Practical aspects of managing multimorbidity in older adults with cancer

Congratulations to UCD School of Medicine’s (opens in a new window)Professor Shane O’Hanlon, and to all those involved, on a new review in Current Opinion: Supportive and Palliative Care. The review is titled ‘Practical aspects of managing multimorbidity in older adults with cancer’ and the key findings are as follows:

• The literature supports a practical 2-step approach, using screening tools like the G-8 to trigger a full Comprehensive Geriatric Assessment (CGA) with management, which is proven to reduce treatment toxicity.
• In decision-making, the focus has shifted from guideline-concordant to goal-concordant care.
• A needs-based paradigm for integrating palliative care is replacing older, prognosis-based models.

Purpose of review 

Managing multimorbidity in older adults with cancer is a central, complex challenge in modern oncology. Historically, this population was underrepresented in clinical trials, leaving clinicians without practical guidance. This review synthesizes recent evidence that moves beyond simply documenting frailty to deploying targeted, evidence-based interventions to improve supportive and palliative care.

Recent findings 

The literature supports a practical 2-step approach to assessment, using screening tools like the Geriatric-8 to trigger a full Comprehensive Geriatric Assessment (CGA) with management, which is proven to reduce treatment toxicity. Goal-aligned deprescribing has emerged as an active clinical skill to manage polypharmacy. In decision-making, the focus has shifted from guideline-concordant to goal-concordant care. Finally, a needs-based paradigm for integrating palliative care is replacing older, prognosis-based models, distinguishing between generalist skills for all clinicians and specialist consultation for complex cases.

Summary 

Recent evidence provides clinicians with practical approaches. By using validated screening, CGA-led interventions, systematic deprescribing, and needs-based palliative care, clinical teams can reduce treatment toxicity, lessen medication burden, and align complex cancer care with the personal priorities and quality-of-life goals of older patients.

(opens in a new window)Read the review on the Supportive and Palliative Care website.