Practical aspects of managing multimorbidity in older adults with cancer

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.

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.

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.