Importance: Although older patients are at increased risk of developing grade 3 or higher chemotherapy-related toxic effects, no studies, to our knowledge, have focused on the association between toxic effects and quality of life (QOL) and physical functioning.Objective: To investigate the association between grade 3 or higher chemotherapy-related toxic effects and QOL and physical functioning over time in older patients.Design, Setting, and Participants: In this prospective, multicenter cohort study, patients aged 70 years or older who were scheduled to receive chemotherapy with curative or palliative intent and a geriatric assessment were included. Patients were treated with chemotherapy between December 2015 and December 2021. Quality of life and physical functioning were analyzed at baseline and after 6 months and 12 months.Exposures: Common Terminology Criteria for Adverse Events grade 3 or higher chemotherapy-related toxic effects.Main Outcomes and Measures: The main outcome was a composite end point, defined as a decline in QOL and/or physical functioning or mortality at 6 months and 12 months after chemotherapy initiation. Associations between toxic effects and the composite end point were analyzed with multivariable logistic regression models.Results: Of the 276 patients, the median age was 74 years (IQR, 72-77 years), 177 (64%) were male, 196 (71%) received chemotherapy with curative intent, and 157 (57%) had gastrointestinal cancers. Among the total patients, 145 (53%) had deficits in 2 or more of the 4 domains of the geriatric assessment and were classified as frail. Grade 3 or higher toxic effects were observed in 94 patients (65%) with frailty and 66 (50%) of those without frailty (P = .01). Decline in QOL and/or physical functioning or death was observed in 76% of patients with frailty and in 64% to 68% of those without frailty. Among patients with frailty, grade 3 or higher toxic effects were associated with the composite end point at 6 months (odds ratio [OR], 2.62; 95% CI, 1.14-6.05) but not at 12 months (OR, 1.09; 95% CI, 0.45-2.64) and were associated with mortality at 12 months (OR, 3.54; 95% CI, 1.50-8.33). Toxic effects were not associated with the composite end point in patients without frailty (6 months: OR, 0.76; 95% CI, 0.36-1.64; 12 months: OR, 1.06; 95% CI, 0.46-2.43).Conclusions and Relevance: In this prospective cohort study of 276 patients aged 70 or older who were treated with chemotherapy, patients with frailty had more grade 3 or higher toxic effects than those without frailty, and the occurrence of toxic effects was associated with a decline in QOL and/or physical functioning or mortality after 1 year. Toxic effects were not associated with poor outcomes in patients without frailty. Pretreatment frailty screening and individualized treatment adaptions could prevent a treatment-related decline of remaining health.

Immune checkpoint inhibitors (ICIs) have strongly improved the survival of melanoma patients. However, as durable response to ICIs are only seen in a minority, there is an unmet need to identify biomarkers that predict response. Therefore, we provide a systematic review that evaluates all biomarkers studied in association with outcomes of melanoma patients receiving ICIs. We searched Pubmed, COCHRANE Library, Embase, Emcare, and Web of Science for relevant articles that were published before June 2020 and studied blood, tumor, or fecal biomarkers that predicted response or survival in melanoma patients treated with ICIs. Of the 2536 identified reports, 177 were included in our review. Risk of bias was high in 40%, moderate in 50% and low in 10% of all studies. Biomarkers that correlated with response were myeloid-derived suppressor cells (MDSCs), circulating tumor cells (CTCs), CD8+ memory T-cells, T-cell receptor (TCR) diversity, tumor-infiltrating lymphocytes (TILs), gene expression profiling (GEP), and a favorable gut microbiome. This review shows that biomarkers for ICIs in melanoma patients are widely studied, but heterogeneity between studies is high, average sample sizes are low, and validation is often lacking. Future studies are needed to further investigate the predictive utility of some promising candidate biomarkers.

Implementation of national cancer policy is frequently shaped by medical guidelines. These guidelines often lack detail addressing the intricate care needs of vulnerable groups such as older adults, hindering the potential impact of these policies. To provide an overview of the representation of older adults in European cancer guidelines to identify areas for improvement. A scoping review was conducted using the Arksey and O’Malley framework and Levac et al. extension. The search strategy was developed for grey literature (i.e. guidelines) for the five most prevalent primary malignancies (prostate, breast, colorectal, lung, and urinary bladder) in 29 countries (member states of the European Union, Switzerland, and the UK). Data were extracted by a national expert and at least one other reviewer. A total of 187 guideline reports from 31 jurisdictions were analysed, encompassing general cancer care and selected primary malignancies. The representation of older adults varied by cancer type and region. Dedicated guidelines for older adults were uncommon, with only a few jurisdictions, such as France and Spain, providing age-specific recommendations for certain malignancies. Although some national guidelines addressed older patients, this focus was inconsistent both across different cancers and within the guidelines of the same country. There is limited representation of geriatric oncology across European cancer guidelines. To enhance representative guideline development, there is a call for greater consideration of older adults’ unique needs. Suggestions include further guidance on the implementation of the comprehensive geriatric assessment and consequent treatment across neoadjuvant, adjuvant, and metastatic settings.

Background: Despite the increasing integration of wearable technology in oncology, its application in the care of older adults, representing most patients with cancer, is poorly defined. Objective: This systematic review aimed to summarize the current use of wearables in studies in older adults with cancer. Methods: This systematic review was conducted following the PRISMA guidelines. A systematic search was conducted in PubMed, Embase, Emcare, Web of Science, and Cochrane Library on May 1, 2024. Studies involving wearable devices and patients aged ≥60 years diagnosed with cancer were included. Outcomes reported were study characteristics, wearable outcomes, feasibility and adherence. The mixed method appraisal tool was used to assess the quality of included studies. Results: A total of 31 publications were included, comprising 1298 older patients. Of these, 12 were pilot/feasibility studies, 12 were observational studies, 6 were randomized controlled trials, and 1 was a cross-sectional study. Most studies used wearable data to measure recovery (19 studies, 61%). Physical activity was the most studied wearable outcome (27 studies, 87%). Adherence to the wearable device was documented in 11 of the 31 studies (35%), with adherence ranging from 74% to 100%. Conclusions: Our systematic review found wearables were mostly used to measure physical activity, with the most common primary aim of measuring recovery. Most studies reported high adherence, although definitions of adherence were diverse. Our results highlight the need for more and larger studies on wearable technology in older cancer patients, the use of standardized reporting frameworks, and increased participation in research in low- and middle-income countries.

Studies investigating the long-term effects of breast cancer treatment on cognition in older women with breast cancer are lacking, even though preserving cognition is highly valued by the older population. Specifically, concerns have been raised regarding the detrimental effects of endocrine therapy (ET) on cognition. Therefore, we investigated cognitive functioning over time and predictors for cognitive decline in older women treated for early breast cancer. We prospectively enrolled Dutch women aged ≥70 years with stage I-III breast cancer in the observational CLIMB study. The Mini-Mental State Examination (MMSE) was performed before ET initiation and after 9, 15 and 27 months. Longitudinal MMSE scores were analysed and stratified for ET. Linear mixed models were used to identify possible predictors of cognitive decline. Among the 273 participants, the mean age was 76 years (standard deviation 5), and 48% received ET. The mean baseline MMSE score was 28.2 (standard deviation 1.9). Cognition did not decline to clinically meaningful differences, irrespective of ET. MMSE scores of women with pre-treatment cognitive impairments slightly improved over time (significant interaction terms) in the entire cohort and in women receiving ET. High age, low educational level and impaired mobility were independently associated with declining MMSE scores over time, although the declines were not clinically meaningful. Cognition of older women with early breast cancer did not decline in the first two years after treatment initiation, irrespective of ET. Our findings suggest that the fear of declining cognition does not justify the de-escalation of breast cancer treatment in older women.

Purpose: Palbociclib has become the standard of care for estrogen receptor-positive (ER+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer, but real-world evidence in older women remains scarce. Therefore, we investigated tolerability of palbociclib in older women with metastatic breast cancer.Methods: Consecutive women aged ≥ 70 with ER+/HER2- metastatic breast cancer, treated with palbociclib in any treatment line in six hospitals, were included. Primary endpoint was grade ≥ 3 palbociclib-related toxicity. Predictors of toxicity were identified using logistic regression models. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan Meier.Results: We included 144 women with a median age of 74 years. Grade 3–4 toxicity occurred in 54% of patients, of which neutropenia (37%) was most common. No neutropenic fever or grade 5 toxicity occurred. Dose reduction during treatment occurred in 50% of patients, 8% discontinued treatment due to toxicity and 3% were hospitalized due to toxicity. Polypharmacy (odds ratio (OR) 2.50; 95% confidence interval (CI) 1.12–5.58) and pretreatment low leukocytes (OR 4.81; 95% CI 1.27–18.21) were associated with grade 3–4 toxicity, while comorbidities were not. In first-line systemic therapy, median PFS was 12 months and median OS 32 months. In second-line, median PFS was 12 months and median OS 31 months.Conclusion: Although grade 3–4 toxicity and dose reductions occurred frequently, most were expected and managed by dose reductions, showing that palbociclib is generally well tolerated and thus represents a valuable treatment option in the older population.