Geriatric oncology at 25 years: Personalized cancer care for an aging global population

Prof Dr Martine Extermann, medical oncologist at Moffitt Cancer Center in Tampa, Florida is a past president and founding member of the SIOG, established in 2000. This year’s SIOG conference marked the 25th anniversary of the society, reflecting the maturation of geriatric oncology as a distinct clinical and scientific discipline addressing the needs of older adults with cancer. 

Advancing age is the strongest risk factor for cancer, with individuals aged 80 years having an approximately 50-fold higher cancer risk than those aged 20 years. Despite this, for decades, older adults were underrepresented in oncology clinical trials, as early therapeutic strategies prioritised maximal treatment intensity and frequently excluded patients over 60–70 years because of presumed toxicity. Given that more than half of patients with cancer are aged 70 years or older, this resulted in a major discrepancy between trial populations and real-world patients. Recognition of this gap in the 1990s prompted the emergence of geriatric oncology, integrating principles of geriatrics and oncology to better characterise patient heterogeneity and guide treatment decisions.

Early research in geriatric oncology focused on patient profiling through comprehensive geriatric assessment (GA), revealing a substantial burden of comorbidities, functional impairments, and psychosocial vulnerabilities. Subsequent prognostic studies demonstrated that traditional oncology metrics, such as ECOG or WHO performance status, inadequately predicted outcomes in older patients, whereas GA provided superior prognostic and predictive value. Randomised trials have since shown that GA-guided, integrated oncogeriatric management improves clinical outcomes, including approximately a 20% reduction in severe treatment-related toxicity, decreased hospital length of stay, preservation of functional status, and improved treatment delivery.

These advances have supported the development of geriatric oncology services worldwide,  with accumulating evidence of improved patient-centered outcomes and viable care models. SIOG provides an essential international platform for collaboration, knowledge exchange, and mentorship in a field that remains relatively young and often represented by limited expertise within individual institutions.

Beyond care delivery, geriatric oncology encompasses a growing biological science exploring the interactions between aging and cancer. Aging-related changes in immune, metabolic, and cellular homeostasis influence cancer biology, treatment response, and resistance. Emerging evidence suggests that tumour biology differs by age, with implications for treatment selection. Research into senescence, senolytics, and age-related metabolic alterations offers opportunities to combine aging-targeted and cancer-directed therapies to optimise outcomes in older adults.

Finally, geriatric oncology has important health policy implications in the context of global population aging, particularly in low- and middle-income countries where most older adults will reside in coming decades. Through collaboration with international organisations, such as the WHO, SIOG contributes to defining global priorities aligned with the sustainable development goals. By promoting age-appropriate, resource-adapted cancer care, geriatric oncology strives to deliver highly personalised treatment while preserving function, autonomy, and societal participation among older adults—representing the ultimate form of personalised cancer care.