Geriatric oncology in the most aged societies

Remarkable advancements have been made in the care and treatment of older adults with cancer. When I first became a doctor, I recall that it was a common practice to withhold treatment from older patients with cancer. Today, this approach might be criticized as ageism [1,2]; however, at that time, cytotoxic chemotherapy was the sole available option, and its efficacy was limited. Steroids were the only antiemetics available; consequently, patients often experienced anorexia and nausea. Hence, it was justifiable to refrain from administering chemotherapy to older patients with cancer to preserve their quality of life. This was also true for surgical procedures; the patient’s chronological age occasionally prevented the performance of potentially curative surgeries. It was precisely during this period that the National Comprehensive Cancer Network (NCCN) published its first guidelines specifically for older patients with cancer [3], and the International Society of Geriatric Oncology, an organization dedicated to the care of older patients with cancer [4], was established. In the last two decades, the early detection of cancer through improved diagnostic techniques, advancements in medical devices and surgical methods that enable minimally invasive procedures, and rapid developments in cancer pharmacotherapy and supportive care have enabled effective cancer treatment for older adults while maintaining their quality of life. Nowadays, clinical guidelines for various malignancies include specific recommendations for older adults. Japan has published its own guidelines specifically designed for this population [5]. Although evidence to guide treatment decisions for older adults with cancer remains limited, there have been numerous reports of phase III trials targeting this demographic [6–8]. The Japanese Journal of Clinical Oncology (JJCO) has published a series on geriatric oncology, which is a significant milestone for those of us who remember the state of cancer care for older adults in the past. In this issue, prominent experts in cancer treatment from Japan have contributed 3 overview articles and 14 specific reviews. The overview articles discuss the current state and challenges of cancer treatment for older adults in Japan [9]. They also delve into the epidemiology of cancer among older adults using Japan’s national database and the benefits of cancer rehabilitation for this population [10,11]. These data are crucial as they reflect the current state of Japan, the country with the most advanced aging population in the world, and they provide insights into the state of geriatric oncology in Japan. It is particularly important for healthcare providers, researchers, and policymakers worldwide to understand the innovative work of Japanese professionals in the field of cancer treatment for older adults. The specific reviews encompass cancer treatment for older adults across 14 different types of cancer. Although there is still a lack of robust evidence to guide treatment decisions for older adults with cancer, randomized phase III trials are not the sole form of evidence. Community-based consensus and theoretically optimal treatments are valuable evidence, even if they are supported by weaker scientific evidence. Considering this, Japan’s leading cancer specialists have introduced various innovative approaches within each review, such as citing integrated and subgroup analyses of randomized phase III trials [12–19]. Additionally, where available, these reviews have also included randomized phase III trials that are specifically aimed at older adults with cancer. Notably, some authors have demonstrated a strong commitment to generating robust evidence by planning and conducting their own randomized phase III trials that focus on older adults with cancer [20,21]. Furthermore, these reviews address attempts to classify older adults based on frailty using geriatric assessments, as well as introduce appropriate cancer treatments for each group [22–25]. These reviews showcase the advancements in geriatric oncology in Japan, and I trust that readers will find them educational. This JJCO series follows a similar structure to Japan’s guidelines for older adults and those published by the European Society for Medical Oncology [26]. It provides detailed information on managing cancer treatment for each specific type of cancer. In contrast, the NCCN and the American Society of Clinical Oncology guidelines [27] focus more on addressing issues related to treating older adults with cancer, such as identifying and resolving problems that may arise in this population when administering cancer treatment, rather than providing specific instructions for cancer treatment. These guidelines advocate for the implementation of geriatric assessments. Recent research has demonstrated that the reduction of severe adverse events and the preservation of health-related quality of life can be achieved by not only conducting these assessments but also providing support to frail areas, as demonstrated in randomized phase III trials. Traditionally, geriatricians in Japan have not been involved in cancer treatment. Hence, the introduction of geriatric oncology was delayed since previous geriatric oncology initiatives in Japan were led by oncologists. However, recently, the Japan Geriatrics Society has shifted its emphasis to geriatric oncology [28], and organizations, such as the Japan Geriatric Oncology Society, which exclusively focuses on cancer treatment for older adults, have been established [29]. Therefore, we can expect active collaboration between oncologists and geriatricians in the future. The JJCO geriatric oncology series is expected to demonstrate even greater advancements in its second edition, and I eagerly look forward to it. None declared. None declared.