Background: Structured care processes that provide a framework for how oncologists can incorporate geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. Methods: The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were geriatric oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. Results: From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in geriatric oncology research. The panel met consensus that “all patients aged 75 years or older and those who are younger with age-related health concerns” should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. Conclusions: This Delphi investigation of geriatric oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes.

Adjuvant radiation therapy (RT) in breast cancer treatment has been proven to enhance outcome, improving recurrence and mortality rates. RT, however, gives rise to unfavourable side-effects, fatigue the most frequent. The aim of this study was to assess the effect of exercise (and different exercise prescription parameters) during adjuvant RT on fatigue among breast cancer patients. Quality of life was a secondary outcome. Randomised controlled trials that investigated the effect of exercise during adjuvant RT on fatigue for breast cancer patients were searched using MEDLINE, EMBASE, Google Scholar, CINAHL, AMED and ClinicalTrials.gov. Reference lists of included studies and relevant reviews were also checked. Nine studies (802 participants) were included. A meta-analysis, including results for 738 participants, revealed that exercise was statistically more effective at reducing fatigue than the control intervention (SMD - 0.46, 95%CI -0.79 to -0.14). Statistically significant benefits of supervised, combined aerobicresistance exercise on fatigue were achieved. Further research is required to confirm this finding and determine the effect of alternative exercise modes. Exercise during adjuvant RT can be considered beneficial in breast cancer patients. Supervised, combined aerobic-resistance exercise shows promise in alleviating fatigue with further investigation into alternative exercise modes required.

• Treatment decisions in older adults receiving radiotherapy is often difficult. • Older people with cancer are significantly under-represented in trials. • This is especially true of frailer older adults. • Personalised radiotherapy should include frailty assessment.