Explore the vast range of titles available.

SummaryIn 2011, the International Society of Geriatric Oncology (SIOG) published the SIOG 10 Priorities Initiative, which defined top priorities for the improvement of the care of older adults with cancer worldwide. Substantial scientific, clinical, and educational progress has been made in line with these priorities and international health policy developments have occurred, such as the shift of emphasis by WHO from communicable to non-communicable diseases and the adoption by the UN of its Sustainable Development Goals 2030. Therefore, SIOG has updated its priority list. The present document addresses four priority domains: education, clinical practice, research, and strengthening collaborations and partnerships. In this Policy Review, we reflect on how these priorities would apply in different economic settings, namely in high-income countries versus low-income and middle-income countries. SIOG hopes that it will offer guidance for international and national endeavours to provide adequate universal health coverage for older adults with cancer, who represent a major and rapidly growing group in global epidemiology.

Circulating microRNAs (miRNAs) hold great promise as easily accessible biomarkers for diverse (patho)physiological processes, including aging. We have compared miRNA expression profiles in cell-free blood from older versus young breast cancer patients, in order to identify \"aging miRNAs\" that can be used in the future to monitor the impact of chemotherapy on the patient's biological age. First, we assessed 175 miRNAs that may possibly be present in serum/plasma in an exploratory screening in 10 young and 10 older patients. The top-15 ranking miRNAs showing differential expression between young and older subjects were further investigated in an independent cohort consisting of another 10 young and 20 older subjects. Plasma levels of miR-20a-3p, miR-30b-5p, miR106b, miR191 and miR-301a were confirmed to show significant age-related decreases (all p≤0.004). The remaining miRNAs included in the validation study (miR-21, miR-210, miR-320b, miR-378, miR-423-5p, let-7d, miR-140-5p, miR-200c, miR-374a, miR376a) all showed similar trends as observed in the exploratory screening but these differences did not reach statistical significance. Interestingly, the age-associated miRNAs did not show differential expression between fit/healthy and non-fit/frail subjects within the older breast cancer cohort of the validation study and thus merit further investigation as true aging markers that not merely reflect frailty.

Background Falls and fall-related injuries are a major public health problem. Data on falls in older persons with cancer is limited and robust data on falls within those with a frailty profile are missing. The aim of this study is to investigate the incidence and predictive factors for falls and fall-related injuries in frail older persons with cancer. Methods This study is a secondary data analysis from data previously collected in a large prospective multicenter observational cohort study in older persons with cancer in 22 Belgian hospitals (November 2012–February 2015). Patients ≥70 years with a malignant tumor and a frailty profile based on an abnormal G8 score were included upon treatment decision and evaluated with a Geriatric Assessment (GA). At follow-up, data on falls and fall-related injuries were documented. Results At baseline 2141 (37.2%) of 5759 included patients reported at least one fall in the past 12 months, 1427 patients (66.7%) sustained an injury. Fall-related data of 3681 patients were available at follow-up and at least one fall was reported by 769 patients (20.9%) at follow-up, of whom 289 (37.6%) fell more than once and a fall-related injury was reported by 484 patients (62.9%). Fear of falling was reported in 47.4% of the patients at baseline and in 55.6% of the patients at follow-up. In multivariable analysis, sex and falls history in the past 12 months were predictive factors for both falls and fall-related injuries at follow-up. Other predictive factors for falls, were risk for depression, cognitive impairment, dependency in activities of daily living, fear of falling, and use of professional home care. Conclusion Given the high number of falls and fall-related injuries and high prevalence of fear of falling, multifactorial falls risk assessment and management programs should be integrated in the care of frail older persons with cancer. Further studies with long-term follow-up, subsequent impact on cancer treatment and interventions for fall prevention, and integration of other important topics like medication and circumstances of a fall, are warranted. Trial registration B322201215495.

Background Cancer and its treatments accelerate frailty in older adults with cancer (OACA). Exercise is safe and beneficial during and after treatment, yet many, including older adults, do not meet current exercise guidelines. The primary objective of this study was to understand oncology clinic nurses’ knowledge and current practices regarding exercise discussion and promotion in patients with cancer, including in older patients. The secondary objectives were to: (1) explore barriers to initiating exercise discussion and promotion; and (2) explore the relationship between oncology nurses’ exercise behavior, and their knowledge about existing guidelines and exercise promotion practices. Methods A cross-sectional online survey was conducted via REDCap between February and May 2023 involving nurses who practice in outpatient oncology clinics. The survey was developed based on the expert consensus of the study team and was distributed through professional networks. Descriptive statistics and chi-square were used to analyze the collected data. Results Ninety-seven nurses participated. The majority were aged 41–50 years (38.1%) and 31–40 years (27.8%). Mean years of practice was 13.5 (0.5–45). Many nurses lacked formal training on exercise discussion with patients (57.8%), yet expressed interest in learning (91%). Most nurses (90%) agreed exercise benefits patients during treatment. The majority (75%) reported discussing or recommending exercise to patients with cancer, especially advising patients to stay active during and after treatment. Barriers to promoting exercise included limited clinic time (77.7%) and concerns about safety especially for OACA (72.2%). 37.6% of nurses reported engaging in moderate-intensity aerobic activity. 26.6% endorsed both being quite/very knowledgeable in discussing exercise guidelines with patients with cancer in general and 74.7% reported typically discussing exercise with patients with cancer in general. A statistically significant association was found between nurses’ exercise promotion behaviour and perceived knowledge about exercise promotion ( p  = .01). Conclusion Many nurses agree that exercise promotion is important and consider it part of their scope of practice to discuss exercise with patients with cancer. Although perceived knowledge regarding specific recommendations is generally low, nurses express interest in enhancing their knowledge and participating in diverse educational opportunities. Institutions should prioritize nurse education to support efforts in exercise promotion. Clinical trial number Not applicable.

Background MicroRNAs (miRNAs) are important regulators of cellular function and have been associated with both aging and cancer, but the impact of chemotherapy on age-related miRNAs has barely been studied. Our aim was to examine whether chemotherapy accelerates the aging process in elderly breast cancer patients using miRNA expression profiling. Methods We monitored age-related miRNAs in blood of women, aged 70 or older, receiving adjuvant chemotherapy (docetaxel and cyclophosphamide, TC) for invasive breast cancer (chemo group, CTG, n  = 46). A control group of older breast cancer patients without chemotherapy was included for comparison (control group, CG, n  = 43). All patients underwent geriatric assessment at inclusion (T0), after 3 months (T1) and 1 year (T2). Moreover, we analysed the serum expression of nine age-related miRNAs (miR-20a, miR-30b, miR-34a, miR-106b, miR-191, miR-301a, miR-320b, miR-374a, miR-378a) at each timepoint. Results Except for miR-106b, which behaved slightly different in CTG compared to CG, all miRNAs showed moderate fluctuations during the study course with no significant differences between groups. Several age-related miRNAs correlated with clinical frailty (miR-106b, miR-191, miR-301a, miR-320b, miR-374a), as well as with other biomarkers of aging, particularly Interleukin-6 (IL-6) and Monocyte Chemoattractant Protein-1 (MCP-1) (miR-106b, miR-301a, miR-374a-5p, miR-378a-3p). Moreover, based on their ‘aging miRNA’ profiles, patients clustered into two distinct groups exhibiting significantly different results for several biological/clinical aging parameters. Conclusions These results further corroborate our earlier report, stating that adjuvant TC chemotherapy does not significantly boost aging progression in elderly breast cancer patients. Our findings also endorsed specific age-related miRNAs as promising aging/frailty biomarkers in oncogeriatric populations. Trial registration ClinicalTrials.gov, NCT00849758 . Registered on 20 February 2009. This clinical trial was registered prospectively.

Objectives Aging is associated with altered immune function and chronic low‐grade inflammation, referred to as immunosenescence. As breast cancer is an age‐related disease, the impact of aging on tumor immune responses may have important consequences. However, effects of immunosenescence on breast tumor immune infiltration remain largely unknown. Methods This exploratory study investigated a broad panel of immune/senescence markers in peripheral blood and in the tumor microenvironment of young, middle‐aged and old patients diagnosed with early invasive luminal (hormone‐sensitive, HER2‐negative) breast cancer. In the old group, G8‐scores were computed as a correlate for clinical frailty. Results Significant age‐related changes in plasma levels of several inflammatory mediators (IL‐1α, IP‐10, IL‐8, MCP‐1, CRP), immune checkpoint markers (Gal‐9, sCD25, TIM‐3, PD‐L1), IGF‐1 and circulating miRs (miR‐18a, miR‐19b, miR‐20, miR‐155, miR‐195 and miR‐326) were observed. Shifts were observed in distinct peripheral blood mononuclear cell populations, particularly naive CD8+ T‐cells. At the tumor level, aging was associated with lower total lymphocytic infiltration, together with decreased abundance of several immune cell markers, especially CD8. The relative fractions of cell subsets in the immune infiltrate were also altered. Clinical frailty was associated with higher frequencies of exhausted/senescent (CD27−CD28− and/or CD57+) terminally differentiated CD8+ cells in the blood and with increased tumor infiltration by FOXP3+ cells. Conclusion Aging and frailty are associated with profound changes of the blood and tumor immune profile in luminal breast cancer, pointing to a different interplay between tumor cells, immune cells and inflammatory mediators at higher age. In this study, apart from age‐related changes in the immune profile of patients with luminal breast cancer, remarkable frailty‐related changes within the subgroup of older patients were observed. Our data support age‐dependent remodelling of both systemic immunity features and anti‐tumor immune responses.

International organizations, such as the International Society of Geriatric Oncology and the American Society of Clinical Oncology, recommend integrating comprehensive geriatric assessment (CGA) into the care of older adult patients with cancer. Geriatric screening and assessment, which are part of the CGA process, detect many geriatric problems related to all geriatric domains, predict survival and toxicity, and influence treatment decisions.

International organizations, such as the International Society of Geriatric Oncology and the American Society of Clinical Oncology, recommend integrating comprehensive geriatric assessment (CGA) into the care of older adult patients with cancer. Geriatric screening and assessment, which are part of the CGA process, detect many geriatric problems related to all geriatric domains, predict survival and toxicity, and influence treatment decisions. AT A GLANCE: The Belgian experience shows that the implementation of geriatric screening and assessment, and the integration of geriatric recommendations and interventions, remains a challenge in daily oncology practice. The implementation of GA delivers meaningful information for healthcare providers in daily oncology practice. Although the benefits of GA are well known, identified key barriers for a systematic implementation are high workload, not enough time, and financial or staffing issues

Background Cancer predominates in adults over age 65. Cancer treatments are known to create physical and psychosocial challenges, which may be amplified for older adults with cancer. Learning and applying self-management behaviours and skills during treatment with cancer can help to manage/recover health and improve quality of life. In many other chronic illnesses, self-management interventions are known to improve health outcomes and lower healthcare costs. The purpose of this systematic review is to determine the effectiveness of self-management interventions for older adults with cancer on physical, psychosocial, and health system-related outcomes. Methods We are conducting a systematic review of self-management interventions for older adults (65+) diagnosed with cancer (solid tumour or haematological) in the active treatment phase of cancer. This systematic review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Studies are limited to experimental or quasi-experimental methods published in English, French, German, or Dutch. A search strategy was designed with a Health Sciences librarian and performed using the following electronic databases: Ageline, AMED, ASSIA, Cinahl, Cochrane, Embase, Medline, PsychINFO, and Sociological Abstracts. Approximately 14,000 titles and abstracts are being electronically screened by a minimum of 2 reviewers, with relevant studies to be screened for full text. The final sample of included studies will be assessed for quality using the Cochrane Risk of Bias tool and Down and Black for quasi-experimental studies, with data synthesized in a narrative and tabular format. Discussion This systematic review will expand the knowledge base of interventions supporting self-management for older adults with cancer. This study will inform future intervention development by identifying gaps and strengths in effective self-management interventions targeting the needs of older adults receiving active treatment for cancer. Systematic review registration PROPERO registry ID# CRD42019134113

Purpose Recent evidence suggests that age-accumulated methylmalonic acid (MMA) promotes breast cancer progression in mice. This study aims to investigate the association between baseline serum MMA concentrations in patients with breast cancer and the development of subsequent distant metastases. Methods We included 32 patients with early Luminal B-like breast cancer (LumB, median age 62.4y) and 52 patients with early triple-negative breast cancer (TNBC, median age 50.5y) who developed distant metastases within 5 years. They were matched to an equal number of early breast cancer patients (median age 62.2y for LumB and 50.5y for TNBC) who did not develop distant metastases with at least 5 years of follow-up. Results Baseline serum MMA levels at breast cancer diagnosis showed a positive correlation with age ( P  < 0.001) and a negative correlation with renal function and vitamin B12 (all P  < 0.02), but no statistical association was found with BMI or tumor stage ( P  > 0.6). Between matched pairs, no significant difference was observed in MMA levels, after adjusting for kidney function and age ( P  = 0.19). Additionally, in a mouse model, a significant decline in MMA levels was observed in the tumor-bearing group compared to the group without tumors before and after tumor establishment or at identical times for the control group ( P  = 0.03). Conclusion Baseline serum MMA levels in patients with breast cancer are not correlated with secondary distant metastasis. Evidence in the mouse model suggests that the presence of a tumor perturbates MMA levels.