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Cited by 79COVID-19 and healthcare impactsFrailty in Older AdultsNutrition and Health in Aging

Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group

Open access
Battisti, Nicolò Matteo Luca, Mislang, Anna Rachelle, Cooper, Lisa, O'Donovan, Anita, Audisio, Riccardo A., Cheung, Kwok-Leung, Sarrió, Regina Gironés, Stauder, Reinhard +15 more·2020·Journal of Geriatric Oncology
DOI 10.1016/j.jgo.2020.07.008PMC PMC7365054
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Abstract

The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population.

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Crossref · 10.1016/j.jgo.2020.07.008

Cites

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Claims the paper makes

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  • Premisecitation

    In the CCC19 cohort, mortality was closely associated with age; relative risk of death was 11% for ages 65-74 and 25% for over 75, compared with 6% for under 65.

    “Mortality was found to be closely associated with age, with patients aged 65–74 and over 75 years having a relative risk of death of 11% and 25% respectively, compared to 6% for patients below the age of 65 years.”
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    SBRT offers an improved safety profile, especially important for frail and older patients.

    “In contrast, stereotactic body RT (SBRT) might still be appropriate in the context of its better safety profile, which is particularly relevant in frail and older individuals [61].”
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    There is a lack of baseline epidemiological information about cancer type, stage, and treatment at the time of COVID-19 infection.

    “On the other hand, baseline information from epidemiological data on specific cancer types, stage, and treatment at the time of COVID-19 infection are lacking.”
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    The FAST-Forward trial's experimental arm included 15% of patients aged 70 years and above.

    “For early breast cancer, 15% of patients enrolled in the FAST-Forward study experimental arm were aged 70 years and older and this trial confirmed non-inferiority of a shorter course of adjuvant RT (26 Gy in 5 fractions) compared with a standard regimen of 40 Gy in 15 fractions [53].”
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    Primary endocrine therapy for older patients with early-stage ER-positive, HER2-negative breast cancer is supported by evidence showing no positive impact of surgery on overall survival.

    “For example, the use of primary endocrine therapy for older patients with early-stage ER-positive, HER2-negative breast cancer is supported by evidence demonstrating no positive impact of surgery on overall survival (OS) [[48], [49], [50]].”
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    Interpretationreasoning

    COVID-19 is an additional competing risk to consider when making treatment decisions for older adults with cancer.

    “COVID-19 represents an additional competing risk factor to consider when undertaking therapeutic decisions for older adults with cancer (Fig. 1 ).”
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    COVID-19 mortality rises with increasing age and with comorbidities.

    “While the virus affects people of all ages, data have consistently shown that mortality is higher with increasing age and comorbidities [[3], [4], [5], [6]].”
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    The case fatality rate for COVID-19 in patients younger than 70 years was reported as 0.3-3.5%.

    “The case fatality rates (CFR) in patients aged less than 70 years were reported as 0.3–3.5% [7,8].”
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    Older age and a cancer diagnosis are significant predictors of poor outcomes from COVID-19.

    “Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection.”
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      “Older age and comorbidities such as cardiovascular disease, diabetes, chronic respiratory disease, chronic renal impairment, and cancer have been shown to increase risk for worse outcomes from COVID-19. [11,12]”
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    In New York City, the death rate among people aged 75 years or older was more than 1511 per 100,000 population.

    “In the United States, the death rate in New York City among patients aged 75 years or older was more than 1511 per 100,000 population [10].”
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    The University of Rochester SOCARE and Ohio State University group described a multi-domain GA framework that is mostly telephone-based.

    “One example was outlined by the University of Rochester Specialized Oncology Care and Research in the Elderly (SOCARE) and the Ohio State University group. They presented a framework for multi-domain GA that can be conducted mostly by telephone.”
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    Among older patients, underlying comorbidities are linked to more severe COVID-19 and higher mortality.

    “Older patients with underlying comorbidities have increased disease severity and mortality from COVID-19 [26].”
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    In Italy, the mean age of patients who died from COVID-19 was 80 years, and the case fatality rate rose with age beyond 70 years: 12.5% (70-79), 19.7% (80-89), and 22.7% (over 90).

    “In Italy, epidemiological data shows that the mean age of patients dying from COVID-19 was 80 years [9], with CFR rising with increasing age beyond 70 years: 12.5% (70–79), 19.7% (80–89) and 22.7% (over 90) [8].”
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    For high-risk early prostate cancer, RT may be delayed by 2-3 months while initiating ADT.

    “in cases of high-risk disease, RT can be delayed for up to 2–3 months while starting patients on ADT [67].”
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    In China, the case fatality rate for COVID-19 was 8% in patients aged 70-79 years and around 15% in those over 80 years.

    “This is in contrast to the CFR of 8% in patients aged 70–79 years and around 15% in those aged over 80 years in China [7].”
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    In low-risk early prostate cancer, RT may be postponed for 3-6 months while pursuing active surveillance or initial ADT.

    “RT can be delayed by 3–6 months for patients with early prostate cancer in case of low-risk disease while aiming for either active surveillance or upfront androgen deprivation therapy (ADT) [65,66];”
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    In the CCC19 cohort, patients with both cancer and COVID-19 had a median age of 66 years, and 56% were at least 65 years old.

    “In the recently published COVID-19 and Cancer Consortium (CCC19) cohort, the median age of patients with cancer and COVID-19 was 66 years, and 56% were aged 65 years and older [14].”
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    Telehealth has been widely implemented during the pandemic and is effective, even for vulnerable populations.

    “Telehealth has been implemented widely across settings in the midst of the current pandemic, and has been shown to be an effective modality [37] even for vulnerable populations [38].”
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    Social restrictions and shielding can decrease physical activity, which can accelerate loss of muscle mass and bone density, and mobility and functional impairment in older adults.

    “In addition, social restrictions and shielding can lead to significant decrease in physical activity which, in turn, can contribute to or accelerate loss of muscle mass and bone density, as well as mobility and functional impairment in older adults; [18,19]”
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    People in nursing homes or other institutional settings face higher risk of COVID-19 infection, abandonment, and mental health problems.

    “institutionalized patients, such as those in a nursing care facility are at higher risk of acquiring COVID-19 infection, increased feelings of abandonment, as well as mental health problems [20,21].”
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    The telemedicine GA includes a pre-visit phone screen to identify vulnerability and guide decision-making for older adults with cancer.

    “This telemedicine version of the GA includes a pre-visit phone screen to identify areas of vulnerability and help guide decision-making for older adults with cancer (Table 1 ) [39].”
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    Prevention measures during the pandemic have included home confinement and social distancing for cancer patients, limiting hospital visits, and reducing immunosuppression and treatment-related toxicities.

    “Primary and secondary prevention measures have included home confinement and social distancing of patients with cancer, limiting their hospital visits where the risk of acquiring COVID-19 is high, and reducing iatrogenic immunosuppression and treatment-related toxicities, which often leads to inpatient admissions that could put pressure on already stretched resources [17].”
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    Frailty is a superior predictor of adverse outcomes compared with chronological age in older adults across multiple clinical settings.

    “Prior to this pandemic, frailty had been increasingly adopted as a superior predictor of adverse outcomes over chronologic age for older adults in multiple clinical settings.”
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    Interpretationreasoning

    For most patients, screening for frailty may be enough, reducing visits and infection exposure.

    “In the majority of cases, in the interest of time to limit visits and infection exposure for professionals and patients, geriatric screening may be sufficient to identify the risk of frailty in some way.”
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    GA is particularly valuable when competing risks are more prevalent.

    “GA is particularly valuable in a context where competing risks are more prevalent.”
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    Interpretationreasoning

    Surgical management of non-invasive tumors like breast ductal carcinoma in situ can be delayed because it is unlikely to affect survival in older adults.

    “Surgical management of non-invasive tumors, such as breast ductal in-situ carcinoma, can also be delayed since they are unlikely to impact on survival outcomes in this age group.”
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    Premisecitation

    Essential procedures include those where a delay of two or three months significantly impacts outcomes, or where surgery is crucial for managing cancers such as breast, colon, gastric, pancreatic, liver, bladder, renal, lung, and brain tumors.

    “Apart from emergency operations, any essential procedures may include those where a delay by two or three months can significantly impact on outcomes and/or those where surgery is a crucial component of cancer management, such as for breast, colon, gastric, pancreatic, liver, bladder, renal, lung and brain tumors [42,43].”
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    Interpretationreasoning

    GA may estimate physiologic reserve and adaptive capability, assess risk-benefits of providing or withholding treatments, and determine patient preferences to inform treatment decisions.

    “GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions.”
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      “GA may estimate physiologic reserve and adaptive capability, assess risk-benefits of either providing or temporarily withholding treatments, and determine patient preference to help inform treatment decisions.”
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    Interpretationcitation

    The decision to treat older cancer patients is best guided by GA and multidisciplinary discussion to determine treatment options, predict toxicities, and manage cancer and competing risks.

    “The decision to treat older patients with cancer is best guided with GA and discussed in a multidisciplinary setting to help care providers determine the best treatment options, predict treatment-related toxicities, and establish ongoing management for cancer and other competing risks [31].”
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    The risk of delirium is important and underestimated.

    “The risk of delirium is especially important and underestimated, called by some experts the “silent epidemic within the pandemic.” [22,23]”
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    COVID-19 is acquired through respiratory virus transmission by close contact, droplets, or aerosol, and viral stability and viability depend on objects or surfaces.

    “In general, COVID-19 is acquired by transmission of a respiratory virus via close contact, droplet spray or aerosol, with the duration of viral stability and viability maintained depending on various objects or surfaces [16].”
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    Scheduled elective inpatient surgery may be postponed.

    “Elective surgical procedures scheduled at inpatient facilities may be delayed [40,41].”
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    The use of these tools has not been validated in COVID-19, and evidence for their use is limited.

    “However, others have highlighted that their use has not been validated in these circumstances, and advocate for cautious implementation in the context of the pandemic as clear evidence is limited [34,35].”
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    Premisecitation

    Tools such as the Clinical Frailty Scale and the Frailty Index have been suggested for screening and stratifying frailty during COVID-19.

    “Different tools, such as the Clinical Frailty Scale and the Frailty Index have been proposed to screen and stratify frailty in the setting of COVID-19 [32,33].”
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    Premisecitation

    In oncology, frailty predicts treatment toxicity and mortality, and cancer societies recommend GA to assess frailty before treatment in older adults.

    “In the oncology setting, frailty has been proven to predict toxicity from treatment and mortality, and leading cancer societies have recommended GA to gauge frailty prior to treatment in older adults to assess such risks [[28], [29], [30]].”
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    For older adults with cancer, who are already underrepresented in oncology research, the pandemic adds another major obstacle to trial participation.

    “The COVID-19 pandemic presents a further major barrier to participation in clinical trials for older adults with cancer, who are already under-represented in oncology studies [102].”
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    In older ER-positive, HER2-negative breast cancer patients, aromatase inhibitors show low toxicity and reasonable response rates at 3-4 months.

    “A neoadjuvant endocrine approach is particularly valuable for older patients with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer, as aromatase inhibitors are associated with low toxicity and reasonable response rates at 3–4 months [92].”
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    Geriatric assessment-based models exist for predicting chemotherapy toxicity and can support treatment choices in older adults.

    “Models based on GA have been developed to predict chemotherapy toxicity and may aid therapeutic decisions in older patients.”
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    More than two-thirds of cancer survivors are older adults.

    “Older people account for more than two-thirds of cancer survivors [99].”
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    Older cancer survivors may experience disproportionate physical and psychosocial effects from COVID-19, with possible long-term unintended consequences.

    “However, COVID-19 may disproportionately impact older cancer survivors' physical health and psychosocial wellbeing, which may lead to unintended consequences in the long-term [100].”
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  • The paper relies on this without support.

    Cancer predominantly affects older adults.

    “Cancer is a disease of older adults.”

  • The paper relies on this without support.

    The COVID-19 pandemic creates a barrier to equal and evidence-based cancer management for older adults.

    “The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults.”

  • The paper relies on this without support.

    Older cancer patients are likely to be doubly disadvantaged when health systems are overwhelmed.

    “older patients with cancer are likely to be doubly disadvantaged as health systems are overwhelmed.”

  • The paper relies on this without support.

    Geriatric screening tools can be self-administered by patients.

    “We recommend using screening tools that can be self-administered by patients, such as the G8 screening tool or Vulnerable Elders-13 Survey (VES13) [36].”

  • The paper relies on this without support.

    Predicting when the COVID-19 outbreak will end remains a significant challenge.

    “Nonetheless, predicting when the outbreak will end, even at a local level remains a significant challenge.”

  • The paper relies on this without support.

    In older patients with early-stage breast cancer, a radiotherapy boost does not enhance survival.

    “Also, adding a RT boost for patients with early-stage breast cancer does not improve survival outcomes and might cause additional toxicities in older patients.”

  • The paper relies on this without support.

    A radiotherapy boost may lead to extra toxicities in older early-stage breast cancer patients.

    “Also, adding a RT boost for patients with early-stage breast cancer does not improve survival outcomes and might cause additional toxicities in older patients.”

  • The paper relies on this without support.

    During a pandemic, systemic therapies' tumor-control benefits remain the same.

    “The potential benefits of systemic treatments (including chemotherapy, targeted therapy, endocrine therapy and immunotherapy) in terms of tumor control are unchanged during a pandemic.”

  • The paper relies on this without support.

    Systemic treatment risks could be elevated, particularly for agents that suppress bone marrow or need frequent hospital visits and raise infection exposure.

    “However, risks may be higher especially for treatments causing myelosuppression or requiring frequent hospital visits and increased infection exposure.”

  • The paper relies on this without support.

    Evidence about how immunotherapy affects COVID-19 is scarce.

    “Data are limited on the impact of immunotherapy on COVID-19 and potential risks and benefits should be balanced and personalized in older patients.”

  • The paper relies on this without support.

    Pandemic restrictions and distancing have cut older people's access to information, family and friend support, and social and personal care services that help them manage at home.

    “COVID-19 restrictions and physical distancing guidelines have resulted in reduced access to available information, care and supports from families and friends, as well as social and personal care services that allow older persons, including those living with disabilities, to cope at home.”

  • The paper relies on this without support.

    Older cancer patients may have symptoms from their cancer, treatment toxicity, worsened comorbidities, or COVID-19 that could necessitate hospital care or palliative referral.

    “Older persons with cancer may present with symptoms associated with their malignancy or treatment toxicity, exacerbation of comorbidities or COVID-19 that may require hospital admission for critical care and/or referral to palliative care.”

  • The paper relies on this without support.

    There is a lack of evidence on survivorship care for older cancer survivors during the pandemic.

    “Nonetheless, as evidence here is still lacking, the recommendations valid for the general population should apply also to older cancer survivors.”
13 of 13

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Prominent national and international cancer organizations have availed resources to inform cancer patients and survivors about their susceptibility to the negative physiological effects of COVID-19.

    “Although prominent national [13, 14] and international [15, 16] cancer organizations have availed resources to inform cancer patients and survivors about their susceptibility to the negative physiological effects of COVID-19, no known studies have assessed the psychosocial implications of COVID-19 on post-treatment of older cancer survivors.”

    From Coping during COVID-19: A mixed methods study of older cancer survivors (2021) · cites this paper as [16]

Cites

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8 of the 102 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. 2020, Zhonghua Liu Xing Bing Xue Za Zhi, 41, 145
  2. Kuderer, 2020, Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study, Lancet, 395, 1907, 10.1016/s0140-6736(20)31187-9 · DOI · Paper page

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Authors
Battisti, N. M. L., Mislang, A. R., Cooper, L., O'Donovan, A., Audisio, R. A., Cheung, K.-L., Sarrió, R. G., Stauder, R., Soto-Perez-de-Celis, E., Jaklitsch, M., Williams, G. R., O'Hanlon, S., Alam, M., Cairo, C., Colloca, G., Gil, L. A., Sattar, S., Kantilal, K., Russo, C., Lichtman, S. M., Brain, E., Kanesvaran, R., & Wildiers, H.
Affiliations
  • Royal Marsden NHS Foundation Trust (GB)
  • Flinders Medical Centre (AU)
  • Brigham and Women's Hospital (US)
  • University of Gothenburg (SE)
  • University of Nottingham (GB)
  • Hospital Universitari i Politècnic La Fe (ES)
  • Innsbruck Medical University (AT)
  • University of Alabama at Birmingham (US)
  • Pfizer (Australia) (AU)
  • Department of Health (PH)
  • Agostino Gemelli University Polyclinic (IT)
  • Universidade de São Paulo (BR)
  • University of Saskatchewan (CA)
  • University of East Anglia (GB)
  • Lyon 1 Université (FR)
  • Memorial Sloan Kettering Cancer Center (US)
  • Institut Curie (FR)
  • SingHealth (SG)
  • Universitair Ziekenhuis Leuven (BE)
Corresponding author
  • Battisti, Nicolò Matteo Luca
  • Mislang, Anna Rachelle
  • Cooper, Lisa
  • Audisio, Riccardo A.
  • Cheung, Kwok-Leung
  • Stauder, Reinhard
  • Jaklitsch, Michael
  • Williams, Grant R.
  • Alam, Mahmood
  • Sattar, Schroder
  • Kantilal, Kumud
  • Russo, Chiara
  • Lichtman, Stuart M.
  • Brain, Etienne
  • Kanesvaran, Ravindran
  • Wildiers, Hans
ORCID
Venue
Journal of Geriatric Oncology
Publisher
Elsevier BV
Published
2020-11
Volume
11
Issue
8
Pages
1190-1198
ISSN
1879-4068 (ISSN-L)
DOI
10.1016/j.jgo.2020.07.008
PMC
PMC7365054
OpenAlex
W3042859035
Semantic Scholar
c8ffcfb0e11220467d6a48ee2ed2c1c0dd739af3
Cited by
79
References
102
Citations by year
2026: 3 · 2025: 5 · 2024: 2 · 2023: 10 · 2022: 24 · 2021: 28 · 2020: 7
FWCI
6.23
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Geriatric Oncology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • National Cancer Institute (P30CA008748)
  • Institute of Cancer Research
  • NIHR Bristol Biomedical Research Centre
Topics
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
COVID-19 pandemic, older adults, geriatric oncology, geriatric assessment, cancer surgery, radiotherapy, systemic cancer therapy, palliative care, treatment de-escalation, telemedicine, risk-benefit assessment, treatment decision-making
MeSH terms
COVID-19, Aged, Geriatrics, Humans, Medical Oncology, Neoplasms, Palliative Care, Societies, Medical, Geriatric Assessment, Risk Assessment, Consensus, Pandemics

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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