Tiffany Zhang, Shely Kagan, Lauren Curry, Martine Extermann, Grant R Williams, Gustavo Nader Marta, Ana C D Grisotto, Chad Han, Wendy Chan, Leonardo Brandão de Oliva, Edward Chow, Henry C Y Wong, Adrian Wai Chan
This review examined leading international geriatric oncology practice guidelines, including the International Association of Geriatric Oncology (SIOG) 2014, SIOG Screening Tools Update 2014, National Comprehensive Cancer Network (NCCN) 2025, American Society of Clinical Oncology (ASCO) 2023, The European Society for Medical Oncology (ESMO)/SIOG 2025, and ASCO Global 2025, to specifically delineate areas of convergence and divergence. This analysis aimed to highlight critical inconsistencies that influence clinical decision-making and propose directions for future research. Particular emphasis is placed on how heterogeneity in assessment strategies and intervention frameworks may influence feasibility, implementation, and patient outcomes across a range of health care system and resource settings. Analysis demonstrated universal agreement that multidomain geriatric assessment (GA) is essential for evaluating functional status, cognition, nutrition, psychological health, social support, polypharmacy, and the risk of treatment-induced morbidities. GA-guided interventions are consistently emphasized to reduce treatment toxicity, improve advanced care planning and quality of life outcomes. However, significant divergence was identified across the recommended tools, screening strategies, age cut-off for GA, recommended clinical interventions and the use of non-cancer specific life expectancy data. Most guidelines cited evidence from high-income countries, limiting generalizability of their recommendations regarding GA to other settings. Few guidelines provide recommendations based on cost-effectiveness analyses or implementation research, nor do they address patient or caregiver perspectives systematically. Awareness of the differences and gaps in existing geriatric oncology guidelines may aid clinicians and policymakers to choose an appropriate GA strategy that is recommended by the guidelines, while accounting for resource constraints, patient characteristics and treatment contexts. Future research should focus on standardizing framework for collecting essential geriatric oncology data to allow pooled data analysis, harmonization of a universally accepted, minimum core set of GA components, the development of consensus-based, resource-stratified intervention models that incorporate patient and caregiver perspectives, and leveraging technology to enhance patient care.