Geriatric Oncology: From Research to Reality at SIOG 2025
It's time to face it: geriatric oncology has moved beyond the research lab and into the real world. The SIOG 2025 plenary session, titled “Geriatric oncology: from research to clinical practice,” showcased a significant shift. Cancer centers worldwide are actively creating structured care models for older adults, tailoring treatment plans, and revolutionizing how multidisciplinary teams collaborate.
Chaired by Lore Decoster (Brussels), Cindy Kenis (Leuven), and Hans Wildiers (Leuven), the session explored a global perspective, highlighting a crucial point: the evidence is there. Now, the challenge lies in expanding these practices and integrating them into everyday oncology care.
The Crucial First Step: Bridging Research and Clinical Practice
Lore Decoster set the stage by emphasizing that the primary goal of geriatric oncology today is not just to gather data, but to ensure it directly influences how older adults with cancer are treated. While research on geriatric assessment, predicting treatment side effects, and patient-centered decision-making is robust, the real hurdle is implementation. This involves addressing workforce needs, streamlining care pathways, fostering a supportive culture, and securing adequate funding.
The subsequent presentations offered practical examples of how different centers are tackling these challenges.
Building a Geriatric Oncology Pathway: The Royal Marsden's Approach
Susie Monginot from Toronto shared the 10-year journey of the Older Adults with Cancer Clinic at Princess Margaret Cancer Centre. With nearly half of new patients being 65 years or older, many of whom are frail, the clinic expanded from a small pilot program in 2015 to four half-day clinics. These clinics are supported by geriatricians, fellows, social workers, and dietitians.
The team provides comprehensive geriatric assessments and actively implements recommendations, from adjusting medications to referring patients to allied health services. Despite facing challenges with space, funding, and wait times, the model demonstrates clear demand and a meaningful impact on treatment planning.
Integrating Patient Goals and Nurse Input: The Integrated Oncological Decision-Making Model
Hanneke van der Wal-Huisman (Groningen, Netherlands) described the Integrated Oncological Decision-Making model, designed to incorporate patient goals and nurse insights into multidisciplinary team (MDT) discussions. Her team found that critical information, such as functional status, psychosocial factors, and what truly matters to patients, was often missing from decision-making processes, even though nurses possessed this knowledge. In the new model, nurses conduct structured assessments focused on patients' goals, priorities, and daily functioning, which is then formally included in the MDT.
This approach leads to more personalized care and enhanced communication. Patients feel heard, and clinicians believe decisions better reflect the whole person. The team stressed the importance of collaboration, leadership support, clear documentation, and a culture that encourages reflection and constructive criticism.
A Continuum-of-Care Model: A Geriatric Hospital's Perspective
Rejiv Rajendranath from Chennai presented a unique model: a geriatric cancer care program embedded within a dedicated geriatric hospital. This center combines acute geriatric beds, long-term and transitional care, home visits (with over 330,000 home visits in three years), assisted living facilities, and community clinics. Cancer care for older adults is integrated into this ecosystem, rather than being treated as a separate entity.
In a setting where most older adults are self-paying and insurance coverage is limited after age 60–65, the model emphasizes continuity and accessibility:
- Geriatricians see almost every patient.
- Comprehensive Geriatric Assessments (CGAs) and tools like the G8 and Indian-specific instruments are used selectively but systematically.
- Oncologists, geriatricians, palliative care specialists, psycho-oncologists, and rehabilitation specialists work as a unified team.
- Home care and assisted living reduce hospital stays, travel burdens, and caregiver strain.
Cultural factors, such as family-centered decision-making and reluctance to discuss prognosis directly with the patient, are addressed through multi-session counseling and sensitive communication. Treatment is often tailored through escalation/de-escalation decisions based on both biological factors and patient/family preferences.
This model, still evolving, demonstrates how geriatric oncology principles can be adapted to middle-income settings, self-pay situations, and strong family involvement, all while maintaining individualized, goal-oriented care.
Building a Senior Adult Oncology Programme
Nicolò Matteo Luca Battisti presented the Senior Adult Oncology Programme at The Royal Marsden (UK). Developed over four years, the program operates in a hospital without geriatricians. With initial cancer-alliance funding, the team established a multidisciplinary service – including nursing, rehabilitation, pharmacy, dietetics, psychology, and administrative support – and anchored it in a screening-based pathway using tools like the G8/SIOG 2 and structured goal-setting questions.
The program was deliberately aligned with hospital priorities, such as reducing unplanned admissions and improving efficiency, which helped secure long-term institutional funding. It has since expanded to cover more disease sites.
Education is a central focus, with international fellows rotating through the service, geriatric oncology concepts integrated into training, and a new research fellowship supporting ongoing development.
Scaling Up Through “Practical GA” and Smart Nudges
Ramy Sedhom (Philadelphia/Princeton) presented a highly practical approach focused on implementation: integrating “practical geriatric assessment” and multidisciplinary pathways designed to be scalable across a large healthcare system.
Recognizing that full CGAs for every older patient are often unrealistic, his team leveraged behavioral economics and electronic health record (EHR) design:
- A concise geriatric assessment is built into Epic and automatically sent to patients aged 70 and older as a pre-visit survey.
- Results are displayed in a structured flowsheet, allowing oncologists to quickly identify impairments.
- Pop-up prompts “nudge” clinicians towards appropriate referrals based on detected deficits (falls, nutrition, mood, social issues, etc.).
A geriatric nurse navigator and a weekly multidisciplinary conference (oncologists, advanced practice providers, psychosocial oncology, palliative care, and navigation) ensure high-risk cases are proactively addressed. Structured emails summarize recommendations and maintain communication with treating teams.
In two years, over 200 practical GAs have been completed, each generating multiple referrals on average. Most older adults had unrecognized functional or psychosocial vulnerabilities, and most prioritized quality of life over pure survival. Early analyses suggest better end-of-life care and, for those under enhanced navigation, longer hospice stays and smoother transitions.
Global Models: Diverse Pathways, Shared Principles
Colm Mac Eochagain (Dublin) provided a global overview of 38 geriatric oncology services worldwide, categorizing their structures into broad model types:
- Consultative clinics (one-off GA and recommendations)
- Co-management models (shared responsibility across the cancer journey)
- Screen-and-refer models (systematic screening to triage who needs GA)
- Comprehensive units (fully integrated geriatric-oncology-supportive care continuum)
- Emerging hybrid/digital models that use telehealth, patient portals, and regional networks
Despite local differences in staffing, funding, and healthcare systems, some common elements emerged: routine use of geriatric assessment (full or pragmatic), multidisciplinary decision-making, and structured methods for identifying older adults at risk.
Key Takeaway: The Path Forward
The science of geriatric oncology is now well-established. The most pressing task is implementation: creating models that fit local contexts, securing funding, integrating assessment tools into workflows, and ensuring that every older adult with cancer receives care that considers both their biology and their personal goals.
But here's where it gets controversial... Should geriatric oncology be a standard of care for all older adults with cancer, or should it be reserved for those deemed most vulnerable? What are the ethical considerations of tailoring treatment based on age and frailty?
And this is the part most people miss... The importance of patient and family involvement in decision-making. How can we ensure that the voices of older adults are heard and respected in their cancer care?
What do you think? Share your thoughts in the comments below! Do you agree that geriatric oncology is the future of cancer care for older adults? What challenges do you see in implementing these models in your own community?
