the value of interdisciplinary collaboration. The new survey is, however, the first to capture real-world practice at this scale and breadth, and its country-level tables for Italy, France, Spain, the Netherlands, Denmark, the United Kingdom, Turkey, Ireland, Portugal, and Belgium offer a benchmark clinicians and policymakers can use to locate their own systems.

The study’s limitations deserve clear acknowledgment. The response rate was modest, many countries provided fewer than ten responses or none at all, and self-selection likely favored geriatricians with an existing interest in oncology, meaning the true extent of inequality across Europe is probably even greater than the results indicate. Because the survey was anonymous and center identifiers were not collected, over-representation of interested institutions cannot be excluded, and residual confounding cannot be ruled out of the statistical associations. Yet the overall message is difficult to dispute. The authors argue that the goal should not be to crown a single best model, but to guarantee core elements everywhere: frailty screening, geriatric assessment, and genuine geriatrician participation in multidisciplinary decision-making, with progressively stronger co-management pathways for surgery. Harmonized European guidelines, structured training, and longitudinal monitoring, they conclude, are essential if the growing population of older adults with cancer is to receive equitable, high-quality care regardless of borders.

Subject of Research: Geriatric oncology and geriatric surgical oncology care models for older cancer patients across Europe

Article Title: A survey among geriatricians on geriatric oncology and geriatric surgical oncology models in Europe

Article References: Sobrini-Morillo, P., Moens, I., Cruz-Jentoft, A., Ciccone, A. S., Dhesi, J. K., Gonzalez-Senac, N. M., Hamaker, M., Lund, C., Mattace-Raso, F., Neuendorff, N., Rostoft, S., Shipway, D., Testa, G. D., Velghe, A., Polinder-Bos, H. A., & on behalf of the SIG Perioperative Geriatric Medicine and the SIG Gero-Oncology of the European Geriatric Medicine Society (2026). A survey among geriatricians on geriatric oncology and geriatric surgical oncology models in Europe. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01575-y

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01575-y

Keywords: geriatric oncology, comprehensive geriatric assessment, frailty screening, multidisciplinary team, surgical oncology, Europe, older adults, cancer care, G8 screening tool, prehabilitation, co-management, health services survey