Geriatric Oncology at SIOG 2025: Turning Evidence Into Care
The Plenary Session at SIOG 2025 (https://oncodaily.com/event/247138) on geriatric oncology revealed a significant shift: it's no longer a niche concept or research slogan. Cancer centers worldwide are embracing structured care models for older adults, adapting treatments, and transforming multidisciplinary teamwork. The session, chaired by Lore Decoster (Brussels), Cindy Kenis (Leuven), and Hans Wildiers (Leuven), transitioned from individual institutional models to a global perspective, emphasizing the challenge of scaling and integrating evidence into everyday oncology practice.
Research to Clinic: The Crucial Link
Lore Decoster opened the session, highlighting the core mission of geriatric oncology: translating research into improved treatment for older adults with cancer. While evidence on geriatric assessment, toxicity prediction, and patient-centered decision-making is robust, the bottleneck lies in implementation. The focus now is on workforce, pathways, cultural shifts, and funding.
Subsequent presentations showcased practical solutions from various centers.
Building a Geriatric Oncology Pathway at The Royal Marsden
Susie Monginot from Toronto shared the 10-year journey of the Older Adults with Cancer Clinic at Princess Margaret Cancer Centre. With nearly half of new patients aged 65+, many frail, the clinic expanded from a 2015 pilot to four half-day clinics supported by geriatricians, fellows, social workers, and dietitians. They conduct comprehensive geriatric assessments and actively implement recommendations, from medication adjustments to allied-health referrals. Despite challenges, the model demonstrates clear demand and positive impact on treatment planning.
Integrating Patient Goals and Nurse Input into Tumor Boards
Hanneke van der Wal-Huisman (Groningen, Netherlands) introduced the Integrated Oncological Decision-Making model. This model integrates patient goals and nurse insights directly into MDT discussions. The team found that functional status, psychosocial factors, and patient priorities were often overlooked in decision-making, despite nurses' expertise. In the new model, nurses conduct structured assessments focusing on goals, priorities, and daily functioning, with their input formally included in MDTs. This approach enhances individualized care and communication, making patients feel heard and clinicians feel decisions better reflect the patient's whole self. Key factors for success include collaboration, leadership support, clear documentation, and a culture open to reflection and challenge.
Continuum-of-Care Model in a Geriatric Hospital
Rejiv Rajendranath from Chennai presented a comprehensive geriatric cancer care program embedded within a dedicated geriatric hospital. This center combines acute geriatric beds, long-term and transitional care, home visits (over 330,000 in three years), assisted living facilities, and community clinics. Cancer care for older adults is integrated into this ecosystem, not isolated. The model prioritizes continuity and proximity: geriatricians see most patients, CGA tools are used selectively but systematically, and oncologists, geriatricians, palliative care, psycho-oncology, and rehab collaborate as one team. Home care and assisted living reduce hospital stays, travel burden, and caregiver strain. Cultural factors like family-centered decision-making and reluctance to discuss prognosis directly with patients are addressed through multi-session counseling and sensitive communication. Treatment is often tailored through escalation/de-escalation decisions grounded in biology and patient/family preferences.
Building a Senior Adult Oncology Programme
Nicolò Matteo Luca Battisti presented the Senior Adult Oncology Programme at The Royal Marsden (UK), developed over four years in a hospital without geriatricians. Initially funded by a cancer alliance, the team built a multidisciplinary service (nursing, rehab, pharmacy, dietetics, psychology, admin support) and anchored it in a screening-based pathway using tools like G8/SIOG 2 and structured goal-setting questions. The program was aligned with hospital priorities like reducing unplanned admissions and improving efficiency, securing long-term institutional funding. It has since expanded to more disease sites. Education is central, with international fellows rotating through the service, geriatric oncology concepts integrated into training, and a new research fellowship supporting ongoing development.
Scaling Through Practical GA and Smart Nudges
Ramy Sedhom (Philadelphia/Princeton) presented an implementation-focused approach: embedded "practical geriatric assessment" and multidisciplinary pathways designed for scalability. Recognizing the impracticality of full CGA for every older patient, the team leverages behavioral economics and EHR design:
- A concise geriatric assessment is built into Epic and automatically pushed to patients ≥70 as a pre-visit survey.
- Results appear in a structured flowsheet, making it easy for oncologists to see impairments at a glance.
- Pop-up prompts "nudge" clinicians toward appropriate referrals based on detected deficits (falls, nutrition, mood, social issues, etc.).
A geriatric nurse navigator and weekly multidisciplinary conference ensure high-risk cases are proactively addressed. Structured emails summarize recommendations and close the loop with treating teams. In two years, over 200+ practical GAs have been completed, generating multiple referrals per assessment. Most older adults had unrecognized functional or psychosocial vulnerabilities, prioritizing quality of life over survival. Early analyses suggest better end-of-life care and longer hospice stays for those under enhanced navigation.
Global Models: Different Pathways, Same Principles
Colm Mac Eochagain (Dublin) presented a global overview of 38 geriatric oncology services worldwide, categorizing them into broad model types: consultative clinics, co-management models, screen-and-refer models, comprehensive units, and emerging hybrid/digital models. Despite local differences in staffing, funding, and health systems, common elements emerged: routine geriatric assessment (full or pragmatic), multidisciplinary decision-making, and structured identification of at-risk older adults.
Take-Home Message
The science of geriatric oncology is mature enough. The pressing task now is implementation – building models tailored to local realities, securing funding, integrating assessment tools into workflows, and ensuring every older adult with cancer receives care reflecting both their biology and goals. For more information, visit https://siog2025.abstractserver.com/program/#/details/sessions/13.
