Geriatric Oncology: An Overview
Authors: Stuart M. Lichtman, Arti Hurria, Paul B. Jacobsen
Journal: Journal of Clinical Oncology (2014)

It is a great privilege for us to introduce the second special issue of Journal of Clinical Oncology (JCO) to be devoted to geriatric oncology. The first special issue, which was published in 2007, focused on the treatment of cancers in older adults, with a specific call for additional research given the impending rise in the number of older adults with cancer. The demographic shift and the resultant increase in the number of elderly patients with cancer, which was predicted by the founders of geriatric oncology (Kennedy, Yancik, and others), has now arrived. It has long been recognized that the most significant risk factor for the development of cancer is aging. Cancer and its treatment can affect the overall life expectancy as well as the active life expectancy and functioning of older individuals. The traditional study of cancer, with its focus on younger, healthier patients, has resulted in a lack of high-quality data to adequately guide care for older patients. In 1983, Yancik organized a symposium sponsored by the National Cancer Institute and the National Institute on Aging and published a monograph, “Perspectives on Prevention and Treatment of Cancer in the Elderly,” which highlighted the importance of research in cancer and aging. In the 1988 American Society of Clinical Oncology (ASCO) Presidential Address, Kennedy encouraged the study of aging and cancer. He stated, “Our society need not ration how we will treat our disadvantaged members, but should continue to seek those preventive and positive measures that can shorten our later period of morbidity. A very major cancer load will persist well into the 21st century, even if the attempts at prevention are eventually a total success... There is a developing knowledge on aging. Care of the older person needs to be part of medical education and oncology education. Research will help attain a desirable quality of life with aging and a reduced morbidity.” The goals set forth by Yancik and Kennedy are yet to be fully achieved; however, many strides have been made toward those ends. There has been increased recognition of the importance of the relationship between aging and cancer, as well as an increase in evidencebased research to guide the care of older adults with cancer. In addition, this research is being performed by a growing number of investigators at institutions across the nation, as well as internationally. The International Society of Geriatric Oncology, founded in the year 2000, fosters the mission of developing health professionals in the field of geriatric oncology to optimize treatment of older adults with cancer through education, clinical practice, and research. The Society’s publication, Journal of Geriatric Oncology, is the first journal devoted solely to the field. The Cancer and Leukemia Group B (now the Alliance for Clinical Trials in Oncology) Cancer in the Elderly Committee has supported furthering research in geriatric oncology through clinical trials and secondary data analyses. The Cancer and Aging Research Group has developed an instrument to predict chemotherapy toxicity, initiated and supported trials to validate this methodology in different clinical settings, and, most importantly, mentored junior investigators in geriatric oncology. The Elderly Taskforce of the Gynecologic Oncology Group is supporting the first prospective trial in older women with ovarian cancer and planning additional studies in other diseases and modalities. ASCO has also fostered a number of initiatives in geriatric oncology. These include a Geriatric Oncology Issue Exploration Team; educational materials, including some offered through ASCO University; sessions at the Annual Meeting, including a Geriatric Oncology track; the B.J. Kennedy Award for Excellence in Geriatric Oncology; and a Geriatric Oncology component of the Cancer Education Committee. This special issue of JCO highlights the achievements of researchers in the field, brings clinical oncologists up to date on evidence-based treatment recommendations for older patients with cancer, and highlights gaps in knowledge to stimulate ideas for future research. The issue can be subdivided into a number of broad topics, including disease-specific reviews in geriatric oncology, the approach to clinical trial design in older adults, assessment of the older patient with cancer, and survivorship issues that face older adults. The diseases highlighted are those that contribute significantly to the cancer burden of older patients, including breast, lung, colon, and prostate cancer, as well additional areas where important clinical advances have been made, such as acute leukemia, ovary cancer, and multiple myeloma. Advances in clinical trial design and patient evaluation are critical to efforts to improve the quality of care for the older patient. There is a need for both elderly specific trials and for increases in the overall participation of older patients in clinical trials. Investigators in geriatric oncology have been evaluating various clinical trial design components to enroll a population of patients who are more representative of the older patients seen in practice (eg, patients with multiple comorbidities and impairments in function). A new approach is imperative to obtain meaningful data that can be easily applied to daily treatment decisions for older adults with cancer. This issue includes a general overview of clinical trial design and the role of biomarkers in cancer and aging research. Components of patient selection for clinical trials and patient evaluation in standard practice are discussed, including a comprehensive geriatric assessment. JOURNAL OF CLINICAL ONCOLOGY S P E C I A L S E R I E S O V E R V I E W VOLUME 32 NUMBER 24 AUGUST 2