Background: It is increasingly recognized that frailty should be assessed and considered in treatment decision making in patients with cancer. This review and meta-analysis synthesizes existing evidence evaluating the association between baseline frailty and systemic anticancer treatment outcomes in adults with cancer. Methods: Five databases were systematically searched from database inception to January 2023 to identify prognostic factor studies (cohort or case-control design) reporting the associations between validated frailty assessments (pretreatment) and follow-up outcomes in adults with solid-organ malignancy undergoing systemic anticancer treatment. Risk of bias was assessed via Quality of Prognosis Studies in Systematic Reviews tool. Where appropriate, associations between frailty and outcomes (survival, toxicity, treatment tolerance, functional decline/quality of life, and hospitalization) were synthesized in meta-analysis and presented as forest plots. Results: A total of 58 studies met inclusion criteria. They were undertaken in a range of tumor sites and mainly in older patients and advanced and/or palliative disease settings. Most had low or moderate risk of bias. Nine frailty assessment tools were evaluated. Four outcomes were synthesized in meta-analysis, which demonstrated the prognostic value of 2 tools: Geriatric-8 (survival, treatment tolerance, hospitalization) and Vulnerable Elders Survey-13 (survival, toxicity, treatment tolerance). Overall pooled estimates indicate that frailty conveys an increased risk of mortality (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.41 to 2.00), toxicity (odds ratio [OR] 1.83, 95% CI = 1.24 to 2.68), treatment intolerance (OR = 1.68, 95% CI = 1.32 to 2.12), and hospitalization (OR = 1.94, 95% CI = 1.32 to 2.83). Conclusion: Simple, brief frailty assessments including Geriatric-8 and Vulnerable Elders Survey-13 are prognostic for a range of important outcomes in patients undergoing systemic anticancer treatment. Risk estimates should be used to support shared decision making.

Cancer is a disease associated with ageing. Managing cancer in older adults may prove challenging owing to pre-existing frailty, comorbidity, and wider holistic needs, as well as the unclear benefits and harms of standard treatment options. With the ongoing advances in oncology and the increasing complexity of treating older adults with cancer, the geriatric oncology field must be a priority for healthcare systems in education, research, and clinical practice. However, geriatric oncology is currently not formally taught in undergraduate education or postgraduate training programmes in the United Kingdom (UK). In this commentary, we outline the landscape of geriatric oncology undergraduate education and postgraduate training for UK doctors. We highlight current challenges and opportunities and provide practical recommendations for better preparing the medical workforce to meet the needs of the growing population of older adults with cancer. This includes key outcomes to be considered for inclusion within undergraduate and postgraduate curricula.

The British Oncology Network for Undergraduate Societies (BONUS) surveyed students who attended an oncology revision day to determine their views on the current quantity, quality and type of curriculum-based oncology teaching they have experienced. Students attending two BONUS revision days received a questionnaire assessing their experience of oncology teaching within the medical curriculum and interest in pursuing a future career in oncology using a 10-point Likert scale. Data were collected with informed consent to be anonymised and used for research. Student demographics and qualitative and quantitative data about experiences of oncology education were analysed. In total, 451 students registered to attend the revision days. After removal of duplicates, non-responders and non-UK participants, responses from 153 students studying across years 1-6 at 22 UK medical schools were analysed. The mean quantity of oncology lectures students reported receiving was 8.9 hours and the mean quantity of clinic/ward-based oncology teaching was 7.5 hours. Ninety (62.1%) of the 145 students who responded to the relevant question reported that they had received dedicated teaching in oncology. Students who had received dedicated oncology teaching reported a statistically significantly higher mean quality 6.1 (95% confidence interval 5.6-6.5) versus 5.0 (95% confidence interval 4.3-5.5; P = 0.003) and quantity 5.2 (95% confidence interval 4.7-5.6) versus 4.3 (95% confidence interval 3.7-4.9; P = 0.03) of oncology teaching compared with those who had not received this. Appropriate oncology education is essential for all medical students due to the high prevalence of cancer. All future doctors need the appropriate knowledge and communication skills to care for cancer patients. Our analysis provides quantitative evidence to support the value of specialist oncology teaching within the medical school curriculum in improving student-reported experience. National student-led revision days and events may widen interest in a future career in oncology and aid collaboration between oncology societies. It is important for the general undergraduate medical curriculum to integrate specialty content. An integrated curriculum should facilitate a holistic approach that spans prevention, screening, treatment and palliation rather than being split by subspeciality.

With rising rates of human obesity, this study aimed to determine the relationship between maternal diet-induced obesity, offspring morphometrics, and behavior in mice. Pregnant and lactating female mice fed a diet high in fat and sugar (HFHS) commonly consumed by human populations showed decreased food, calorie, and protein intake but increased adiposity at the expense of lean mass. The pre-weaning body weight of the HFHS offspring was reduced for the first postnatal week but not thereafter, with HFHS female offspring having higher body weights by weaning due to continuing higher fractional growth rates. Post-weaning, there were minor differences in offspring food and protein intake. Maternal diet, however, affected fractional growth rate and total body fat content of male but not female HFHS offspring. The maternal diet did not affect the offspring’s locomotor activity or social behavior in either sex. Both the male and female HFHS offspring displayed reduced anxiety-related behaviors, with sex differences in particular aspects of the elevated plus maze task. In the novel object recognition task, performance was impaired in the male but not female HFHS offspring. Collectively, the findings demonstrate that maternal obesity alters the growth, adiposity, and behavior of male and female offspring, with sex-specific differences.

Background: Increasing numbers of adolescents and young adults with cancer (AYACs) are surviving long term, highlighting the importance of effective oncofertility communication. We undertook this study to understand documentation of fertility discussions with AYACs, what options are offered, and how this differs for AYACs on treatment compared with those post-treatment. Methods: We reviewed the documentation of fertility discussions with 122 AYACs treated between 2000 and 2020: 72 AYACs on treatment and 50 AYACs at least 3 years post-treatment (“late effects” cohort). Results: Diagnoses were split evenly between hematological and solid tumor diagnoses, and biological sex. Seventy-five percent of patients were diagnosed and treated by the AYAC team and 25% by the pediatric team. Median age at diagnosis was 19 years (range 4–24) for on-treatment patients and 16 years (range 3–25) for late effects patients. Fertility was discussed with 93% of on-treatment patients and 48% of late effects patients. Seventy-nine percent of on-treatment patients and 48% of late effects patients pursued a pre-treatment fertility preservation option. Post-treatment, 84% of late effects patients had a discussion and 57% pursued an option. Only four patients across both cohorts underwent oocyte or ovarian tissue cryopreservation. Those referred to specialist reproductive medicine clinics had more detailed documentation about fertility discussions. Nurse-led late effects clinics had a key role in facilitating post-treatment discussions. Conclusions: It is important to communicate oncofertility options to AYACs repeatedly throughout treatment. Referral to specialist oncofertility services and adequate information for both sexes is important pre-treatment, and can be facilitated post-treatment by a late effects service.

We report an unusual initial presentation for metastatic lung adenocarcinoma (LAC) with progressive loss of vision, a rare molecular phenotype and rapid visual response to surgical resection. A 60-year-old female presented with rapid and progressive visual loss over four weeks. Contrast-enhanced CT and MRI scans showed an enhancing lobulated mass in the base of skull infiltrating into the sella turcica. The patient underwent transnasal endoscopic debulking of the mass with rapid improvement in her vision. Histology showed a collision tumour with a pituitary adenoma and a microacinar metastatic adenocarcinoma. Staging CT of the chest, abdomen and pelvis showed a T4 N2 M1 right LAC. Molecular profiling of the metastasis confirmed an activating mutation involving codon 600 of BRAF gene (BRAF V600E). The patient was treated with combination chemotherapy but rapidly deteriorated and unfortunately died due to progressive disease. Efforts to access BRAF/MEK inhibitors for off-label use were unsuccessful. We believe our patient would have benefited from a BRAF/MEK inhibitor. This case illustrates the very unusual presentation of metastatic LAC with visual loss secondary to a collision tumour containing a pituitary adenoma and metastatic adenocarcinoma.