Representation of geriatric oncology in cancer care guidelines in Europe: a scoping review by the International Society of Geriatric Oncology (SIOG)

Abstract

Introduction: Implementation of national cancer policy is frequently shaped by medical guidelines. These guidelines often lack detail addressing the intricate care needs of vulnerable groups such as older adults, hindering the potential impact of these policies.

Objective: To provide an overview of the representation of older adults in European cancer guidelines to identify areas for improvement.

Methods: A scoping review was conducted using the Arksey and O'Malley framework and Levac et al. extension. The search strategy was developed for grey literature (i.e. guidelines) for the five most prevalent primary malignancies (prostate, breast, colorectal, lung, and urinary bladder) in 29 countries (member states of the European Union, Switzerland, and the UK). Data were extracted by a national expert and at least one other reviewer.

Results: A total of 187 guideline reports from 31 jurisdictions were analysed, encompassing general cancer care and selected primary malignancies. The representation of older adults varied by cancer type and region. Dedicated guidelines for older adults were uncommon, with only a few jurisdictions, such as France and Spain, providing age-specific recommendations for certain malignancies. Although some national guidelines addressed older patients, this focus was inconsistent both across different cancers and within the guidelines of the same country.

Conclusions: There is limited representation of geriatric oncology across European cancer guidelines. To enhance representative guideline development, there is a call for greater consideration of older adults' unique needs. Suggestions include further guidance on the implementation of the comprehensive geriatric assessment and consequent treatment across neoadjuvant, adjuvant, and metastatic settings.

Keywords: cancer; guidelines; healthcare system; older adults; policy.

Figure 1

Map indicating European countries (European Union, Switzerland, and the UK) included in this scoping review (image generated in BioRender).

Figure 2

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flowchart for the identification of reports.

Figure 3

Number of primary malignancies with nationally produced age-specific recommendations in Europe. AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften.