Integrating Supportive Care in Geriatric Oncology

William Dale, MD, PhD, FASCO

Advancements in geriatric oncology have highlighted the importance of integrating supportive care into routine cancer treatment, particularly for older adults. According to William Dale, MD, PhD, FASCO, key advancements in the field include the development of standardized geriatric assessments, evidence-based supportive care interventions, and innovative approaches to improving access.

Dale, a professor and vice chair for academic affairs in the Department of Supportive Care Medicine at City of Hope, also achieved the prestigious B.J. Kennedy Geriatric Oncology Award, an honor he accepted during a lecture delivered at the 2024 American Society of Clinical Oncology Annual Meeting. He used his lecture to explore the evolving intersection of cancer care and aging.

“The next step is integrating these supportive care interventions into standard cancer care so patients receive both cancer treatment and supportive care based on standardized assessments,” he explained.

In an interview with Targeted Oncology^TM, Dale discussed the key themes of his lecture, highlighting the shift from the first geriatric oncology guidelines made in 2018 to the advancements that are shaping the field today.

Targeted Oncology: Could you provide us with a brief overview of this lecture?

Dale: I lectured on the history of cancer and aging, starting from the first guidelines in 2018 to today, and then looking into the future. I emphasized the assessments we perform and the interventions we implement, while also taking time to thank the community that made it all possible.

What are some of the unmet needs for the agent cancer population?

We've made significant progress in developing assessments that work. These allow us to identify patients’ vulnerabilities and issues, and we’ve conducted randomized trials showing that interventions can improve those deficits.

The next step is integrating these supportive care interventions into standard cancer care so patients receive both cancer treatment and supportive care based on standardized assessments.

A major goal is to address how cognitive and physical problems impact a patient’s ability to tolerate treatment. Additionally, improving access is critical, especially for frail, older adults who may not be able to visit cancer centers or participate in clinical trials. Telehealth and other solutions will play a big role in making these services more accessible.

Are there any highlights happening in this area that are on your radar?

I am especially interested in translating what works in academic centers—where only about 20% of cancer patients are seen—to the broader community. This includes underserved areas, whether in Chicago, remote parts of the US, or even other countries like Brazil.

For instance, we recently secured funding to expand geriatric assessments and supportive care interventions across Brazil, which has a diverse healthcare landscape. At City of Hope, we’re also extending telehealth interventions to patients at our 35 clinics, some located up to 80 miles from our main center.

The next challenge is convincing patients, doctors, and payers that these interventions provide significant value and should be better funded. Compared to other areas like drug development, supportive care interventions need more attention and resources.

Beyond telehealth, are there other supportive or palliative care interventions growing in popularity?

Holistic care is in demand—nutrition, physical therapy, cognitive rehabilitation, fall assessments. However, delivering these remotely remains challenging. Technology like wearable devices could help, such as fall monitors or remote physical therapy tools. Also, the electronic medical records, taking these assessments, which 80% of them are patient reports, and making them so that they are done prior to the clinic, for example, and not during clinic time is going to be another big innovation that is coming. People are working out the details of how to do that, including us.

There is [also] this question about are we going to have AI style decision support, which could improve information flow while maintaining the high-touch care approach patients need. We’re also exploring the “minimal viable dose” of supportive care necessary for effective delivery.

How do you see palliative and supportive care evolving?

Patients [now] expect supportive care as part of their cancer treatment. To meet this demand, we’ve made tools and resources easily accessible, such as downloadable assessments on our website. Teaching and training [is a hurdle] because a lot of the oncologists might say, I know this is important. I just don't know what to do with it when I get the information. Providing digested summaries of patient assessments and actionable steps, integrated into the medical record, is a priority.

With so few geriatricians available, most supportive care will need to be delivered by non-specialists. Our role will be to handle complex cases remotely while supporting general providers. [But we have made significant strides]. A year ago, we published 2 large studies in The Lancet and JAMA Oncology demonstrating the impact of supportive care. These studies showed a 20% reduction in chemotherapy toxicity, fewer medications, more completed advance directives, and improved communication.

The evidence now firmly supports the value of supportive care. The challenge ahead is integrating it into routine practice and convincing stakeholders that the benefits outweigh the costs.