ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual , ASCO Guidelines follow the ASCO Conflict of Interest Policy for Clinical Practice Guidelines . Clinical Practice Guidelines and other guidance (“Guidance”) provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature, and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in Appendix 1 for more. PURPOSE: To guide clinicians and policymakers in global resource-constrained settings to assess the geriatric needs of patients older than 65 years with cancer when Maximal-setting guideline–recommended resources are unavailable. METHODS: A multidisciplinary, multinational Expert Panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes. RESULTS: An ASCO resource-neutral guideline was adapted for resource-constrained settings, informing one round of formal consensus; recommendations received ≥75% agreement. RECOMMENDATIONS: The Expert Panel endorses the Maximal-setting guideline's overarching recommendation that end users utilize geriatric assessment (GA), including essential domains, to identify “vulnerabilities or impairments not routinely captured in oncology assessment for all older patients over 65 years old with cancer.” All care plans for patients with cancer over 65 years old receiving systemic therapy with GA-identified deficits should include GA-guided management. A geriatric evaluation should at a minimum include the use of a brief geriatric screening tool. Tools in the Practical Geriatric Assessment (PGA) are validated in multiple languages, but users may use more appropriate tools in some settings and languages, if they include the relevant guideline-specified domains. Maximal-resource settings of high-income countries have traditionally developed cutoffs for GA-identified deficits, but locally validated research and practice may inform differing cutoffs. If validated all-cause mortality prognosis tools do not adequately represent the setting, clinicians may use actuarial life-expectancy tables with quartiles of overall health status. Additional information can be found at www.asco.org/global-guidelines . It is the view of ASCO that health care clinicians and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

Positron emission tomography in conjunction with computed tomography (PET/CT) is a relatively novel diagnostic tool which has been proven to be clinically useful in various neoplasms. Currently, only a handful of developing countries have PET/CT capabilities, and in those that do units are mostly located in large urban areas, which limits their availability. The implementation of PET/CT units in low-and-middle income countries is hampered by their high cost, the difficulties associated with their operation, and the limited availability of trained personnel. Furthermore, although the clinical appropriateness of PET/CT is well defined in many scenarios, little is known about its cost-effectiveness, particularly in settings with limited resources. Here, we provide a brief overview of the challenges associated with the implementation of PET/CT in resource-limited settings, including some examples of available data on its cost-effectiveness.

Purpose The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. Methods As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. Results All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. Conclusions Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.

PURPOSE: There is limited information regarding the use of the geriatric assessment (GA) for older adults with cancer in developing countries. We aimed to describe geriatric oncology practice among Mexican oncology professionals and to identify barriers and facilitators for the implementation of GA into the routine care of older adults with cancer in Mexico. METHODS: We conducted an explanatory sequential mixed-methods study. We administered an online survey to cancer specialists in Mexico about the routine use of GA and barriers for its use. We then conducted online semistructured interviews with survey respondents selected by their use of GA, expanding on barriers and facilitators for performing GA. Descriptive statistical analyses were performed for quantitative data; qualitative data were analyzed inductively through thematic analysis. We developed joint displays to integrate quantitative/qualitative results. RESULTS: We obtained 196 survey responses: 37 physicians (18.9%) reported routinely performing a GA. Medical oncologists ( P = .002) and physicians seeing ≤ 10 patients/day ( P = .010) were more likely to use GA. The most frequent barriers for GA use were lack of qualified personnel (49%), limited knowledge (43.9%), and insufficient time (37.2%). In the interviews (n = 22), the limited availability of geriatricians was commonly mentioned. Respondents highlighted the lack of geriatric oncology knowledge among cancer specialists and geriatricians. Saturation of oncology services and a lack of effective referral pathways for GA were also common issues. Facilitators included availability of geriatricians, system/administrative facilitators, presence of a multidisciplinary team, and availability of geriatric oncology education. CONCLUSION: The routine use of geriatric oncology principles in Mexico is limited by the availability of qualified personnel and by insufficient knowledge. An educational intervention could improve the implementation of GA in cancer care.