Critical assessment of geriatric oncology guidelines based on the AGREE II tool

The world's population is aging rapidly and older adults carry a disproportionate cancer burden. Despite this, older patients remain underrepresented in clinical research. As a result, the evidence base informing guideline development remains limited. Existing guidelines vary in methodological quality and applicability. We aimed to evaluate the quality and clinical applicability of established geriatric oncology guidelines using the Appraisal of Guidelines Research and Evaluation, version II (AGREE II) instrument.

A systematic search was conducted across PubMed, Embase, and the Cochrane Library, in addition to official oncology society websites (ASCO, NCCN, SoFOG, Japanese Geriatric Oncology Group). The search covered publications from January 2000 to May 2025 and was limited to English and to guidelines that specifically address cancer care in older adults and provide documented methodologies. Two reviewers independently appraised each guideline using the AGREE II tool across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence.

A total of 807 records were identified,out of which only 6 guidelines met the eligibility criteria. The AGREE II assessment revealed significant variability in guideline quality. Most guidelines scored high in clarity of presentation and scope and purpose, but showed moderate to low scores in stakeholder involvement and applicability. The recent ASCO guidelines demonstrated higher overall methodological rigor, whereas others lacked comprehensive documentation of evidence synthesis and user applicability.

While several geriatric oncology guidelines demonstrate acceptable quality, inconsistencies remain, particularly in stakeholder engagement and practical implementation. Enhanced methodological rigor and inclusive development processes are essential for future guideline improvement and effective translation into geriatric oncology practice.