New JCO Guidelines Enhance Care for Older Cancer Patients
Recent guidelines published in the Journal of Clinical Oncology (JCO) represent a meaningful step forward in ensuring older adults recieve appropriate and effective cancer treatment. These guidelines, spurred by advocacy for improved data reporting in clinical trials involving older patients, emphasize the critical need to incorporate geriatric baseline parameters into study design and reporting.
For too long, data on cancer treatment outcomes in older individuals have been incomplete, hindering a precise understanding of treatment effects within this demographic. The new JCO guidelines align with recommendations from the American Society of Clinical Oncology (ASCO) and utilize modified templates from the Cancer Therapy Evaluation Program (CTEP) to address this gap. These templates call for comprehensive assessments of functional status, cognitive function, nutritional status, and comorbidities - factors crucial to understanding how treatments impact older patients.
the importance of this data lies in its potential to reveal whether older patients experience comparable benefits to younger patients, and to mitigate the risk of avoidable toxicity. Older adults often exhibit unique responses to cancer therapies, potentially experiencing greater side effects or a diminished quality of life. Comprehensive baseline data allows for a more nuanced understanding of these vulnerabilities.
To ensure adherence, the guidelines advocate for mandatory collection and reporting of these parameters in all relevant studies. Reviewers, including institutional review boards and the National Cancer Institute, are encouraged to enforce these standards.Furthermore, JCO editors will now require a written clarification, published alongside the paper, for any study failing to comply, along with plans for future data collection.
These changes build upon previous calls for improved reporting, dating back to 20122, and reflect a growing recognition of the need for specialized geriatric oncology research3, 4. Existing ASCO guidelines5, 6, 7 already emphasize practical assessment and management of vulnerabilities in older cancer patients, and the new JCO guidelines strengthen the framework for implementing these principles in clinical trials. Ethical considerations surrounding overtreatment and undertreatment in this population further underscore the importance of these changes8.
Dr. Steven M.Lichtman, a leading advocate for geriatric oncology, expressed gratitude for the JCO editors’ responsiveness to a proposal made in September 2023, suggesting it was instrumental in bringing these vital guidelines to fruition. Dr. Lichtman reported no conflicts of interest.
REFERENCES
- Wheeler SB, Iasonos A, Cheng I, et al: Guidance for JCO authors on subgroup representation and reporting. J Clin Oncol 43:2759-2762,2025.
- Lichtman SM: Call for changes in clinical trial reporting of older patients with cancer. J Clin Oncol 30:893-894, 2012.
- Lichtman SM: Missed opportunities in geriatric oncology research. Oncologist 28:373-375, 2023.
- Lichtman SM: all oncologists are geriatric oncologists…they just don’t no it yet. The ASCO Post. August 25, 2019.
- Dale W, Klepin HD, Williams GR, et al: Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol 41:4293-4312,2023.
- Mohile SG, Dale W, Somerfield MR, et al: Practical assessment and management of vulnerabilities in older patients receiving chemotherapy. ASCO guideline for geriatric oncology. J Clin Oncol 36:2326-2347, 2018.
- Hurria A, Levit LA, Dale W, et al: Improving the evidence base for treating older adults with cancer: American Society of Clinical Oncology statement.J Clin Oncol 33:3826-3833, 2015.
- DuMontier C, Dale W, Revette AC, et al: Ethics of overtreatment and undertreatment in older adults with cancer. BMC Med Ethics 26:105,2025.
Dr. lichtman is an attending physician (retired) at Memorial Sloan Kettering Cancer Center, Commack, New York; Professor of Medicine at Weill Cornell Medical College, New York; a consultant for Wilmot Cancer Institute Geriatric Oncology Research, University of Rochester; and Past President of the International Society of Geriatric Oncology (SIOG). Dr. Lichtman is also Guest Editor of the Geriatrics for the Oncologist column in The ASCO Post.
