Real-world treatment patterns, outcomes and geriatric vulnerability in older adults with cancer

Dr Kathelijn Versteeg, oncologist and geriatrician at Amsterdam UMC, the Netherlands, summarised several studies of her team. These studies focus on real-world outcomes of systemic cancer treatment in older adults and the integration of geriatric principles into oncological care.

The first study is a real-world cohort analysis of approximately 500 older patients with gastrointestinal malignancies treated with 5-FU–based chemotherapy, including capecitabine and oxaliplatin-containing regimens. The analysis demonstrated that older adults received lower cumulative chemotherapy doses compared with standard trial-based regimens, particularly with respect to oxaliplatin. Importantly, these dose reductions were not associated with inferior OS or PFS. An exception was observed in patients who initiated capecitabine at a reduced starting dose, who experienced significantly worse OS. These findings suggest that treatment de-escalation during therapy may be safe in selected older adults, whereas upfront dose reduction of capecitabine may compromise outcomes.

The second study examined real-world treatment patterns and outcomes in patients with locally treatable colorectal liver metastases. Patients were stratified into three age groups: <50 years, 50–70 years, and >70 years. This stratification reflects the underrepresentation of both older and very young adults in clinical trials, despite these groups constituting a substantial and growing proportion of the colorectal cancer population. Younger patients (<50 years) were more likely to receive neoadjuvant or induction systemic therapy prior to local treatment, while older patients (>70 years) received such therapy less frequently. When systemic therapy was administered, older adults more often received less intensive regimens, such as 5-FU monotherapy, and were less likely to receive anti-EGFR agents.

Despite these differences in treatment intensity, OS and PFS were comparable across age groups. Notably, younger patients exhibited inferior PFS, despite receiving the most intensive treatment. Differences in tumour characteristics were observed, with older patients more often presenting with potentially favourable disease features, such as metachronous metastases or a lower metastatic burden. However, these factors did not fully explain the comparable survival outcomes, raising the hypothesis that overtreatment may occur in younger patients in this clinical setting.

The final study focused on older patients admitted to a medical oncology ward, in whom a bedside geriatric assessment was systematically performed. Nearly all patients exhibited impairments in multiple geriatric domains, most commonly in functional status, while cognitive impairment was present in more than 50% of patients. These vulnerabilities were associated with poor clinical outcomes: approximately two-thirds of patients experienced unfavourable events, including hospital readmission or inability to return home directly after discharge, with many requiring placement in a nursing facility. Furthermore, one-third of patients died within three months of hospital admission. These findings underscore that oncological treatment alone is insufficient in this population and highlight the critical need for integrated geriatric and oncological care.