Older adults make up the largest group of people diagnosed with cancer, yet their needs are often underrepresented in clinical trials and care models. Given that the mean age of lung cancer diagnosis in Australia is 72, many lung cancer patients are older and have distinct, often complex needs, making the tailoring of cancer care to this population not just good practice—it’s a medical necessity.
Why Geriatric Oncology matters
The cornerstone of Geriatric Oncology, a multidisciplinary field focused on the intersection of ageing, cancer, and health, designed to deliver person-centred care.
A person’s age in years is not a reliable indicator of health. Age in numbers (their chronological age) may not compare well with how their body functions (their biological or functional age), or their capacity for certain treatments. Furthermore, a patient’s preferences may change depending on their life circumstances and their experience with cancer.
Person-centred care must acknowledge this complexity, which goes beyond clinical fitness—it encompasses logistical and functional barriers: perhaps a patient with mobility issues requires more time in a radiotherapy appointment, issues with hearing are affecting communication, or arthritis is preventing someone from being able to access supportive care medicines. To properly capture these dynamic factors and non-medical challenges, it is essential to undertake appropriate assessments and have open conversations throughout the patient’s cancer experience.
Key tools for Healthcare Professionals assessing older Adults
A meta-analysis has shown comprehensive geriatric assessment was associated with a lower risk of treatment toxicity, indicating its potential to optimise cancer treatment in older population with cancer. It may also lead to reduced treatment toxicity, increased treatment completion, and improved health-related quality of life scores. The tools listed below can be used to assess the capacity of older Adults with cancer and assist with personalised care – matching treatment intensity to an older person’s health and values, rather than applying a one-size-fits-all approach.
Tool Category | Tool Name | Purpose | Link |
|---|---|---|---|
Screening | Geriatric 8 (G8) | A quick, eight-question screening tool (based on the mini nutritional assessment). A score of ≤14 triggers a formal geriatric assessment. | mdCalc |
Formal Assessment | Practical Geriatric Assessment (PGA) | A pragmatic, multi-dimensional tool, recommended by ASCO guidelines for all patients ≥65 being considered for cancer treatment. | ASCO |
Formal Assessment | eGFA (Electronic Geriatric Assessment) | A multidimensional assessment covering cognitive function, mobility, and vital status. | SIOG |
Frailty Measurement | Clinical Frailty Scale | A nine-category, holistic scale using features like slowing down and need for help with activities of daily living (ADLs). | Rockwood |
Frailty Measurement | Fried Phenotype | Based on five criteria, with three or more criteria indicating frailty: slowness, weakness, weight loss, exhaustion, and low physical activity. | Frailty Science |
Development of an Optimal Care Pathway for older people with cancer
Professor Meera Agar and A/Professor Christopher Steer with support from the COSA Geriatric Oncology Group Executive, have developed an Optimal Care Pathway (OCP) for older people with cancer.
The new OCP maps the cancer journey for older Australians, outlining key steps and decision points to guide clinicians in delivering high-quality, evidence-based, patient-centred care. By integrating geriatric oncology principles, it seeks to promote equity, collaboration, and age-friendly practice, while addressing systemic ageism in cancer care.
Funded by Cancer Australia, this initiative aligns with the Australian Cancer Plan and prioritises improving outcomes and experiences for older adults with cancer
What can an older Australian diagnosed with cancer do to communicate their needs?
Sharing as much information about your health and wellbeing with your cancer team is very important to communicate your needs, but sometimes it can be hard to find the words, or appointments may feel rushed.
This is Me was created by older adults with cancer to encourage conversations with their healthcare team about what matters most during their cancer experience. It is designed to help people share information about their health, quality of life, and personal preferences when decisions about treatment and care are being made.
It can be used once or many times during your care, and there are no right or wrong answers.
Providing optimal and equitable care
Ask ‘What Matters Most”
The fundamental principle driving optimal, equitable care is a commitment to the patient’s priorities: “What really matters to you, what matters most to you?”.
For many older individuals, there may be a strong preference for Quality of Life over the absolute length of life. Probing beyond survival statistics can assist with understanding patient goals, such as maintaining independence, being able to enjoy life (e.g., travel, spending time with family), being present for an upcoming special event and addressing fears about suffering or losing cognitive function (e.g., “Am I going to be me at the end of all of this?”).
Ageism Exists
According to WHO, ageism, displayed as stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age, is associated with earlier death (by 7.5 years). A core message in providing comprehensive care is to not make assumptions about older people and to approach every patient with open minds and open conversations. This is especially critical in lung cancer, where a patient may be experiencing deep internal distress. Anxiety and depression may be present, and with lung cancer this is often compounded by nihilism, fatalistic thinking, or the feeling that their cancer is ‘deserved’ due to current or former tobacco smoking. Clinicians must create a safe space, a world where we do not have to judge patients.
Adapted Consultations
Successfully treating older patients requires clinic-level flexibility and a commitment to adapting standard practice. Treatments and consultations must be individually tailored to overcome practical barriers identified during the initial assessment. For instance, mobility issues may necessitate scheduling longer than standard radiotherapy appointments to allow time for transfers, positioning, and rest. Staff must be proactive in using aids and ensuring clear communication to overcome sensory issues like poor hearing. Additionally, clinicians should be aware that low literacy levels can impede adherence to complex schedules or medication instructions. Finally, in terms of systemic therapy, utilising dose reductions upfront is often a necessary and appropriate strategy to minimise toxicities and prevent downstream complications, rather than waiting for an adverse event to occur.
As Dr. Michael Krasovitsky reminded colleagues at TOGA 2024 ASM, optimal care is not just medical care. It means ensuring patients can spend time at home, maintain cognition, and feel connected to their families and communities.
When healthcare teams adopt a geriatric oncology lens, they:
- Reduce treatment toxicities.
- Improve physical and social functioning.
- Enable shared decision-making that reflects the patient’s own priorities.
The message is clear: cancer care for older people should always begin with the question—what matters most?
Listen to Challenging Ageism: Optimising Lung Cancer Treatment in Older Adults
To hear the full discussion with Dr Michael Krasovitsky, A/Professor Christopher Steer, Professor Shalini Vinod, and Ms. Nicole Webb, listen to the episode here:
