Geriatric Oncology in 2040: From Evidence to Implementation as the Next Frontier

For more than a decade, geriatric oncology has evolved from a niche discipline into an evidence-based component of high-quality cancer care. Landmark randomized trials—including the Geriatric Assessment for Patients 70 Years and Older Starting Cancer Treatment (GAP70+) (搜索)搜索该靶点 trial, the Geriatric Assessment-Driven Intervention (GAIN) (搜索)搜索该靶点 trial, the Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) (搜索)搜索该靶点 study, and the Geriatric Intervention in Frail Older Patients With Cancer Receiving Chemotherapy (GERICO) (搜索)搜索该靶点 trial—have consistently demonstrated that geriatric assessment–guided interventions can reduce treatment toxicity, improve communication and patient-centered care, and support treatment decision-making for older adults with cancer.

These data have led ASCO (搜索)搜索该公司, the National Comprehensive Cancer Network (NCCN) (搜索)搜索该词条, and the International Society of Geriatric Oncology (SIOG) (搜索)搜索该词条 to recommend routine geriatric assessment for older adults receiving systemic therapy. Despite this strong evidence base, however, implementation remains challenging. Many oncology practices lack access to geriatricians, geriatric oncologists, or dedicated multidisciplinary resources. Time constraints, staffing limitations, workflow complexity, and competing clinical priorities have further hindered adoption, even in well-resourced settings.

At the 2026 ASCO (搜索)搜索该公司 Annual Meeting, a recurring theme emerged: the field is moving beyond asking whether geriatric assessment works and toward determining how to deliver geriatric oncology care efficiently and consistently in everyday practice. Several presentations focused on scalable implementation strategies, offering a glimpse into the field's next phase.

A Field Comes of Age

The maturation of geriatric oncology was perhaps best reflected by ASCO (搜索)搜索该公司's selection of Dr. Enrique Soto Pérez de Celis as the recipient of the 2026 B.J. Kennedy Geriatric Oncology Award. Named for one of the pioneers in the field, the award honors individuals who have made substantial contributions to improving cancer care for older adults.

In his remarks, Dr. Soto highlighted both the progress made and the challenges that remain. He emphasized that although the evidence supporting geriatric assessment is well established, many older adults worldwide still lack access to geriatric-informed cancer care. He called for continued efforts to develop scalable, equitable models that can extend the benefits of geriatric oncology care beyond specialized academic centers.

Workforce Innovation: Expanding Access Through Nurse-Led Models

One of the most clinically relevant presentations evaluated a co-designed, nurse-led multidisciplinary geriatric oncology model for treatment-naive older adults with solid tumors. Rather than relying exclusively on physicians to conduct geriatric assessments and coordinate interventions, the model used trained oncology nurses to perform structured assessments and facilitate multidisciplinary review by medical oncology and geriatric medicine teams. Full geriatrician-led comprehensive geriatric assessment was reserved for patients with more complex needs.

Among 431 eligible patients, 204 (47.3%) participated in the geriatric oncology assessment. Of those who participated, 81.4% had a G8 screening score of ≤ 14, indicating a high prevalence of vulnerability in this population. Participation was associated with higher rates of systemic anticancer therapy (70.6% vs 59.7%, P = .019) and monotherapy use (22.5% vs 13.7%, P = .016), with no differences in treatment discontinuations, delays, or dose modifications due to toxicity. Upfront treatment modification due to frailty was numerically higher among participants (21.1% vs 13.1%, P = .076), suggesting that the model facilitated appropriate treatment tailoring based on identified vulnerabilities.

The study addresses one of the most important practical barriers facing oncology programs: workforce capacity. As the number of older adults with cancer continues to rise, relying on geriatric oncologists alone to meet growing demand may not be feasible. Team-based models that distribute responsibilities across multidisciplinary providers may offer a more scalable and sustainable approach.

Telehealth as a Vehicle for Geriatric Oncology

Telehealth also emerged as an important tool for implementing geriatric oncology care. Investigators from Brazil reported results from the GAIN-S study, which evaluated the feasibility of remote geriatric assessment–guided supportive care in public oncology settings. A total of 109 patients were enrolled across public (n = 48) and private (n = 61) settings. Patients aged 65 years and older who were initiating chemotherapy underwent comprehensive geriatric assessment at baseline and again at 12 weeks, evaluating functional status, cognition, mood, nutrition, chemotherapy toxicity risk (CARG score), and quality of life (FACT-G).

The study found that remote geriatric assessment was feasible and identified actionable vulnerabilities. Among patients in the public setting, 21% were referred to one or more specialists and 44% were referred to two or more. The public cohort was younger than the private cohort (mean age, 72 vs 76 years), included a higher proportion of Black participants (58% vs 44%), had lower educational attainment, and had a higher prevalence of advanced disease (92% had stage III to IV disease). Despite these differences, baseline geriatric vulnerability profiles were similar between the public and private cohorts.

Investigators also systematically documented real-world implementation barriers: 63% of patients had limited digital literacy, 73% had limited access to videoconferencing technology, 38% experienced delays in obtaining nutritional supplements, and 50% required adaptations to exercise interventions. These findings underscore both the potential and the challenges of telehealth-based geriatric oncology care.

Artificial Intelligence as a Force Multiplier

Another notable presentation explored whether artificial intelligence (AI) could help address one of the most persistent barriers to geriatric oncology implementation: limited workforce capacity. The Geriatric Risk and Capability Evaluation (GRACE) (搜索)搜索该靶点 platform uses a conversational AI interface to conduct geriatric assessments through natural language interactions and identify age-related vulnerabilities that may affect treatment decisions and supportive care needs.

In a validation study of 70 adults aged 65 years and older enrolled from the UCLA patient portal and affiliated senior living centers, GRACE demonstrated good agreement with clinician-administered assessment, with a sensitivity of 0.73, specificity of 0.94, Cohen's kappa of 0.63, and Gwet's AC1 of 0.82. Agreement was highest in the polypharmacy domain (κ ≈ 0.97; AC1 ≈ 0.98). Usability scores were above the 80th percentile on the System Usability Scale, and 84% of participants reported confidence in using the platform.

Qualitative interviews with 15 clinicians identified GRACE as a potentially useful previsit intake tool that could facilitate integration with electronic health records and timely referrals. Rather than replacing clinicians, the platform automates portions of the assessment process, potentially reducing the time and personnel needed to conduct comprehensive evaluations. The investigators noted that larger, multisite studies are needed to evaluate clinical impact and integration into routine oncology practice.

Community-Based Implementation

A complementary approach to implementation was presented through the Cancer-Oriented Geriatric Assessment (COGA) (搜索)搜索该靶点 Clinic initiative. Investigators at the University of Toledo's Eleanor N. Dana Cancer Center, which serves a predominantly rural and suburban population across Northwest Ohio and Southeast Michigan, developed a structured model to integrate geriatric assessment into routine community oncology practice.

Patients aged 65 years and older with a positive G8 screen (≤ 14) undergo a tiered workflow based on the 5Ms framework of age-friendly care: Mind, Mobility, Medications, Matters Most, and Multicomplexity. The model incorporates standardized screening, geriatrician-led assessment, medication review and deprescribing, and goals-of-care discussions. Risk stratification is guided by validated tools, including the CARG chemotherapy toxicity score and the Schonberg Index.

Notably, the initiative was designed as a Type III hybrid implementation–effectiveness study, with primary outcomes focused on reach, adoption, and fidelity rather than clinical efficacy alone. This design reflects an important methodological shift toward evaluating whether geriatric oncology programs can be successfully integrated into routine clinical workflows.

The Road to 2040

A central message from the 2026 ASCO (搜索)搜索该公司 Annual Meeting is that the future of geriatric oncology does not depend solely on training more geriatric oncologists. Progress will also require scalable systems that enable oncology practices to deliver geriatric-informed care. Nurse-led multidisciplinary models, telehealth-enabled supportive care programs, AI-assisted assessment tools, and structured community implementation frameworks each offer potential strategies for achieving that goal.

This implementation-focused agenda aligns with a forward-looking review published in the Journal of Geriatric Oncology (JGO), which brings together diverse expert perspectives on how demographic shifts, technological advances, and evolving patient needs may reshape geriatric oncology by 2040. Key themes include the role of precision medicine and digital health, adaptation of care models, workforce challenges, and the need to address disparities while maintaining patient-centered care.

As Dr. Soto emphasized in accepting the B.J. Kennedy Geriatric Oncology Award, improving cancer care for older adults is no longer simply a research challenge; it is also an implementation challenge. The evidence supporting geriatric assessment is well established. The task now facing the oncology community is translating that evidence into practice so that older adults with cancer can benefit, regardless of geography, practice setting, or available resources.