On April 22, 2025, an ASCO Expert Panel voted to approve ASCO’s global guideline on geriatric assessment of patients with cancer older than age 65 who are being treated in resource-limited settings or countries.1 Guideline recommendations were informed by the ADAPTE methodology and formal consensus methodology, as opposed to the more common de novo guideline development. The ADAPTE process takes advantage of existing guidelines, and in this case, a previously published ASCO resource-neutral guideline was adapted for resource-constrained settings. [For more on geriatric assessment of older patients with cancer, see the perspective JCO Authorship Guidelines Are of Benefit to Those Caring for Older Patients, by Stuart M. Lichtman, MD, FACP, FASCO, here.]
“The main guideline was originally published in 2018 and updated in 2023, and its idea was to guide the implementation of geriatric assessment and management recommendations for people with cancer,” said Guideline Co-Chair Enrique Soto Pérez de Celis, MD, PhD, MSc, FASCO, of the University of Colorado Anschutz Medical Campus.2,3
Rising Burden of Cancer Among Older Adults in Low- and Middle-Income Countries
The burden of cancer among older adults in low- and middle-income countries is on the rise, with an estimated half of all new cancer cases occurring in individuals aged 65 years and older.1 By the year 2035, this number is projected to more than double and reach approximately 14 million cases per year, representing about 60% of the global cancer burden among older adults.4 Therefore, the oncology community has recognized a need for a geriatric oncology guideline in settings where access to specialized providers and interventions may be limited.
Enrique Soto Pérez de Celis, MD, PhD, MSc, FASCO
“Last year, we started working on this global guideline that uses a resource-stratification framework to provide clinicians around the world who are working in limited-resource settings with tools needed to implement evidence-based geriatric oncology interventions for patients with cancer using available resources,” Dr. Soto said. “We now have outstanding evidence from randomized trials in geriatric oncology showing that geriatric assessment works. These trials have been conducted across different settings—some in cancer centers and others in community settings in the United States. And community settings in the United States are not that different from some places in low- and middle-income countries.”
Evidence-Based Recommendations for Geriatric Assessment in Older Patients With Cancer
The new guideline focuses on the latest research evidence to address four overarching clinical questions posed in the 2023 guideline update, all in resource-limited settings:
- What is the role of geriatric assessment in older adults?
- Which geriatric assessment tools and component elements should clinicians use to predict adverse outcomes in patients considering systemic treatments?
- Which noncancer-specific life expectancy data should clinicians consider to best inform therapeutic decisions for older patients with cancer?
- How should geriatric assessment be used to guide the management of older patients with cancer?
Besides providing the answers to these questions, the goal of the new guideline is to help jumpstart the geriatric oncology programs and incentivize research in areas of the world where geriatric oncology research is sparse.
“We have developed a large table, in which we stratified all information available in the literature, to better guide our physicians and health-care teams regarding how each element of the geriatric assessment can be used in their practice, their studies, or their own country,” said Guideline Co-Chair Cristiane Decat Bergerot, PhD, BS, MS, of Oncoclínicas&Co in Brazil. “We also provide a list of all the elements in the geriatric assessment that need to be assessed—physical function, comorbidities, polypharmacy, cognition, nutrition, social support, and psychological health.” Finally, the guideline also aims to help guide health-care providers’ treatment decisions in resource-limited settings.
Cristiane Decat Bergerot, PhD, BS, MS
Drs. Bergerot and Soto are optimistic that the new guideline will quickly prove beneficial in the management of older patients with cancer who are being treated in resource-limited settings. “We hope these guidelines will give clinicians, regardless of where they practice, strong tools and structure on how to assess and provide evidence-based interventions for older adults and this will ultimately improve their cancer care, quality of life, and supportive measures,” Dr. Soto said.
“It will be a way for us to make sure that all older adults with cancer will receive thoughtful and appropriate care, no matter where they are,” Dr. Bergerot said. “It is not about perfection; it is really about progress, personalization, and compassion for our patients.”
REFERENCES
1. Bergerot CD, Temin S, Verduzco-Aguirre HC, et al: Geriatric assessment: ASCO global guideline. J Clin Oncol. August 27, 2025 (early release online).
2. Mohile SG, Dale W, Somerfield MR, et al: Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol 36:2326-2347, 2018.
3. Dale W, Klepin HD, Williams GR, et al: Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol 41:4293-4312, 2023.
4. Pirrelon S, Sarfati D, Janssen-Heijnen M, et al: Global cancer incidence in older adults, 2012 and 2035: A population-based study. Int J Cancer 144:49-58, 2019.
Originally published in ASCO Daily News. © American Society of Clinical Oncology. ASCO Daily News, August 27, 2025. All rights reserved.
