Geriatric oncology in Brazil is becoming increasingly important as population aging profoundly transforms the epidemiology of cancer. Older adults account for the majority of incident cancer cases and frequently present with complex health and functional needs, making therapeutic decision-making substantially more challenging than in younger populations1–3. Nevertheless, geriatric oncology remains underdeveloped within the Brazilian healthcare system.
One of the major challenges is the limited availability of dedicated geriatric oncology services and multidisciplinary teams integrating oncologists, geriatricians, nurses, nutritionists, physiotherapists, pharmacists, psychologists, and social workers. Consequently, treatment decisions continue to rely predominantly on chronological age and performance status, despite growing evidence demonstrating that these parameters alone fail to capture the heterogeneity of biological aging 2,4.
Comprehensive Geriatric Assessment (CGA) has consistently demonstrated its ability to identify functional decline, frailty, cognitive impairment, malnutrition, psychological disorders, polypharmacy, and social vulnerabilities that directly influence treatment tolerance, toxicity, postoperative complications, and survival2,5. Although international guidelines strongly recommend incorporating CGA into routine oncologic practice, its implementation in Brazil remains limited by insufficient training, time constraints, inadequate reimbursement, and the absence of structured care pathways5.
Another important barrier is ageism. Older adults with preserved functional reserve are still frequently denied potentially curative therapies solely because of their chronological age. Conversely, frail patients may receive overly aggressive treatments without prior optimization through geriatric interventions, resulting in avoidable toxicity and functional decline2. Both undertreatment and overtreatment reflect the lack of individualized, patient-centered care. Regional disparities, delayed diagnosis, unequal access to specialized oncology services, limited availability of rehabilitation, nutritional support, and palliative care further contribute to poorer outcomes among older Brazilians with cancer1.
Moreover, older adults, particularly those living with frailty, cognitive impairment, or multiple chronic conditions remain substantially underrepresented in clinical trials, limiting the external validity of current evidence for this rapidly growing population2,5. Strengthening geriatric oncology in Brazil requires more than establishing specialized clinics. It demands the integration of geriatric principles into routine oncology practice, expansion of multidisciplinary care models, greater investment in professional education, increased national research, and recognition of Comprehensive Geriatric Assessment as a fundamental component of therapeutic planning.
Treating cancer in an older adult is not merely about selecting chemotherapy, surgery, radiotherapy, or targeted therapies. It is about understanding the individual behind the diagnosis: their functional reserve, frailty status, goals of care, personal values, and expected quality of life. Therapeutic decision-making should be guided not by chronological age alone, but by individualized, evidence-based, and person-centered care.
Written by Dr. Silmara Moura, MD
Geriatrician | Brazil Hub, OncoDaily
- References
Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Estimativa 2023: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2022. - Wildiers H, Heeren P, Puts M, Topinková E, Janssen-Heijnen MLG, Extermann M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014;32(24):2595-603.
- Sgnaolin V, Sgnaolin V, Schneider RH. Implicações da avaliação geriátrica ampla na qualidade de vida em pessoas idosas com câncer: revisão integrativa. Rev Bras Geriatr Gerontol. 2021;24(1):e200297.
- Travassos RO, et al. Avaliação geriátrica ampla como preditor de morbimortalidade em pacientes oncológicos vulneráveis submetidos ao tratamento quimioterápico. Rev Med (São Paulo). 2019;98(3):180-6.
- Hsu T, Mohile SG, et al. Implementation of geriatric assessment in oncology settings: a systematic realist review. J Geriatr Oncol. 2021;12(1):22-33.