Three studies presented at the 2026 ASCO Breakthrough conference in Singapore focused on problems that can derail cancer care even when treatment is otherwise on track: nausea after starting morphine, continued smoking after a cancer diagnosis, and unrecognized frailty in older adults.

Although the studies had little in common clinically, each addressed a practical question. Could a single dose of dexamethasone reduce nausea during morphine initiation? Could an ongoing messaging intervention help smokers with cancer quit? And could frailty assessment capture social and literacy barriers that routine oncology visits may miss?

In one randomized trial from India, prophylactic dexamethasone reduced early opioid-induced nausea during oral morphine initiation. In a multicenter trial from Hong Kong, a self-determination theory–based smoking cessation intervention delivered via instant messaging improved abstinence among smokers with cancer. In an implementation study from Dana-Farber Cancer Institute, investigators proposed a “complex frailty” paradigm after finding that unmet health-related social needs and limited health literacy were closely linked with frailty in older adults with gastrointestinal cancers.

Dexamethasone Reduced Early Nausea During Morphine Initiation

For most patients with cancer, oral morphine remains an important option for pain control. However, nausea and vomiting during opioid initiation can make it difficult for patients.

Presenting results from the DEX-OINV randomized trial,¹ Suhana Sulfiker, MD, of the All India Institute of Medical Sciences, New Delhi, said opioid-induced nausea and vomiting is a major concern when cancer patients are started on opioids for pain control.

“These symptoms can lead to poor adherence, delayed dose escalation, and inadequate pain control,” she said.

The study evaluated whether a single oral dose of dexamethasone could prevent opioid-induced nausea and vomiting in adult patients with cancer who were initiating oral morphine. Investigators randomly assigned 150 patients to receive prophylactic dexamethasone plus rescue antiemetics or no prophylactic antiemetic; rescue antiemetics were permitted in both groups.

Nausea severity was lower in the dexamethasone arm at all assessed time points.

Patients who received dexamethasone were also less likely to report clinically meaningful nausea. The effect on vomiting was less consistent. Rescue antiemetic use was lower with dexamethasone but did not differ significantly between groups. Dexamethasone was generally well tolerated, with no serious adverse events reported in either arm.

According to Dr. Sulfiker, the appeal of the approach is its simplicity.

“A single oral dose of dexamethasone is inexpensive, widely available, and, more importantly, familiar to both oncology and palliative-care physicians,” she said.

Still, Dr. Sulfiker said the findings should be interpreted in light of the trial’s single-center, open-label design, its focus on oral morphine initiation, and the fact that it was not powered for secondary outcomes. “These findings will need confirmation from larger, multicenter, placebo-controlled trials,” she said.

Lawson Eng, MD, of Princess Margaret Cancer Centre and the University of Toronto, called the trial an important contribution to an area with limited evidence.

“This is one of the first studies that demonstrated a benefit to prophylactic steroids for opioid-induced nausea/vomiting,” Dr. Eng said in a discussion of the study.

He described the intervention as pragmatic and potentially useful in low-resource settings but said several questions remain, including the optimal dexamethasone dose, whether a lower dose would be effective, and whether the findings apply to other opioids or specific cancer populations. He also noted that future placebo-controlled studies should evaluate longer-term pain control and opioid adherence.

Messaging Intervention Helped Patients With Cancer Quit Smoking

Another study addressed a different supportive care problem: how to help patients with cancer quit smoking when many have smoked for decades, have high nicotine dependence, and are not ready to quit immediately after diagnosis.

Ho Cheung William Li, PhD, of The Chinese University of Hong Kong, presented results of a multicenter randomized controlled trial testing a self-determination theory–based smoking cessation intervention delivered via instant messaging.²

The trial enrolled 1,448 smokers with cancer from outpatient clinics at five major acute care hospitals in Hong Kong. Participants were randomly assigned to the intervention or control group, with 724 patients in each arm.

Ho Cheung William Li, PhD

The intervention was designed to give patients more choice and ongoing support rather than a one-time recommendation to quit. Research nurses first provided brief advice, after which patients selected either an immediate or progressive quit schedule. Participants received smoking cessation support through WhatsApp or WeChat, with weekly messages for the first 3 months and monthly messages thereafter. The intervention also included four 1-minute educational videos, delivered at weeks 1, 5, 9, and 13, that focused on the health benefits of quitting after a cancer diagnosis. Patients who chose progressive quitting also received a smoking reduction leaflet. The control group received brief advice recommending immediate cessation, along with instant messages on general health topics delivered on the same schedule.

The participants had a long history of smoking and varied in their readiness to quit. The mean duration of regular smoking was 45.3 years, and less than half of participants (48.3%) intended to quit within 30 days. Dr. Li said many patients face nicotine dependence, withdrawal symptoms, cravings, and relapse, but psychological and informational barriers also matter: some patients may not understand the relationship between smoking and cancer, may worry that quitting will harm their physical well-being, or may think it is too late to benefit because their cancer is advanced.

At 6 months, biochemically validated abstinence was significantly higher in the intervention group than in the control group: 7.7% vs 4.8% (P = .03). The difference persisted at 12 months, with abstinence rates of 8.0% vs 5.2% (P = .04).

Self-reported outcomes also favored the intervention. At 12 months, 7-day self-reported abstinence was 32.2% in the intervention group and 26.2% in the control group (P = .01). A reduction of at least 50% in daily cigarette consumption was also reported by 38.5% vs 33.3% of patients (P = .04).

“This brief, low-cost intervention grounded in self-determination theory significantly improved quit rates among smokers with cancer in outpatient settings,” Dr. Li reported.

He said the approach could be incorporated into routine oncology care and may be scalable because it relies on tools already widely used by patients and care teams.

According to Dr. Eng, who commented on the research, the modest absolute quit rates did not diminish the relevance of the study. Instead, he said, the findings underscored the need for longitudinal support that recognizes that patients’ readiness to quit may change over time.

“Even though a diagnosis of cancer is a motivator to help patients quit smoking, some patients might not be ready at the time of diagnosis,” he said.

Patients may be overwhelmed by a new diagnosis, treatment planning, and a flood of medical information, he noted. However, a digital intervention delivered over time may help move some patients from low readiness toward action.

Dr. Eng noted several strengths of the trial, including its large size, assessor-blinded design, theoretical foundation, and use of validated abstinence outcomes. He also said the intervention was accessible, convenient, and potentially scalable across regions.

Still, he raised questions for future research. It remains unclear how much of the effect was driven by the educational videos, instant messaging support, the ability to choose a quit schedule, or other smoking cessation support patients may have received. He also said future studies should consider where patients are in their treatment course, because the needs of newly diagnosed patients may differ from those of patients in long-term follow-up.

The findings, he said, support further evaluation of longitudinal digital interventions for smoking cessation in cancer care.

Frailty, Social Needs, and Health Literacy Intersect in Older Adults With GI Cancers

The final study shifted from symptom management and behavior change to frailty assessment in older adults with gastrointestinal cancers.

Presenting findings from the Dana-Farber Cancer Institute, Nadine A. Jackson, MD, MPH, BSN, said oncology cannot deliver precision care for older adults if it does not routinely measure frailty and the contextual factors that shape it.³

“Age is not the problem,” Dr. Jackson said. “Unmeasured vulnerability is.”

The study evaluated the relationships among frailty, unmet health-related social needs, and health literacy in older adults with gastrointestinal malignancies. Dr. Jackson and colleagues proposed the concept of complex frailty, defined as prefrail or frail status in the presence of any unmet health-related social need and limited or marginal health literacy.

The work was conducted through Dana-Farber’s Older Adult GI Cancer Program, which uses an electronic frailty assessment for patients aged 65 years or older with gastrointestinal cancers of any type or stage. The assessment, based on a modified Rockwood approach, was embedded in the electronic health record, available in multiple languages, and could be completed by the patient or a proxy at home or on a clinic tablet. It included domains such as functional status, nutrition, cognition, social support, and comorbidities, and categorized patients as robust, prefrail, or frail. Health-related social needs and health literacy were assessed using questionnaires, including a brief health literacy screening tool.

Patients receiving treatment who were identified as prefrail or frail were referred through the Older Adult GI Cancer Program for integrated geriatrics and pharmacy co-management, tailored health education, care coordination, and assistance programs.

From January 2022 through November 2025, 3,804 older adults were enrolled, and 75.6% completed the electronic frailty assessment. About 31% of those assessed were categorized as prefrail or frail.

The assessment also showed how frequently frailty overlapped with social needs. More than one-quarter of patients reported at least one unmet health-related social need, most commonly involving financial assistance, housing, transportation, nutrition, or caregiving.

Patients with unmet needs were more likely to be prefrail or frail. Nearly half of patients with at least one unmet need fell into these categories, compared with 23.0% of those without unmet needs. The rate was highest among patients who had both unmet social needs and limited or marginal health literacy: 60.2% were prefrail or frail.

Dr. Jackson said the findings show that frailty is not merely a biologic or functional label but is also shaped by the conditions in which patients try to receive care.

“Frailty is not optional; it is foundational,” she said. “If we don’t measure frailty, we are effectively practicing imprecise medicine in the population that needs precision the most.”

She noted that older adults with cancer vary widely in physiologic reserve, functional status, and social context, yet they remain underrepresented in clinical trials. Even when trials do not explicitly exclude older patients, eligibility criteria and concerns about toxicity may exclude those with frailty, multimorbidity, limited functional reserve, or unmet social needs. Traditional trial endpoints such as survival and tumor response may also fail to capture outcomes that older adults often prioritize, including function, independence, and quality of life.

Dr. Jackson said frailty is dynamic and potentially modifiable, making it important not only as a risk marker but also as a target for intervention. In the Dana-Farber model, identifying frailty can trigger multidisciplinary support, including physical therapy, nutrition, social work, symptom support, geriatrics, pharmacy review, and care coordination.

The broader goal, she added, is to build oncology systems that account for the biology of aging, cancer biology, social determinants, treatment context, and patient priorities.

“If we continue to ignore frailty, we will continue to generate evidence that does not serve the patients we care for,” Dr. Jackson said. “But if we measure it, understand it, and design our systems around it, we can truly deliver precision oncology for older adults.”

Dr. Jackson noted that the findings come from a single institution with three campuses, and that additional work is needed to determine whether interventions triggered by frailty assessment improve outcomes. Future studies, she said, should also integrate biomarkers and clarify how frailty, cancer biology, and social context interact.

Discussant Nisha Mohd Shariff, MBChB, of University Malaya Medical Center, said the findings support recognizing complex frailty as a distinct entity and addressing each component individually.

Nisha Mohd Shariff, MBChB

The study suggests that interventions focused solely on frailty may not be sufficient if unmet health-related social needs and limited health literacy are not also addressed, Dr. Shariff said. She also raised questions about directionality: unmet needs may increase the risk of frailty, but frailty may also make it more difficult for patients to meet their health-related social needs.

Dr. Shariff called the study clinically meaningful from a multidisciplinary perspective, while noting that the model may be more difficult to implement in smaller oncology services or resource-constrained settings. Her take-home message was that complex frailty should be recognized and managed as a whole rather than reduced to a single clinical measure.

What Supportive Care Requires

Across the three studies, the focus was not on replacing cancer treatment but on making cancer care easier to deliver and sustain: preventing early nausea during morphine initiation, supporting smoking cessation after diagnosis, and identifying frailty alongside social needs and health literacy.

The findings do not settle how these approaches should be used in every setting. But they do point to a practical theme for supportive care: identify problems early, continue to address them over time when needed, and connect the findings to interventions the care team can provide. 

DISCLOSURE: Drs. Sulfiker, Li, Eng, and Jackson reported no conflicts of interest. Dr. Shariff reported a consulting or advisory role with BeiGene; speakers bureau participation with Amgen, DKSH, and Zuellig Pharma; and travel, accommodations, or expenses from Arcus Biosciences.

REFERENCES

1. Sulfiker S, Mishra S. Efficacy of prophylactic dexamethasone in preventing opioid-induced nausea and vomiting in cancer patients: A randomized controlled trial. 2026 ASCO Breakthrough, Singapore. Abstract 313. Presented June 27, 2026.

2. Li HCW, Loong HHF, Chung JO, et al: Effects of a self-determination theory–based smoking cessation intervention plus instant messaging for smokers with cancer: A randomized controlled trial. 2026 ASCO Breakthrough, Singapore. Abstract 314. Presented June 27, 2026.

3. Hshieh T, Goniwiecha S, Taylor BD, et al: The intersection between frailty and unmet health-related social needs: Establishing the complex frailty paradigm. 2026 ASCO Breakthrough, Singapore. Abstract 96. Presented June 27, 2026.