With the aging population, older adults constitute a growing proportion of the new cancer cases. Given the heterogeneous health status among older adults and their susceptibility to aging-related vulnerabilities, understanding their diversity and its implications becomes increasingly crucial for prognostication and guiding diagnostics, treatment decisions, and follow-up, as well as informing supportive care interventions. Geriatric assessment and management (GAM) refers to the comprehensive evaluation of an older individual's health status with subsequent management plans focusing on both oncologic and non-oncologic interventions. In 2019, the European Society for Medical Oncology (ESMO) and the International Society of Geriatric Oncology (SIOG) established the ESMO/SIOG Cancer in the Elderly Working Group. This position paper reflects the recommendations of the working group. Our paper summarizes the existing evidence with a focus on recent key trials and based on this, we propose several recommendations and future directions.

The current standard of care for the management of estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer has been redefined by the introduction of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors. Although adults aged 65 years and older account for the majority of patients with breast cancer, limited data are available about the age-specific dosing, tolerability, and benefit of CDK4/6 inhibitors in this growing population. Older adults are under-represented in clinical trials and as a result, clinicians are forced to extrapolate from findings in younger and healthier patients when making treatment decisions for older patients. In this article, we review the limited age-specific evidence on the efficacy, toxicity, and quality of life (QoL) outcomes associated with the use of CDK4/6 inhibitors in older adults. We also describe ongoing trials evaluating CDK4/6 inhibitors in the older population and highlight that only a minority of adjuvant and metastatic trials of CDK4/6 inhibitors in the general breast cancer population includes geriatric assessments. Finally, we propose potential strategies to help guide decision making for fit and unfit older patients based on disease endocrine sensitivity, the need for rapid response and geriatric assessment.

This overview aims to create an understanding of the nutritional issues concerning patients with cancer and provide evidence-based practical guidance to healthcare professionals (physicians, nurses, and dietitians), caregivers, and all others involved in the care of patients with cancer. The focus of this paper is therefore on providing a simple guide for daily clinical practice. The theoretical background and in-depth comprehensive reviews of malnutrition are described elsewhere. Nutrition plays a crucial role in cancer care. It affects treatment tolerability, outcomes, and quality of life. However, a focus on nutrition is still lacking among oncologists because of insufficient training in nutrition topics received during graduate and postgraduate training and an underestimation of its importance. The consequences of the disease and its treatment, such as anorexia-sarcopenia-cachexia, are therefore still often overlooked, underdiagnosed, and undertreated. The authors have summarized the most important challenges, evidence-based recommendations, and common clinical scenarios to bridge the gap between comprehensive guidelines and clinical practice, where brief concrete advice is preferred to systematic reviews. Furthermore, an easy applicable overview is provided, which can be used as a guide during daily routines.