J Geriatr Oncol
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The management of older persons with cancer has become a major public health concern in developed countries because of the aging of the population and the steady increase in cancer incidence with advancing age. Nurses and allied health care professionals are challenged to address the needs of this growing population. The International Society of Geriatric Oncology (SIOG) Nursing and Allied Health (NAH) Interest Group described key issues that nurses and allied health care professionals face when caring for older persons with cancer. ⋯ Advice for integration of assessment of these geriatric domains into daily oncology practice is made. Research has mainly focused on the role of treating physicians but the involvement of nurses and allied health care professionals is crucial in the care of older persons with cancer through the GA process. The ability of nurses and allied health care professionals to perform this assessment requires specialized training and education beyond standard oncology knowledge.
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Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). ⋯ However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.
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The population is aging accounting for a large increase in anticipated cancer cases. Specialty training for trainees interested in geriatric oncology have been established in many countries and is growing globally. However, the number of clinicians with a particular interest in geriatric oncology and who complete training in both specialties is low. ⋯ The majority of older adults with cancer are, and will continue to be, treated by oncologists. Currently clinicians caring for patients with cancer receive little to no formal training in caring for older adults, resulting in gaps in knowledge as well as a lack of confidence when treating older adults with cancers. Key strategies to accelerate the uptake and impact of educational initiatives to address this gap include the use of effective educational strategies, broad dissemination of educational material that is freely available, and the integration of geriatric oncology topics into teaching, curriculum, assessments and exams.