The analysis, published in Frontiers in Oncology on 20 October 2026, was designed to characterize the research landscape rather than test a treatment, estimate clinical effectiveness, or assess patient outcomes. The researchers searched the three databases independently and retained English-language articles and reviews. From an initial 1,913 records, they removed 125 published after 2025 or lacking a valid publication year, excluded 13 non-target document types, and applied a three-stage deduplication process. The final library contained 1,003 papers after removal of 610 exact DOI duplicates, 153 additional duplicates identified through normalized title-and-year matching, and nine fuzzy-title matches confirmed manually. Bibliometric calculations used R, bibliometrix, VOSviewer, and CiteSpace, with citation relationships analyzed only in the eligible Web of Science subset.

Database overlap was substantial, but each source also contributed distinct coverage. Scopus supplied 759 records, Web of Science supplied 591, and PubMed supplied 422; 321 papers appeared in all three databases, while 412 final records were absent from Web of Science. This distinction matters because a database can retrieve an article when breast cancer and frailty are not both explicit in its title or abstract, for example when the concepts occur in controlled vocabulary, indexed keywords, or broader contextual discussion. A title-and-abstract audit classified 421 records, or 41.97%, as mentioning both concepts; 83 mentioned breast cancer only, 361 mentioned frailty only, and 138 mentioned neither category. The mapped corpus therefore combined direct co-mentioning publications with a broader group retrieved through indexing practices and contextual language.

Annual output remained limited before 2000, when most years produced fewer than five publications, but it rose to eight in 2000, 20 in 2010, 31 in 2014, 47 in 2018, 81 in 2021, 90 in 2023, 114 in 2024, and 115 in 2025. A segmented Poisson regression estimated an annual rate ratio of 1.133, with a 95% confidence interval of 1.119 to 1.147, before 2018 and 1.151, with a 95% confidence interval of 1.105 to 1.200, after 2018. The change in slope was not statistically significant, with a P value of 0.465. The measured pattern therefore supports sustained growth over time, but not a statistically established acceleration beginning in 2018.

The United States contributed the most publications, with 355, followed by Italy with 144 and the United Kingdom with 140. France produced 82, the Netherlands 66, Canada 61, Belgium and China 57 each, Germany 54, and Spain 41. Among these leading contributors, the highest descriptive proportions of internationally coauthored papers came from Germany at 68.5% and Belgium at 66.7%, whereas the United States had the largest output but a multiple-country publication proportion of 24.5%. Because internationally coauthored papers contribute to each participating country’s total, and because the analysis did not conduct pairwise significance tests, these percentages characterize collaboration patterns rather than establishing that one country collaborates more effectively than another.

Research activity was concentrated among established academic and clinical networks. The University of Toronto ranked first among institutions with 79 publications, followed by KU Leuven with 73, UNICANCER with 65, Harvard University with 61, and Harvard Medical Affiliates with 54. The Journal of Geriatric Oncology was the most productive journal, containing 78 mapped papers, ahead of Cancers with 36. H Wildiers was the most prolific author with 24 publications, followed by K L Cheung with 20 and H J Cohen with 19. The distribution spans oncology, geriatrics, surgery, nursing, rehabilitation, supportive care, and survivorship, indicating that breast cancer and frailty have become shared research concerns across multiple disciplines rather than remaining within a single specialty.

Keyword and network analyses identified three broad domains: identifying frailty and performing geriatric assessment; examining treatment, toxicity, mortality, and survival; and evaluating health status and patient-centered outcomes. “Breast cancer” and “frailty” were the most frequent cleaned keywords, with 852 and 539 occurrences, respectively, followed by “geriatric assessment” with 376, “quality of life” with 227, “older adults” with 200, “comorbidity” with 185, “aging” with 131, “age” with 128, and “chemotherapy” with 127. A VOSviewer network displayed 191 cleaned keywords meeting a minimum occurrence threshold of 20, but a separate Louvain analysis yielded a modularity value of 0.2560, indicating substantial overlap among its exploratory groups. The researchers therefore interpreted the colored network clusters as provisional thematic groupings rather than sharply separated or independently validated categories.

CiteSpace analyses suggested a progression from treatment-centered questions toward multidimensional assessment and longer-term consequences. In the 1995–2025 network, burst terms moved from “adjuvant chemotherapy,” “functional status,” and “comprehensive geriatric assessment” toward “clinical-trials,” “frailty,” “conserving surgery,” “older patients,” and “impact.” A more recent 2016–2025 map contained labels for radiation therapy, breast cancer survivors, HER2-negative breast cancer, geriatric assessment, aromatase inhibitors, cognitive functional outcomes, and treatment-related acute toxicity. The term “toxicity” registered a burst from 2021 through 2023, while “impact” was the only displayed long-window burst active through 2025. The recent network had modularity Q = 0.4069 and a weighted mean silhouette S = 0.7112; for 1995–2025, the corresponding values were 0.4379 and 0.7639. These algorithmic patterns describe changing attention in the literature, but they do not demonstrate that any assessment strategy or intervention improves clinical outcomes.

Citation rankings reinforced the distinction between broad visibility and thematic specificity. The citation analysis covered 591 eligible Web of Science records, or 58.9% of the integrated dataset. This subset closely matched the full collection by publication year and country, with Spearman correlations of 0.986 and 0.911, respectively, but aligned only moderately by journal, at 0.592. A 2015 systematic review on frailty in older cancer patients ranked first globally with 838 Web of Science citations, yet manual review classified it as contextual rather than directly centered on breast cancer and frailty. None of the ten most globally cited records directly examined the joint relationship as its primary question. By contrast, locally cited works more directly addressed frailty assessment, surgery in older women, treatment tolerance, cognition, quality of life, and supportive care. Citation counts therefore measured visibility within the search-defined corpus, not proof of clinical effectiveness.

The findings depict a research field gaining scale and scope, but also one with important measurement limitations. Only English-language articles and reviews were eligible, database indexing practices differed, and comparable citation analysis was unavailable across all three databases. Frailty definitions and assessment instruments vary among studies, while residual keyword variants, including “neoplasm” and “neoplasms,” may have divided some term frequencies. Network structures, cluster assignments, and bursts depend on preprocessing rules, thresholds, and software settings, and the most highly cited papers were not necessarily the most clinically focused. The bibliometric evidence demonstrates the reach and sustained momentum of the literature, but publication growth does not by itself establish improved methodological quality or clinical applicability. The authors consequently identify standardized frailty terminology and assessment, prospective intervention research, clearer links between assessment and clinical decisions, and broader participation from underrepresented regions as priorities for subsequent work.

Subject of Research: Bibliometric mapping of global breast cancer and frailty research from 1973 to 2025

Article Title: Global trends and thematic evolution in breast cancer and frailty research: a multi-database bibliometric analysis, 1973–2025

Article References: Xiang, S., Han, X., & Wang, X. (2026). Global trends and thematic evolution in breast cancer and frailty research: a multi-database bibliometric analysis, 1973–2025. Frontiers in Oncology, 16, Article 1975523. https://doi.org/10.3389/fonc.2026.1975523

Image Credits: AI Generated

DOI: 10.3389/fonc.2026.1975523

Keywords: breast cancer, frailty, geriatric assessment, geriatric oncology, bibliometrics, publication trends, treatment tolerability, survivorship, international collaboration, citation analysis, Global, trends

The scale of that gap is striking. In 2012, adults aged 65 or over accounted for 48 percent of cancer cases, a proportion forecast to climb to 58 percent by 2035. Yet older adults remain chronically under-represented in oncology clinical trials, which means clinicians often extrapolate treatment decisions from studies conducted almost exclusively in younger, fitter patients. Ageing, moreover, is profoundly heterogeneous. Two patients of the same chronological age can differ dramatically in physical reserve, comorbidity burden, cognition, nutrition, and social support, all of which influence how well they tolerate therapy and how long they live.

The instrument behind the new score, the Geriatric Core Dataset, was itself born of consensus. A national and international Delphi process involving a multidisciplinary expert board in geriatric oncology distilled the essentials of a comprehensive geriatric assessment into ten items spanning seven domains: social situation, function, mobility, nutrition, cognition, mood, and comorbidity. The items include whether a patient lives alone and has a primary caregiver; activities of daily living and short instrumental activities of daily living scores; the timed up-and-go mobility test; weight loss over the previous six months and body mass index; the Mini-Cog cognitive screen; a mini Geriatric Depression Scale; and the updated Charlson Comorbidity Index. The goal was to make geriatric data collection in clinical trials brief, standardised, and comparable across centres.

To turn that dataset into a predictive instrument, the team drew on two prospective French cohorts of patients aged 70 or older with solid tumours or haematological malignancies, all referred for geriatric assessment before first-line treatment or a change in treatment. The Elderly Cancer Patients cohort, ELCAPA, from the Greater Paris area, served as the training set with 950 patients contributing complete follow-up data. The Geriatric Oncology Marseille cohort, GOM, provided an independent validation set of 766 patients. The populations differed in clinically meaningful ways: validation patients were younger, more likely to have localised disease, and far more likely to have lung or head and neck cancers, while training patients were more often living alone and carried a heavier comorbidity burden. That diversity was deliberate, because a score that only works in the population where it was built is of little use to anyone else.

The statistical machinery was rigorous. The researchers estimated crude hazard ratios for each G-CODE item against six-month mortality, then entered all items into multivariate Cox proportional hazards regression, using a stepwise selection process based on the Akaike information criterion to identify the optimal model. Regression coefficients were rescaled and rounded to integers using Cole’s algorithm, producing a score that is easy to compute at the bedside. Recursive partitioning analysis was used to find the best cut-points for the comorbidity index, which lacks an established threshold, yielding three classes of increasing risk. Missing data, which reached 38.5 percent for the comorbidity index in the training set, were handled with a random forest imputation algorithm, and a complete-case sensitivity analysis confirmed the results.

What emerged is a 17-point score built from nine of the original ten items. Five predictors carried the greatest weight in forecasting six-month death: a heavy comorbidity burden, particularly an updated Charlson index above 8, which contributed 3 to 5 points; an abnormal timed up-and-go test, indicating impaired mobility, worth 2 points; loss of independence in instrumental activities of daily living, also 2 points; the absence of a caregiver, 2 points; and weight loss exceeding 10 percent over the previous six months, again 2 points. Notably, simply living alone dropped out of the final model, suggesting that the presence of concrete support, rather than cohabitation itself, is what matters for survival.

Performance was solid and, crucially, held up outside the population in which the score was born. On its own, the G-CODE score achieved time-dependent areas under the receiver operating curve of 71.2 percent for six-month mortality, 68.4 percent at twelve months, and 68.1 percent at twenty-four months in the validation cohort. When combined with a baseline model including age, cancer type, metastatic status, and treatment, discrimination rose to between 78 and 82 percent, adding roughly four percentage points over the clinical model alone in both cohorts. Recursive partitioning of the continuous score defined three risk groups, below 7 points, 7 to 8 points, and above 8 points, and Kaplan-Meier curves showed a clear, graded relationship between higher risk categories and worse survival at every time point, with log-rank p-values below 0.0001. Calibration was excellent in the training set and remained good in validation, with a calibration slope of 0.99 at six months.

How does it compare with existing tools? The Geriatric Cancer Scoring System, the only other validated score for three-, six-, and twelve-month mortality, achieved higher discrimination, around 89 percent at six months, but at the cost of eighteen items including laboratory values such as the C-reactive protein to albumin ratio and creatinine clearance. The G-CODE score trades some accuracy for simplicity and standardisation, relying only on bedside geriatric measures. It is also, according to the authors, the first prognostic tool to demonstrate the value of the short four-item instrumental activities of daily living scale for predicting six-month mortality, and the first validated score to extend prediction out to twenty-four months, a horizon that matters when half of the patients in these cohorts died within two years.

The clinical implications cut both ways. For trialists, the score offers a standardised, consensus-based way to stratify older participants by frailty, something international guidelines have long demanded but trials have rarely delivered. For clinicians without easy access to a full geriatric assessment, the score can flag the impairments that matter most, inform conversations with patients and families, guide oncology decision-making, and trigger a referral for comprehensive assessment and targeted geriatric interventions. Predicting short-term mortality is precisely what is needed to avoid both over-treatment of patients unlikely to benefit and under-treatment of those who might.

The authors are candid about limitations. Both cohorts enrolled patients already flagged as potentially frail by a screening score or oncology assessment, so the findings need confirmation in the broader older population. In the training set, the comorbidity index had to be reconstructed from proxy variables because some required comorbidities were not recorded, a potential source of classification bias, although sensitivity analyses and the strong performance in the validation cohort, where the index was complete, argue against serious distortion. The tool also covers the most important geriatric domains but is not exhaustive. Even so, the study represents a rare commodity in geriatric oncology: a simple, externally validated, consensus-derived score that quantifies, in a single number between 0 and 17, how a patient’s ageing body, not just their tumour, will shape their survival.

Subject of Research: Development and external validation of a geriatric assessment-based mortality prediction score for older patients with cancer

Article Title: Using the Geriatric Core Dataset (G-CODE) to predict mortality in older patients with cancer: development and external validation

Article References: Couderc, A.-L., Martinez-Tapia, C., Mathoulin-Pelissier, S., Laurent, M., Bringuier, M., Gay, P., Caillet, P., Bertona, J., Greillier, L., Canovas, J., Soubeyran, P., Rostoft, S., Canouï-Poitrine, F., & Paillaud, E. (2026). Using the Geriatric Core Dataset (G-CODE) to predict mortality in older patients with cancer: development and external validation. British Journal of Cancer. https://doi.org/10.1038/s41416-026-03641-5

Image Credits: AI Generated

DOI: 10.1038/s41416-026-03641-5

Keywords: geriatric oncology, G-CODE, mortality prediction, geriatric assessment, prognostic score, older adults, cancer, ELCAPA cohort, frailty, external validation, Cox regression, comorbidity

The trial, known as APPAHOCA-2, is described in BMC Geriatrics by Heidi Solem-Laviec of the Centre François Baclesse in Caen and her colleagues across two French centers. It is designed as a prospective, multicenter, open-label phase II study that will enroll 60 patients aged 65 and older who are scheduled for elective major cancer surgery or operations expected to carry high morbidity. Rather than waiting until complications appear, the investigators intend to measure whether daily supervised treadmill sessions can preserve or restore what geriatricians call functional fitness, using a well-established clinical yardstick: the six-minute walk test, or 6MWT. The distance a patient can cover in six minutes reflects the integrated performance of the heart, lungs, muscles, and nervous system, which is precisely why it has become a favored endpoint in studies of surgical recovery.

The logic of the design rests on a careful baseline. Before any operation takes place, each enrolled patient completes a comprehensive geriatric assessment during the month preceding surgery, and that visit includes a 6MWT measurement that captures the patient’s preoperative walking capacity. This pre-surgical value then becomes the reference point against which recovery is judged. The main endpoint of the trial is the proportion of patients who, at the time of discharge from the surgical ward, have regained their preoperative functional fitness as measured by the same test. In other words, the study does not ask whether patients simply improved over their hospital stay, but whether the intervention allowed them to climb back to their own personal starting line before going home.

The intervention itself is deliberately pragmatic. Unless a medical contraindication exists, patients in the trial will be offered one to two walking sessions per day on a treadmill, beginning the day after their operation. Each session is supervised by an Adapted Physical Activity Specialist, a professional trained to calibrate exercise intensity to fragile, recently operated patients, and the target duration ranges from six to thirty minutes. That flexibility matters. Early after abdominal, thoracic, or head and neck cancer surgery, a patient may manage only a few cautious minutes, while later in the admission the same person may tolerate a half hour of steady walking. The protocol’s designers have built that natural trajectory into the intervention rather than imposing a rigid dose that many frail patients could not achieve.

The scientific rationale comes in part from an earlier pilot study conducted by the same group, which showed that supervised treadmill walking in older cancer inpatients was feasible and could improve gait speed, with one important caveat: the benefit appeared in patients who were not malnourished. That finding highlights a biological reality that geriatric oncologists know well. Muscle recovery after surgery depends on an adequate supply of protein and energy, and in a patient whose nutrition is compromised, exercise can become a drain rather than a stimulus. The APPAHOCA-2 protocol therefore treats nutritional status as a critical variable, assessing it alongside sarcopenia, the age-related loss of skeletal muscle mass and strength that both cancer and major surgery can accelerate.

What makes the trial unusually comprehensive is the breadth of data it will collect. Assessments are scheduled at three points: before surgery, at hospital discharge, and at routine surgical follow-up visits 30 and 90 days after the operation. At each of these time points, the researchers will record levels of anxiety and depression, concerns about falling, cognitive function, nutritional and sarcopenia status, sleep complaints and changes in sleep-wake patterns, daytime activity, physical performance measures, and results from blood examinations. This multidimensional approach reflects a growing recognition in geriatric medicine that physical recovery cannot be separated from mental health, cognition, sleep, and metabolic state. A patient who walks farther but falls asleep poorly or becomes anxious about falling may not actually function better at home.

The hospital environment itself is a central character in this story. Clinical guidelines on postoperative rehabilitation have long advocated early mobilization, yet hospital wards are rarely designed to make walking safe and appealing for frail older adults. Corridors are busy, floors may be slippery, IV poles and monitoring equipment tether patients to their rooms, and nursing workloads leave little time for escorted walks. A walking treadmill, paradoxically, can offer a more controlled and secure environment than the ward corridor itself: handrails provide support, speed is adjustable and precisely known, and a specialist stands by to intervene. The APPAHOCA-2 investigators are essentially testing whether a piece of equipment more often associated with gyms can be safely redeployed to the surgical ward in the service of older cancer patients.

The study has cleared the standard regulatory hurdles that govern clinical research in France. It received ethical approval from the Comité de Protection des Personnes Ile de France I in December 2023, and the French Health Regulatory Authority, the ANSM, validated the investigation’s compliance with the European Union Medical Device Regulation. The trial is registered on ClinicalTrials.gov under identifier NCT06201884, with registration dated 2 January 2024, and the protocol has reached version 4.1 as of December 2025. Funding comes from the French Ministry of Health through the interregional hospital clinical research program, and the protocol itself was peer-reviewed by the funding body before the trial was granted support. The funding agency, the authors note, played no role in the design, conduct, or analysis of the study. All participants will receive an information file from their surgeons or anesthesiologists and must provide written informed consent before any study-related assessment begins.

The trial’s phase II designation signals its purpose: this is an effectiveness and feasibility study intended to establish whether the intervention works well enough to justify a larger definitive trial. Beyond the primary endpoint, the investigators plan to explore how the level of effectiveness relates to the number and duration of walking sessions patients actually complete during their recovery, a dose-response question that could shape how such programs are prescribed in the future. If patients who accumulate more minutes on the treadmill recover their walking capacity more reliably, that would support structured, supervised early mobilization as a standard component of postoperative care for older adults. If the relationship is weak or absent, the field will need to look elsewhere, perhaps toward nutritional optimization or other rehabilitation strategies.

For now, the value of APPAHOCA-2 lies in its clarity of purpose. It takes a problem that is easy to overlook, the quiet physical decline of older surgical patients during hospital stays, and subjects a simple remedy to rigorous measurement. The six-minute walk test, the geriatric assessments, the 90-day follow-up, and the careful tracking of sleep, mood, cognition, and nutrition together form a portrait of recovery that is far richer than length of stay alone could provide. As populations age and cancer surgery is performed increasingly on patients in their seventies and eighties, the question the French team is asking will only grow more urgent: can the hospital stay itself become part of the cure rather than an obstacle to it? The answer, the researchers hope, may begin with a few supervised steps on a treadmill the day after surgery.

Subject of Research: Early supervised treadmill walking to restore physical fitness in older inpatients recovering from cancer surgery

Article Title: Effectiveness of early supervised walking sessions on a walking treadmill in older inpatients after cancer surgery: study protocol for the APPAHOCA-2 trial

Article References: Solem-Laviec, H., Beauplet, B., Leconte, A., Coquerel, A., Demeude, F., Thuard, O., Ruet, A., Bastit, V., Babin, E., Varatharajah, S., Guilloit, J.-M., Fauvet, R., Waeckel, T., Perrier, J., Lequesne, J., & Clarisse, B. (2026). Effectiveness of early supervised walking sessions on a walking treadmill in older inpatients after cancer surgery: study protocol for the APPAHOCA-2 trial. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08422-6

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08422-6

Keywords: geriatric oncology, cancer surgery, treadmill walking, early mobilization, six-minute walk test, rehabilitation, sarcopenia, gait speed, older inpatients, clinical trial, physical deconditioning, APPAHOCA-2

The research drew on the Geriatric Assessment for Patients (GAP70+) study, a multicentre, cluster-randomized clinical trial conducted across 39 community oncology clinics affiliated with the University of Rochester Cancer Center NCI Community Oncology Research Program Research Base. Participants were aged 70 or older, had incurable stage III or IV solid tumours or lymphoma, and were scheduled to begin a new systemic treatment regimen known to carry a high risk of toxicity. From the trial’s usual care arm, the investigators collected abdominal and pelvic CT or PET/CT scans performed as part of routine care, applying strict time windows around enrollment and rigorous quality control. That process yielded 161 patients whose imaging and clinical data could be fully analysed, with a mean age of 76.6 years, nearly 61 percent male, and most carrying gastrointestinal or lung cancers.

What sets this analysis apart from the bulk of prior sarcopenia research in oncology is its adherence to a full clinical definition of the condition rather than a single imaging measurement. The European Working Group on Sarcopenia in Older People, known as EWGSOP2, defines sarcopenia using three criteria: reduced muscle strength, reduced muscle quantity and quality, and reduced physical performance. In this study, strength was assessed with a five-time chair-stand test, where a time exceeding 16.7 seconds signalled weakness. Muscle quantity was quantified from the mid-L3 lumbar vertebra slice of each CT scan using validated automatic segmentation software, producing a skeletal muscle index with sex- and BMI-specific thresholds. Muscle quality was captured through Hounsfield Unit measures of tissue density on the same scans, and physical performance was evaluated with the timed up-and-go test. Meeting the strength and quantity or quality criteria classified a patient as sarcopenic; meeting all three criteria indicated severe sarcopenia.

The prevalence figures were sobering. More than two-thirds of participants, 68.3 percent, had low muscle quantity by imaging criteria, and 56.5 percent met the full clinical definition of sarcopenia. Among those, 59 percent were classified as having severe sarcopenia. Patients with sarcopenia were on average about two years older than those without it and were significantly more likely to have diabetes. More tellingly, sarcopenia tracked closely with broader geriatric vulnerability: those with the severe form were significantly more likely to show impaired nutrition, dependence in activities of daily living and instrumental activities, recent falls and impaired cognition compared with patients whose muscles were preserved. In other words, the clinical sarcopenia label captured a constellation of ageing-related frailty that a simple muscle measurement did not.

When the researchers turned to treatment outcomes, documented through clinician-reported adverse events graded with the Common Terminology Criteria for Adverse Events, version 4.0, a nuanced picture emerged. Overall severe toxicity, defined as Grades 3 through 5, during the first three months of therapy did not differ significantly between patients with and without sarcopenia. But severe nonhematologic toxicities—a category that includes complications such as dehydration, electrolyte disturbances, infections, fatigue and pain, which frequently lead to hospitalization—were substantially more common in the sarcopenic group, affecting 64 percent versus 44 percent. In multivariable logistic regression adjusting for age, tumour site, sex, comorbidities and treatment type, sarcopenia more than doubled the odds of severe nonhematologic toxicity, with an odds ratio of 2.24. Notably, patients who suffered these severe nonhematologic events also had significantly slower chair-stand times, and each additional second on that strength test raised the odds of toxicity by roughly 15 percent.

The mortality findings were even more striking. At one year, only 46 percent of participants with sarcopenia were alive, compared with 60 percent of those without it. After statistical adjustment this difference fell just short of significance in the full cohort, but when the analysis focused on patients starting first-line chemotherapy, sarcopenia was clearly associated with poorer survival, with a hazard ratio of 2.12. For severe sarcopenia the signal was unmistakable: one-year survival was just 40 percent versus 60 percent among patients without sarcopenia, a difference that remained significant after adjustment with a hazard ratio of 2.08. The mortality gap opened early—within three months, nearly 21 percent of patients with severe sarcopenia had died, versus 7 percent of those without the condition. Crucially, when the investigators evaluated skeletal muscle index alone, stripped of the strength and performance components, no significant association with survival appeared at all.

That last result may be the study’s most important technical message. Much of the oncology literature has equated sarcopenia with low muscle quantity on imaging, treating the skeletal muscle index as a standalone prognostic marker. This analysis suggests that in older adults that approach is insufficient, because muscle mass declines physiologically with age and is not a linear proxy for what muscles can actually do. The consensus definitions that incorporate grip-equivalent strength measures and performance tests appear to identify a genuinely distinct population of patients whose functional reserve is depleted and who are therefore less able to withstand the catabolic assault of cytotoxic therapy. The authors note this contrasts with patterns seen in younger patients, in whom imaging-based muscle measures have shown stronger associations with outcomes.

The comparison with the limited prior work reinforces the point. Only one earlier study, in men with metastatic castrate-resistant prostate cancer, had evaluated treatment toxicity in older adults using a definition of sarcopenia encompassing strength, quantity and performance; it reported a prevalence of 27 percent, lower than the 57 percent seen here, likely reflecting stricter criteria that resemble the severe sarcopenia category. That study likewise linked sarcopenia to poorer survival and heightened toxicity risk. Two recent studies in gastrointestinal cancer patients that relied on muscle index alone produced inconsistent survival associations, underscoring the value of the multi-domain approach. The new analysis also benefits from real-world breadth: patients were treated in community clinics nationwide rather than tertiary referral centres, and toxicity data met the annotation standards of a randomized trial.

The limitations are worth noting. The cohort was predominantly non-Hispanic white, limiting generalizability to other populations. Scans were not mandated by the protocol, and the strict time windows that ensured data quality reduced the analysable sample. As an exploratory secondary analysis, p-values were not corrected for multiple testing, so the findings are hypothesis-generating and require confirmation in prospective cohorts. Treatment regimens and dosing were left to each patient’s oncologist rather than standardized. Even so, the clinical implications are hard to dismiss. Patients with severe sarcopenia received some of the most intensive treatments in the cohort yet had the worst survival, raising the possibility of overtreatment and suggesting that comprehensive geriatric evaluation should precede decisions about aggressive therapy.

The authors argue that sarcopenia screening should become routine in geriatric oncology, and they point to a practical path. Although CT scans are already available for nearly every cancer patient and software tools exist to quantify muscle from them, the expertise to interpret such measurements is not yet part of routine practice. The geriatric assessment, by contrast, is already recommended by ASCO guidelines and captures exactly the measures—chair-stand strength, timed up-and-go performance, falls, daily functioning—that this study linked to toxicity and death. Integrating those simple tests into treatment planning, and designing intervention trials that incorporate sarcopenia status into treatment selection and dosing, could spare the most vulnerable older adults the cruelest harms of therapy while preserving its benefits for those robust enough to tolerate it.

Subject of Research: Sarcopenia and treatment toxicity and mortality in older adults with advanced cancer

Article Title: Sarcopenia Is Associated With Severe Treatment Toxicity and Mortality in Older Adults With Advanced Cancer: A Secondary Analysis

Article References: Mattick, L. J., Mohammed, M., Li, C.-S., Tylock, R. G., Loh, K. P., Flannery, M. A., Peppone, L. J., Lin, P.-J., Goncalves, M. D., Caan, B. J., Cespedes Feliciano, E. M., Popuri, K., Beg, M. F., Bearden, J. D., Berenberg, J., Katato, K., Mustian, K. M., Mohile, S. G., & Dunne, R. F. (2026). Sarcopenia Is Associated With Severe Treatment Toxicity and Mortality in Older Adults With Advanced Cancer: A Secondary Analysis. Journal of Cachexia, Sarcopenia and Muscle, 17(5), Article e70388. https://doi.org/10.1002/jcsm.70388

Image Credits: AI Generated

DOI: 10.1002/jcsm.70388

Keywords: sarcopenia, geriatric oncology, advanced cancer, chemotherapy toxicity, muscle strength, mortality, CT body composition, EWGSOP2, geriatric assessment, cancer cachexia, older adults, clinical trial

The research, published in Cancer Causes & Control by Hülya Bulut of the Health Sciences University Izmir Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital and Kader Mert of Bakırçay University, was conducted as a cross-sectional investigation between March 1 and May 31, 2025. The team recruited 410 older adults diagnosed with lung cancer who were hospitalized at a training and research hospital in İzmir, interviewing each participant face to face. The cohort had a mean age of 70.79 years, with a standard deviation of 4.26 years, and 76.3 percent of the participants were male—a distribution that mirrors the well-documented male predominance in lung cancer epidemiology, driven historically by patterns of tobacco exposure.

What makes the study technically interesting is the trio of validated instruments the researchers deployed. Functional status was measured with the Katz Activities of Daily Living Scale, a classic 1963 instrument that scores a patient’s independence in fundamental self-care tasks such as bathing, dressing, toileting, transferring, continence, and feeding. Frailty was assessed with the Edmonton Frail Scale, a multidimensional screen covering cognition, general health status, functional independence, social support, medication use, nutrition, mood, continence, and physical performance. Care dependency—the outcome of primary interest—was quantified with the Care Dependency Scale developed by Dijkstra and colleagues, which evaluates how much support a patient requires across domains ranging from eating and drinking to mobility, hygiene, communication, and daily activities.

The statistical architecture of the analysis was deliberately conservative. Rather than examining simple correlations, the researchers used multiple regression modeling to determine whether activities of daily living and frailty each contributed independently to care dependency, controlling for the other. The results were striking in both their strength and their symmetry. Higher scores on the Katz scale—indicating greater functional independence—were independently associated with higher scores on the Care Dependency Scale, which reflects lower dependency, with an unstandardized coefficient of 2.344, a standardized beta of 0.309, and a p-value below 0.001. Conversely, higher scores on the Edmonton Frail Scale—indicating greater frailty—were independently associated with lower care dependency scores, meaning greater dependency, with an unstandardized coefficient of −2.391, a standardized beta of −0.652, and again a p-value below 0.001.

The most eye-catching number in the entire analysis is the proportion of variance explained. The regression model accounted for 81.5 percent of the variability in care dependency, with an adjusted R-squared of 0.815 and a p-value below 0.001. In clinical research, where models explaining 20 or 30 percent of an outcome’s variance are often considered respectable, a figure above 80 percent is remarkable. It suggests that for hospitalized older adults with lung cancer, the physics of daily dependence is largely governed by just two forces: how much physical function the patient retains and how deeply frailty has eroded their physiological reserves. Notably, the standardized beta for frailty was roughly twice as large as that for functional status, hinting that the multidimensional syndrome of frailty—including its cognitive, nutritional, and psychological dimensions—may be an even more powerful driver of care needs than the mechanics of self-care alone.

These findings land in a clinical landscape that is changing rapidly. Global cancer statistics from the GLOBOCAN 2022 estimates, cited in the paper’s bibliography, document lung cancer as one of the leading causes of cancer incidence and mortality worldwide across 185 countries. Survival trends tracked by the CONCORD-3 surveillance program, which analyzed records for more than 37 million patients diagnosed with 18 cancers across 71 countries, show gradual improvements that translate into a growing population of older adults living with and beyond lung cancer. As that population expands, the burden of care—delivered by nurses, family caregivers, and formal support systems—becomes a central concern of oncogeriatric medicine rather than an afterthought.

The concept of frailty itself has matured considerably since Clegg and colleagues framed it in The Lancet as a state of heightened vulnerability resulting from cumulative decline across multiple physiological systems. Subsequent work by Hoogendijk and colleagues has emphasized that frailty is not merely a synonym for old age or comorbidity; it is a measurable, potentially modifiable syndrome with real prognostic consequences. Prior research has already demonstrated bidirectional relationships between activities of daily living and frailty in general aging populations, including a large Chinese nationwide cohort study published in Frontiers in Public Health showing that functional decline and frailty reinforce one another over both short- and long-term follow-up. The new lung cancer study extends this framework into a specific oncology context, where tumor burden, treatment toxicity, and cancer-related symptoms such as fatigue can accelerate the frailty spiral.

For nursing science, the study carries particular weight. Care dependency is fundamentally a nursing outcome—it determines staffing intensity, discharge planning, rehabilitation referrals, and the strain placed on family caregivers. Earlier work by the same research group has explored related territory, including the relationship between mental health continuum and care dependency in individuals with chronic obstructive pulmonary disease, and the levels of caregiving burden experienced by family caregivers of lung cancer patients. The current findings give those threads a unified quantitative backbone: if a clinician can measure a patient’s Katz score and Edmonton Frail score at admission, the model suggests those two numbers alone will predict the bulk of the care dependency picture, allowing resources to be targeted before a crisis of dependence unfolds on the ward.

The authors are careful about the study’s design limitations, which are inherent to cross-sectional research. Because all data were collected at a single point in time from a single hospital, the analysis can establish association but not causation—it cannot determine whether frailty causes care dependency, whether emerging dependency accelerates frailty, or whether both are driven by a third factor such as advanced disease stage. The hospitalized setting also means the findings may not generalize to outpatients, community-dwelling patients, or those in palliative care at home. Nevertheless, the magnitude and consistency of the associations, together with the use of internationally validated and Turkish-adapted instruments, lend the results substantial credibility.

The practical implication the authors draw is straightforward and potentially transformative: routine frailty screening and functional assessment should be integrated into oncogeriatric care from the moment of diagnosis. In an era when comprehensive geriatric assessment is often skipped due to time constraints, the study suggests that two brief, inexpensive instruments could identify high-risk patients early enough for targeted interventions—nutritional support, structured exercise, cognitive engagement, medication review, and anticipatory discharge planning—to preserve independence rather than react to its loss. For a disease that will touch millions of older adults in the coming decades, that shift from reactive to proactive care could redefine what growing old with lung cancer looks like, turning a trajectory of escalating dependence into one of preserved autonomy for as long as possible.

Subject of Research: Associations between activities of daily living, frailty, and care dependency in older adults with lung cancer

Article Title: The relationship between activities of daily living, frailty, and care dependency in older adults with lung cancer

Article References: Bulut, H., & Mert, K. (2026). The relationship between activities of daily living, frailty, and care dependency in older adults with lung cancer. Cancer Causes & Control, 37(10), Article 172. https://doi.org/10.1007/s10552-026-02259-5

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02259-5

Keywords: lung cancer, older adults, frailty, activities of daily living, care dependency, geriatric oncology, Katz ADL Scale, Edmonton Frail Scale, nursing, functional status, cross-sectional study, oncogeriatric care

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

The study population reflected the realities of cancer presentation in India, and those realities are sobering. The mean age of patients was 70.7 years, with a standard deviation of 5.2 years, and 73 patients, or 21.9 percent, were 75 or older. Men dominated the cohort at 68.8 percent, yielding a male-to-female ratio of 2.2 to 1. Tumors were distributed across the anatomical spectrum of the digestive system: 151 patients, or 45.3 percent, had tumors of the upper gastrointestinal tract, including the esophagus and stomach; 117 patients, or 35.1 percent, had lower gastrointestinal tumors such as colorectal cancers; and 65 patients, or 19.5 percent, had tumors of the hepato-pancreato-biliary system, encompassing the liver, pancreas, and biliary tree. These are among the most lethal and symptomatically silent cancers known to medicine.

What emerges most forcefully from the data is how late these patients arrived at the clinic. At presentation, 242 patients, or 72.7 percent, already had stage III or stage IV disease, meaning their tumors had either spread extensively to regional lymph nodes or metastasized to distant organs. Even more consequential for treatment planning, 206 patients, or 61.9 percent, had a performance status of 3 or higher on the Eastern Cooperative Oncology Group scale, a widely used metric in which scores range from 0, indicating fully functional patients with no restriction of activity, to 5, indicating death. A score of 3 means the patient is capable of only limited self-care and is confined to bed or a chair for more than half of waking hours. A score of 4 means the patient is completely disabled and entirely dependent on others. In practical terms, nearly two-thirds of these patients were too physically depleted to tolerate the rigors of surgery, chemotherapy, or radiation at the moment they first sought care.

Against this backdrop, curative intent was assigned to 169 patients, or 50.8 percent of the cohort, meaning just over half were deemed candidates for treatment aimed at eradicating the disease. The crude, unadjusted statistics initially suggested that age played a role: the curative-intent rate fell from 53.8 percent among patients aged 65 to 74 to 39.7 percent among those aged 75 and older, an odds ratio of 0.56 with a 95 percent confidence interval of 0.33 to 0.96 and a p-value of 0.034. On its face, this looks like evidence of ageism in treatment allocation, or at least of a biological threshold beyond which curative efforts become less likely. But the raw numbers tell only part of the story, and the researchers knew it.

The far more dramatic gradients appeared along clinical rather than chronological lines. Curative intent was assigned to 78.9 percent of patients with a performance status of 0 or 1, the fittest individuals in the cohort, but to a mere 1.1 percent of patients with a performance status of 4. Similarly, curative intent was recorded in 92.3 percent of patients diagnosed at stage I, when the tumor is still localized, but in only 18.9 percent of those diagnosed at stage IV, when distant metastases have taken hold. These gradients are steep, nearly vertical, and they dwarf the modest decline associated with crossing the 75-year threshold. The pattern strongly suggested that older patients were less likely to receive curative treatment not because of their birthdates but because they arrived at the hospital with more advanced disease and more depleted bodies.

To disentangle these intertwined variables, the team employed multivariable binary logistic regression, a statistical technique that estimates the independent effect of each predictor while holding the others constant. The result was decisive. After adjustment for stage and performance status, age of 75 years or older was no longer statistically significant, with an adjusted odds ratio of 0.54, a 95 percent confidence interval of 0.28 to 1.02, and a p-value of 0.059 that straddles the conventional threshold of 0.05. In contrast, stage IV disease carried an adjusted odds ratio of 0.09, and an ECOG performance status of 3 or 4 carried an adjusted odds ratio of 0.16, both with confidence intervals far from unity and p-values below 0.001. In plain language, a patient with metastatic disease was roughly eleven times less likely to receive curative treatment than a comparable patient with earlier-stage disease, and a severely debilitated patient was roughly six times less likely than a fit one, regardless of age.

The statistical robustness of the model lends considerable weight to these conclusions. The area under the receiver operating characteristic curve, a standard measure of a model’s ability to discriminate between outcomes, reached 0.85, which is generally considered excellent, and the McFadden pseudo-R-squared of 0.31 indicates a strong fit for a logistic model of this kind. In other words, knowing a patient’s cancer stage and functional status allows clinicians to predict the treatment decision with a high degree of accuracy, while knowing the patient’s age adds essentially nothing once those two variables are accounted for. The crude age effect observed in the unadjusted analysis was, as the authors put it, a reflection of confounding by stage and performance status: older patients fared worse not because they were old but because their disease was caught later and had taken a greater toll on their bodies.

Perhaps the most alarming finding in the study concerns the gap between recommendation and delivery. Only 117 of the 333 patients, or 35.1 percent, actually received and completed cancer-directed treatment. Even more striking, 129 patients, or 38.7 percent, were advised to undergo treatment but did not accept it. This rate of treatment non-acceptance is a phenomenon with deep roots in the socioeconomic and cultural landscape of Indian healthcare, encompassing financial constraints, distance from treatment centers, fear of surgery and its complications, family decision-making dynamics, and, in some cases, a fatalistic acceptance of the diagnosis. Whatever its causes, the sheer scale of the problem means that nearly four in ten older patients who were offered a chance at cancer-directed therapy walked away from it, a figure that dwarfs any effect attributable to age itself.

The implications of this study ripple outward in several directions. For clinicians, the message is to evaluate older cancer patients on their individual merits, using validated measures of functional status and comorbidity rather than relying on chronological age as a proxy for frailty or tolerance. A vigorous 82-year-old with stage II colon cancer and an ECOG score of 1 may be an excellent surgical candidate, while a depleted 67-year-old with stage IV disease and an ECOG score of 4 may not. For health policymakers, the data point unambiguously toward the need for earlier diagnosis. When 72.7 percent of patients present with stage III or IV disease and 61.9 percent arrive with severely compromised functional status, the battle is largely lost before treatment planning even begins. Screening programs, public awareness campaigns, and improved access to primary care and diagnostic endoscopy could shift the entire distribution of presentations toward earlier, more treatable stages.

For patients and families, the study offers a measure of reassurance grounded in evidence rather than sentiment. Age alone should not be read as a verdict. The researchers argue that their findings argue for earlier diagnosis rather than age-based treatment limitations, and the numbers bear that out: the crude age effect dissolved under statistical adjustment, while stage and performance status remained the true arbiters of curative possibility. As populations in India and across the world age, and as gastrointestinal cancers continue to claim a rising share of the cancer burden among older adults, the challenge for oncology is not to ration care by birth year but to detect disease sooner, to support patients’ functional health, and to dismantle the barriers, financial, geographic, and cultural, that keep nearly four in ten patients from accepting the treatment they are offered. The study, published open access in the Journal of Cancer Research and Clinical Oncology, was approved by an institutional ethics committee with a waiver of individual informed consent for the analysis of de-identified data, and the authors declare no conflicts of interest.

Subject of Research: Determinants of curative versus palliative treatment intent in older adults with gastrointestinal cancer

Article Title: Performance status over chronology: determinants of curative versus palliative treatment intent in older adults with gastrointestinal cancer

Article References: Simon, P., Krishna, A., Banerjee, S., Athiyamaan, M. S., Sunny, J., Srinivas, C., Lobo, D., Suvarna, M., Baruah, P., & Abinesh, E. (2026). Performance status over chronology: determinants of curative versus palliative treatment intent in older adults with gastrointestinal cancer. Journal of Cancer Research and Clinical Oncology. https://doi.org/10.1007/s00432-026-06625-3

Image Credits: AI Generated

DOI: 10.1007/s00432-026-06625-3

Keywords: gastrointestinal cancer, older adults, performance status, ECOG, cancer staging, palliative care, curative intent, geriatric oncology, logistic regression, India, treatment non-acceptance, early diagnosis

Patient navigation, a concept that originated in the United States in the 1990s, aims to reduce barriers to care by guiding patients through screening, diagnosis, treatment, rehabilitation, survivorship and end-of-life care. Navigators may be nurses, social workers or trained lay people, and their work spans education, barrier assessment, care coordination, psychosocial support and referrals. Yet while navigation has become a fixture of American cancer care, the European evidence base remains fragmented, inconsistently evaluated and rarely tailored to the ageing patient.

The review, conducted as part of the EU-funded EU-NAVIGATE project (2022–2027), followed PRISMA-ScR guidelines and searched PubMed, CINAHL and Web of Science for studies published between 1993 and 2025, supplemented by grey literature and manual reference screening. Of 4,249 records identified, 215 studies met the inclusion criteria. Only 28 of these reported patient navigation interventions conducted in Europe, spanning 11 countries, with Denmark contributing the most studies (six), followed by France (five) and the United Kingdom (four). The United States accounted for 153 studies, reflecting its far longer tradition of navigation research and implementation.

The numbers for older adults are stark. Across the 28 European studies, only one exclusively targeted adults aged 65 and over, and just one focused on adults aged 75 and over — the latter being the EU-NAVIGATE project itself, which is testing a navigation intervention for older people with cancer and their family caregivers across six European countries. Six further studies targeted pre-elderly populations aged 50 and above, while the remaining 20 involved general adult populations that included older participants. Only eight studies worldwide specifically investigated navigation programs for adults aged 65 and over.

The content of European programs varied with the age group served. Among interventions for adults aged 50 and over, education and barrier assessment dominated, with six of the eight programs operating at the cancer screening stage, one in treatment and one in supportive, palliative and end-of-life care. In contrast, programs for broader adult populations most often operated during treatment and placed greater emphasis on education, emotional support, barrier assessment and care coordination, with additional activities including skills building, symptom management, appointment assistance and referrals.

Navigator profiles differed sharply by age group. In European studies involving adults aged 50 and over, lay navigators (50 percent) and social workers (38 percent) predominated, with nurses accounting for just 13 percent. The pattern reversed in studies of general adult populations, where nurses delivered navigation in 16 of the studies and lay navigators were almost absent. In the United States, lay navigators were also the most frequently reported group among programs for people 50 and over, whereas nurses dominated in studies from other regions. The authors suggest that lay and social-work navigators may be particularly suited to addressing the social, practical and community needs of older patients, while professional navigators contribute clinical expertise and familiarity with treatment pathways.

Training practices revealed both promise and inconsistency. Nearly all European studies targeting adults 50 and over reported navigator training, typically lasting from two hours to one week, and European studies in this age group more frequently documented training in psychosocial skills, medical knowledge and the navigation process than did studies from the United States or elsewhere. Training content ranged from communication skills, motivational interviewing and coaching to healthcare system knowledge, nutrition, exercise and disease-specific topics. By contrast, in studies of broader adult populations, training was reported in only half of cases, and competencies were usually inferred from professional qualifications rather than defined by explicit frameworks.

Perhaps the most troubling finding concerns evaluation. Fewer than half of the European studies — 12 of 28 — described any form of evaluation, and only a handful used structured methodological approaches. Where assessment occurred, it often relied on participants’ subjective satisfaction rather than objective outcomes. Systematic evaluation was reported in 38 percent of European studies involving adults 50 and over, compared with just 2 percent in the United States and none elsewhere. Only two European studies assessed cost-effectiveness, and standardized outcome measures, such as quality-of-life instruments and the Work Ability Score, appeared only rarely.

The authors argue that the scarcity of age-tailored navigation may amount to a form of elder neglect in cancer care research, echoing broader concerns about ageism and the underrepresentation of older adults in clinical studies. Older people account for the majority of cancer diagnoses, yet recent ASCO guidelines recommending routine geriatric assessment for patients aged 65 and over have rarely been reflected in the design of navigation programs. Navigation during palliative and end-of-life care — where coordination needs are most acute — was almost entirely absent from the literature, with only one identified program specifically serving adults aged 70 and over.

The review concludes that patient navigation holds genuine promise across the cancer care continuum but must be adapted to the complex, individual needs of older patients, including frailty, cognitive and functional impairment and caregiver burden. The authors call for age-sensitive navigation models with clearly defined competencies, standardized evaluation using outcomes such as quality of life, functioning and independence, and well-structured training for lay navigators as a promising route to expanding navigation within European cancer care systems. Until such models are built and rigorously tested, they warn, Europe’s fastest-growing group of cancer patients will continue to navigate a fragmented system largely on their own.

Subject of Research: Patient navigation interventions for older adults with cancer in Europe

Article Title: Scoping review on navigation interventions for older adults with cancer in Europe and beyond

Article References: Stodolska, A., Wójcik, G., Reigada, C., Ashford, K., Miranda, R., Van den Block, L., Malmur, E., Drapała, N., & Szczerbińska, K. (2026). Scoping review on navigation interventions for older adults with cancer in Europe and beyond. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01609-5

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01609-5

Keywords: patient navigation, older adults, cancer care, geriatric oncology, care coordination, navigator training, psychosocial support, scoping review, Europe, frailty, Scoping, review

A team at Guy’s and St Thomas’ NHS Foundation Trust in London set out to close this gap with a structured, age-adapted initiative known as the GOLD diabetes enhanced monitoring pathway, developed within the Geriatric Oncology Liaison Development clinic. Reporting their work in the European Geriatric Medicine journal, the researchers describe a quality improvement project conducted between February 2022 and June 2025, in which a multidisciplinary group of geriatricians, oncologists, diabetologists and clinical nurse specialists translated national guidance from the UK Chemotherapy Board and the Joint British Diabetes Societies for Inpatient Care into a practical, locally tailored system for older patients at intermediate risk of steroid-induced hyperglycaemia.

The pathway began with careful risk stratification. Patients were classified as low risk if they had an HbA1c below 48 mmol/mol and no history of diabetes, and were followed by their oncology team and general practitioner. High-risk patients, including those on insulin, those with HbA1c of 64 mmol/mol or above, glucose readings of 15 mmol/L or higher, pancreatic cancer, or a previous episode of steroid-induced hyperglycaemia, were referred directly to specialist diabetes services. The intermediate group, typically those with HbA1c between 48 and 63 mmol/mol or capillary glucose between 11 and 14.9 mmol/L, or patients with diabetes managed on oral agents who did not meet high-risk criteria, became the focus of the GOLD pathway.

Once enrolled, each patient received a capillary blood glucose meter and personalised education from a geriatric clinical nurse specialist, delivered face to face or by telephone within days of referral, because the interval between referral and the start of systemic anti-cancer therapy is often extremely short. Education covered the symptoms of high and low blood sugar, how to recognise diabetes emergencies, glucose targets, and practical demonstrations of the meter, all calibrated to each patient’s health literacy, cognition and physical abilities, with caregivers involved where necessary. During every treatment cycle, patients checked their glucose on the day of steroid administration and the following two days, before breakfast and before the evening meal, a schedule designed to capture the late-afternoon and evening peaks characteristic of steroid-induced hyperglycaemia.

Telephone follow-up by nurse specialists after each cycle formed the backbone of the monitoring system. The team reviewed all glucose readings, assessed food intake and treatment side effects, and applied decision-making algorithms for intervention. Hyperglycaemia was defined as at least two readings above 15 mmol/L, and hypoglycaemia as any reading below 4 mmol/L. When medication was required, the protocol favoured gliclazide, a sulphonylurea that directly stimulates insulin secretion and thereby counteracts the steroid-driven suppression of pancreatic beta-cell function. The team deliberately adopted a higher intervention threshold of 15 mmol/L, compared with the 12 mmol/L in national guidance, reflecting broader glycaemic targets for older people and a conscious effort to avoid hypoglycaemia and its consequences, particularly in patients with poor oral intake or renal impairment.

The implementation itself was iterative. The pathway was refined through seven Plan-Do-Study-Act cycles between 2022 and 2023, each incorporating feedback from healthcare professionals and addressing specific local barriers such as the feasibility of glucose measurement, intervention thresholds and the medication titration process. Risk criteria were sharpened over successive cycles, with the glucose range adjusted from 12–20 to 11–15 mmol/L and the HbA1c range expanded from 48–59 to 48–64 mmol/mol. Fortnightly multidisciplinary meetings were introduced from January 2023 to review complex cases, and the geriatric nursing team grew increasingly autonomous in managing intermediate-risk patients, reducing the burden on specialist diabetes services while retaining rapid access to expert advice.

In total, 126 patients were enrolled, with a median age of 74 years, 58% male, and 77% living with pre-existing diabetes. The most common tumour sites were the oesophagus, colon and breast, and 94% received chemotherapy as their primary systemic anti-cancer therapy, most commonly supported by dexamethasone at a median daily dose of 8 mg for the first four days of each cycle, chiefly for its anti-emetic and anti-allergic properties. Comprehensive geriatric assessment data, available for 81% of participants, revealed a largely pre-frail population with a median Clinical Frailty Scale score of 3, and identified malnutrition in 46% of the cohort, alongside social isolation, functional impairment and recent falls in smaller proportions. Personalised geriatric interventions, spanning physiotherapy, occupational therapy, dietary support and medication management, were implemented for the vast majority of those with identified impairments.

The results paint a picture of a pathway that is both feasible and safe. Clinical advice on diabetes management was provided to 89% of patients, and diabetes medication intervention was required in 32%, with gliclazide initiated or escalated in 92% of those cases. Women and patients with pre-existing diabetes were significantly more likely to need medication. Critically, only three hypoglycaemic events occurred, all asymptomatic and all managed without clinical consequences. Among 35 unplanned hospital admissions within a year, only two were related to hyperglycaemia, and there were no episodes of diabetic ketoacidosis or hyperosmolar hyperglycaemic syndrome, and no admissions for hypoglycaemia. During a median follow-up of 300 days, 41 patients died, but mortality was associated with metastatic disease, malnutrition and social isolation rather than with glycaemic control or diabetes intervention, suggesting that proactive metabolic monitoring did not add risk in this fragile population.

The pathway also influenced cancer treatment itself in measurable ways. Steroid regimens were modified for 24% of patients, almost always involving dose reductions driven by hyperglycaemia, and in 80% of those cases the adjustment was linked to the need for diabetes medication. While steroid reduction triggered treatment toxicity symptoms in four patients, leading to early discontinuation or dose reduction of the anti-cancer protocol in two, the overall signal was one of balance: oncologists could taper steroids with confidence knowing that a safety net existed for the metabolic consequences. Notably, secondary referrals to the diabetes team fell dramatically over the project period, from 36% of patients enrolled in 2022 to just 5% in 2025, evidence that the geriatric team’s growing expertise was absorbing demand that would otherwise have overwhelmed specialist services.

The authors are candid about limitations. The single-centre design, the predominance of pre-frail patients, the absence of a comparator group and the use of clinical rather than validated tools for some geriatric domains all constrain generalisability, and under-ascertainment of nocturnal or asymptomatic glycaemic excursions cannot be excluded with intermittent fingerstick testing. Even so, the team argues that the GOLD pathway offers a robust, patient-centred model for integrating geriatric, oncology and diabetes care, aligned with national and international recommendations for multidisciplinary management of older adults with complex needs. Future priorities include multi-centre validation, comparative and randomised designs to confirm effectiveness, integration of continuous glucose monitoring and digital health tools to reduce nursing workload, evaluation of patient-reported outcomes and cost-effectiveness, and incorporation of patient feedback to improve usability for those who struggle with glucometer technology. If those steps succeed, structured diabetes monitoring could become a standard component of geriatric oncology, ensuring that the steroids that help fight cancer no longer silently undermine the patients receiving them.

Subject of Research: A quality improvement project evaluating an age-adapted, multidisciplinary diabetes monitoring pathway for older adults with cancer undergoing steroid-based systemic anti-cancer therapy.

Article Title: Improving diabetes management in older adults with cancer: a quality improvement project to enhance monitoring during steroid-based systemic anti-cancer therapy

Article References: Liuu, E., Evans, R., Bassas-Letissier, N., Amaratunga, G., Compton, S., Georgiou, A., Kalsi, T., Liu, Y.-F., Maguire, J., Nottage, C., Rush, H. L., & Welch, C. (2026). Improving diabetes management in older adults with cancer: a quality improvement project to enhance monitoring during steroid-based systemic anti-cancer therapy. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01585-w

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01585-w

Keywords: geriatric oncology, diabetes, steroid-induced hyperglycaemia, systemic anti-cancer therapy, quality improvement, multidisciplinary care, gliclazide, blood glucose monitoring, older adults, comprehensive geriatric assessment, hypoglycaemia, cancer treatment