High-Quality Cancer Care in Older Adults

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: 1 August 2025 | Viewed by 1862

Special Issue Editors


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Guest Editor
1. Professor of Internal and Geriatric Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
2. Director Geriatrics Unit, Intermediate Care Hospital, Venerabile Confraternita di Misericordia, via Cammeo 24, Navacchio, 56021 Pisa, Italy
Interests: thyroid cancers; aging process; geriatrics; thyroid function and the aging process; immune- and target therapy
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Geriatrics Unit, University of Pisa, Via Savi 10, 56126 Pisa, Italy
Interests: Alzheimer disease and dementia; cancer in the elderly; target therapy; frailty; the aging process
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The number of cancer diagnoses has been increasing in recent decades as a result of improved diagnostic capacities and demographic modifications. More than half of the subjects who are newly diagnosed with cancer are today aged 65 years or older. These estimates are expected to increase in future decades across high-income countries. As observed for other acute and chronic diseases, cancer treatment in older adults faces two major issues: the low rate of older persons enrolled in randomized clinical trials (the so-called 'evidence-based medicine issue' of geriatrics) and the need to tailor interventions for an heterogeneous population that, due to comorbidity and frailty, may differ from the standard adult population in terms of priorities, preferences and clinically relevant outcomes. Consequently, an evidence-based approach to older cancer patients is still hardly achieved in most cases. In addition, the peculiar characteristics of older patients with cancer can easily lead to either under- or overtreatment, with potentially serious drawbacks for the patients and their caregivers. Indeed, along with the overall decline in cancer-related mortality due to advances in early cancer detection and anticancer treatment, the importance of cancer therapy side effects has increased, especially among older patients. The numerous  drawbacks of anticancer treatment include kidney, liver, respiratory and cardiovascular toxicity and dysfunction, especially in frail patients, and should always be taken into account while establishing cancer treatment strategies. Thus, optimizing the management of cancer in older adults represents a major clinical problem and a top priority for modern healthcare systems. The aim of the present Special Issue of Cancers is to sum up the best of scientific knowledge regarding the clinical management and outcome of older patients with cancer, which extends beyond traditional paradigms and implies the assessment of a clinical complexity spanning multiple domains (including physical, cognitive, psychological, affective, socio-economic and environmental aspects). Unpublished research studies as well as reviews and meta-analyses dealing with the peculiar clinical aspects of cancer in older, frail people would, therefore, be much appreciated.

Prof. Dr. Fabio Monzani
Dr. Valeria Calsolaro
Guest Editors

Manuscript Submission Information

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Keywords

  • elderly
  • target therapy
  • cancer treatment
  • cancer care

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Published Papers (2 papers)

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Research

18 pages, 805 KiB  
Article
Predictors and Drivers of End-of-Life Medicare Spending Among Older Adults with Solid Tumors: A Population-Based Study
by Courtney E. Baird, Elizabeth Wulff-Burchfield, Pamela C. Egan, Lee A. Hugar, Ami Vyas, Nikolaos A. Trikalinos, Michael A. Liu, Adam J. Olszewski, Leonidas E. Bantis, Orestis A. Panagiotou and Emmanuelle Bélanger
Cancers 2025, 17(6), 1016; https://doi.org/10.3390/cancers17061016 - 18 Mar 2025
Viewed by 424
Abstract
High-intensity end-of-life (EoL) care for patients with cancer often includes multiple transitions to the hospital and intensive care unit (ICU) and is associated with adverse outcomes, such as declines in patient functional abilities [...] Full article
(This article belongs to the Special Issue High-Quality Cancer Care in Older Adults)
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12 pages, 837 KiB  
Article
Frailty and Overall Survival of Older Patients Undergoing Radiotherapy for Head and Neck Cancer: A Prospective Analysis
by Chiara Giannotti, Silvia Ottaviani, Mariya Muzyka, Luca Tagliafico, Almalina Bacigalupo, Liliana Belgioia, Celjeta Tominaj, Stefania Vecchio, Fiammetta Monacelli and Alessio Nencioni
Cancers 2024, 16(23), 3939; https://doi.org/10.3390/cancers16233939 - 25 Nov 2024
Viewed by 985
Abstract
Background/Objectives: Over 60% of diagnoses of head and neck squamous cell carcinoma (HNSCC) occur in patients aged over 65. The benefits of radiotherapy (RT) combined with chemotherapy remain controversial in geriatric patients. Frailty stratification is underutilized in clinical practice despite evidence suggesting its [...] Read more.
Background/Objectives: Over 60% of diagnoses of head and neck squamous cell carcinoma (HNSCC) occur in patients aged over 65. The benefits of radiotherapy (RT) combined with chemotherapy remain controversial in geriatric patients. Frailty stratification is underutilized in clinical practice despite evidence suggesting its predictive power. We aimed to assess the impact of pre-treatment frailty stratification on overall survival (OS) and acute radiation-related toxicity in a cohort of older patients with HNSCC. Methods: A prospective cohort of 117 patients aged ≥65 years with newly diagnosed HNSCC was enrolled between 2017 and 2022. Patients received RT with or without chemotherapy. Frailty was assessed using the 40-item Frailty Index (FI) as part of a comprehensive geriatric assessment. The primary outcomes were OS and acute RT toxicity, defined as a grade ≥ 3 based on CTCAE 5.0. Cox proportional hazard models and logistic regression models, adjusted for age, tumor stage, and chemotherapy, were used. Results: After a median follow-up of 819 days, FI (HR 1.478, 95% CI 1.182–1.848, p < 0.001) was an independent predictor of OS. Grade ≥ 3 toxicities were observed in 38% of patients, but frailty was not significantly associated with toxicity. A sub-analysis of oropharyngeal carcinoma patients demonstrated improved OS in HPV-positive patients (HR 0.231, 95% CI 0.078–0.686, p = 0.008). Conclusions: the standardized introduction of frailty assessment in the evaluation of older HNSCC patients holds great promise for predicting long-term survival. This approach could be crucial in tailoring treatment protocols that account for the biological heterogeneity of older adults. Full article
(This article belongs to the Special Issue High-Quality Cancer Care in Older Adults)
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