A scoping review of ageism towards older adults in cancer care

Published:October 13, 2022DOI:



      Ageism towards older adults with cancer may impact treatment decisions, healthcare interactions, and shape health/psychosocial outcomes. The purpose of this review is twofold: (1) To synthesize the literature on ageism towards older adults with cancer in oncology and (2) To identify interventions that address ageism in the healthcare context applicable to oncology.

      Materials and methods

      We conducted a scoping review following Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted an exhaustive multi-database search, screening 30,926 titles/abstracts. Following data abstraction, we conducted tabular, narrative, and textual synthesis.


      We extracted data on 133 papers. Most (n = 44) were expert opinions, reviews, and letters to editors highlighting the negative impacts of ageism, expressing the need for approaches addressing heterogeneity of older adults, and calling for increased clinical trial inclusion for older adults. Qualitative studies (n = 3) described healthcare professionals' perceived influence of age on treatment recommendations, whereas quantitative studies (n = 32) were inconclusive as to whether age-related bias impacted treatment recommendations/outcomes or survival. Intervention studies (n = 54) targeted ageism in pre/post-licensure healthcare professionals and reported participants' improvement in knowledge and/or attitudes towards older adults. No interventions were found that had been implemented in oncology.


      Concerns relating to ageism in cancer care are consistently described in the literature. Interventions exist to address ageism; however, none have been developed or tested in oncology settings. Addressing ageism in oncology will require integration of geriatric knowledge/interventions to address conscious and unconscious ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings.


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        • Officer A.
        • de la Fuente-Núñez V.
        A global campaign to combat ageism.
        Bull World Health Organ. 2018; 96: 295
        • World Health Organization
        Global report on ageism: Executive summary.
      1. Gaining momentum: a frameworks communications toolkit. 2020
        • Levy B.
        Stereotype embodiment:a psychosocial approach to aging.
        Curr Dir Psychol Sci. 2009; 18: 332-336
        • Levy B.R.
        • Slade M.D.
        • Chang E.-S.
        • et al.
        Ageism amplifies cost and prevalence of health conditions.
        Gerontologist. 2018; 60: 174-181
        • Westerhof G.J.
        • Miche M.
        • Brothers A.F.
        • et al.
        The influence of subjective aging on health and longevity: a meta-analysis of longitudinal data.
        Psychol Aging. 2014; 29: 793
        • Chang E.-S.
        • Kannoth S.
        • Levy S.
        • et al.
        Global reach of ageism on older persons health: a systematic review.
        PLoS One. 2020; 15e0220857
        • Monahan C.
        • Macdonald J.
        • Lytle A.
        • et al.
        COVID-19 and ageism: how positive and negative responses impact older adults and society.
        Am Psychol. 2020; 75: 887-896
        • Fraser S.
        • Lagacé M.
        • Bongué B.
        • et al.
        Ageism and COVID-19: what does our societys response say about us?.
        Age Ageing. 2020; 49: 692-695
        • Kagan S.H.
        Ageism in cancer care.
        in: Seminars in Oncology Nursing. Elsevier, 2008: 246-253
        • Mohile S.G.
        • Mohamed M.R.
        • Culakova E.
        • et al.
        A geriatric assessment (GA) intervention to reduce treatment toxicity in older patients with advanced cancer: a University of Rochester Cancer Center NCI community oncology research program cluster randomized clinical trial (CRCT).
        Am Soc Oncol. 2020; 38
        • Hurria A.
        Incorporation of geriatric principles in oncology clinical trials.
        J Clin Oncol. 2007; 25: 5350-5351
        • DuMontier C.
        • Loh K.P.
        • Bain P.A.
        • et al.
        Defining undertreatment and overtreatment in older patients with cancer: a scoping review of the literature.
        Am Soc Clin Oncol. 2020; 38: 2558-2569
        • Swaminathan V.
        • Audisio R.
        Geriatric oncology: a problem and solution.
        Oncology News. 2012; 7: 12-13
        • Pham J.
        • Conron M.
        • Wright G.
        • et al.
        Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era?.
        ERJ Open Res. 2021; 7
        • Shin D.W.
        • Park K.
        • Jeong A.
        • et al.
        Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: a nationwide Korean survey.
        J Geriatr Oncol. 2019; 10: 459-464
        • Arksey H.
        • O’Malley L.
        Scoping studies: towards a methodological framework.
        Int J Soc Res Methodol. 2005; 8: 19-32
        • Levac D.
        • Colquhoun H.
        • O’Brien K.K.
        Scoping studies: advancing the methodology.
        Implement Sci. 2010; 5: 1-9
        • Rethlefsen M.L.
        • Kirtley S.
        • Waffenschmidt S.
        • et al.
        PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews.
        Syst Rev. 2021; 10: 1-19
        • McGowan J.
        • Sampson M.
        • Salzwedel D.M.
        • et al.
        PRESS peer review of electronic search strategies: 2015 guideline statement.
        J Clin Epidemiol. 2016; 75: 40-46
        • Bramer W.M.
        • Giustini D.
        • de Jonge G.B.
        • et al.
        De-duplication of database search results for systematic reviews in EndNote.
        J Med Library Associat JMLA. 2016; 104: 240
        • World Health Organization
        WHO clinical consortium on healthy ageing report of consortium meeting 1–2 December 2016 in Geneva, Switzerland. Geneva.
        Switzerland World Health Organization, 2016
        • Adelman R.D.
        • Greene M.G.
        • Phongtankuel V.
        • et al.
        Communication involving special populations: older adults with cancer.
        Curr Opin Support Palliat Care. 2019; 13: 64-68
        • Ayres M.E.R.
        Cancer and the older population: considerations for healthcare professionals.
        Top Ger Rehabilitat. 2004; 20: 75-80
        • Balducci L.
        Studying cancer treatment in the elderly patient population.
        Cancer Control. 2014; 21: 215-220
        • Barta J.A.
        • Zinner R.G.
        • Unger M.
        Lung cancer in the older patient.
        Clin Geriatr Med. 2017; 33: 563-577
        • Berkman B.
        • Rohan B.
        • Sampson S.
        Myths and biases related to cancer in the elderly.
        Cancer. 1994; 74: 2004-2008
        • Bernardi D.
        • Errante D.
        • Bianco A.
        • et al.
        Treatment of elderly cancer patients: a planet in evolution [6].
        J Am Geriatr Soc. 2006; 54: 372-373
        • Bouchardy C.
        • Rapiti E.
        • Blagojevic S.
        • et al.
        Older female cancer patients: importance, causes, and consequences of undertreatment.
        J Clin Oncol. 2007; 25: 1858-1869
        • Bourbonniere M.
        • Kagan S.H.
        Nursing intervention and older adults who have cancer: specific science and evidence based practice.
        Nurs Clin N Am. 2004; 39: 529-543
        • Boyle D.M.
        Realities to guide novel and necessary nursing care in geriatric oncology.
        Cancer Nurs. 1994; 17: 125-136
        • Boyle D.M.
        • Engelking C.
        • Blesch K.S.
        • et al.
        Oncology Nursing Society position paper on cancer and aging: the mandate for oncology nursing.
        Oncol Nurs Forum. 1992; 19: 913-933
        • Byers T.
        Targeting cancer prevention and screening practices for older adults.
        J Am Geriatr Soc. 2009; 57: s243-s245
        • Davis C.
        Age discrimination in breast cancer treatment highlighted.
        Nurs Older People. 2010; 22: 6-7
        • Fuchshuber P.R.
        Age and cancer surgery: judicious selection or discrimination?.
        Ann Surg Oncol. 2004; 11: 951-952
        • Hamnett K.E.
        • Subramanian A.
        Breast reconstruction in older patients: a literature review of the decision-making process.
        J Plast Reconstr Aesthet Surg. 2016; 69: 1325-1334
        • Jack K.
        • Ridley C.
        • Turner S.
        Effective communication with older people.
        Nurs Older People. 2019; 29
        • Kagan S.H.
        Breaking the real language barrier in care for older people.
        Int J Older People Nurs. 2017; 12 (n/a-N.PAG)
        • Kagan S.H.
        • Maloney K.W.
        Cancer screening and early detection in older people: considerations for nursing practice.
        Semin Oncol Nurs. 2017; 33: 199-207
        • Kanaskie M.L.
        • Tringali C.A.
        Promoting quality of life for geriatric oncology patients in acute care and critical care settings.
        Crit Care Nurs Q. 2008; 31: 2-11
        • Kazmierska J.
        Do we protect or discriminate? Representation of senior adults in clinical trials.
        Rep Pract Oncol Radiother. 2013; 18: 6-10
        • Kearney N.
        • Miller M.
        Elderly patients with cancer: an ethical dilemma.
        Crit Rev Oncol Hematol. 2000; 33: 149-154
        • Klepin H.D.
        • Hurd D.D.
        Autologous transplantation in elderly patients with multiple myeloma: are we asking the right questions?.
        Bone Marrow Transplant. 2006; 38: 585-592
        • Kowdley G.C.
        • Merchant N.
        • Richardson J.P.
        • et al.
        Cancer surgery in the elderly.
        Sci World J. 2012; : 303852
        • Langer C.J.
        Elderly patients with lung cancer: biases and evidence.
        Curr Treat Options in Oncol. 2002; 3: 85-102
        • Lawler M.
        • Selby P.
        • Aapro M.S.
        • et al.
        Ageism in cancer care.
        BMJ (Online). 2014; 348 (no pagination)
        • Lu K.
        Older men with locally advanced prostate cancer: to treat or not to treat?.
        J Clin Oncol. 2015; 33: 2832-2833
        • McDougall Jr., G.J.
        • Weber B.A.
        • Dziuk T.W.
        • et al.
        The controversy of prostate screening.
        Geriatr Nurs. 2000; 21: 245-248
        • Miller M.
        Ageism within cancer care: a priority for nursing.
        Eur J Oncol Nurs. 1999; 3: 25-30
        • Moulias S.
        • Cudennec T.
        • Teillet L.
        Ethic reflexion in the care of elderly people with cancer.
        [French] Cancer/Radiotherapie. 2009; 13: 632-633
        • Muss H.B.
        • Muss H.B.
        Older age--not a barrier to cancer treatment.
        N Engl J Med. 2001; 345: 1128-1129
      2. Anonymous: oncology nursing society and geriatric oncology consortium joint position on cancer care in the older adult.
        Eur J Cancer Care. 2004; 13: 434-435
        • Parent A.-S.
        • Buchanan R.
        Age discrimination in breast cancer screening.
        Gerontechnology. 2008; 7: 372-373
        • Penson R.T.
        • Daniels K.J.
        • Lynch Jr., T.J.
        Too old to care?.
        Oncologist. 2004; 9: 343-352
        • Pritchard K.I.
        Have we been guilty of ageism in the primary treatment of breast cancer?.
        Br J Cancer. 2007; 96: 1011-1012
        • Raik B.L.
        • Miller F.G.
        • Fins J.J.
        Screening and cognitive impairment: ethics of forgoing mammography in older women.
        J Am Geriatr Soc. 2004; 52: 440-444
        • Ramesh H.S.J.
        • Jain S.
        • Audisio R.A.
        Implications of aging in surgical oncology.
        Cancer J. 2005; 11: 488-494
        • Repetto L.
        • Comandini D.
        Cancer in the elderly: assessing patients for fitness.
        Crit Rev Oncol Hematol. 2000; 35: 155-160
        • Schroyen S.
        • Adam S.
        • Jerusalem G.
        • et al.
        Ageism and its clinical consequences in oncogeriatry: a review of existing data and intervention leads. [French].
        Rev Med Liege. 2014; 69: 395-401
        • Shumway D.A.
        • Hamstra D.A.
        Ageism in the Undertreatment of high-risk prostate Cancer: how long will clinical practice patterns resist the weight of evidence?.
        J Clin Oncol. 2015; 33: 676-678
        • Strohschein F.J.
        • Newton L.J.
        Mobilizing purpose and passion in oncology nursing care of older adults: from conference workshop to special interest group.
        Can Oncol Nurs J. 2018; 28: 89-101
        • Swaminathan D.
        • Swaminathan V.
        Geriatric oncology: problems with under-treatment within this population.
        Cancer Biol Med. 2015; 12: 275-283
        • Turner N.J.
        • Haward R.A.
        • Mulley G.P.
        • et al.
        Cancer in old age - is it inadequately investigated and treated?.
        Br Med J. 1999; 319: 309-312
        • Wildiers H.
        • Brain E.G.C.
        • Wildiers H.
        • et al.
        Adjuvant chemotherapy in elderly patients with breast cancer: where are we?.
        Curr Opin Oncol. 2005; 17: 566-572
        • Wilson D.
        • Jackson S.
        • Crome I.B.
        • et al.
        Comprehensive geriatric assessment and the special needs of older people.
        in: Crome Ilana Wu Li-Tzy Rao Rahul Tony Crome Peter Substance Use and Older People. xxviii. Wiley-Blackwell, 2015: 173-191 (396 pp)
        • Adelman R.
        • Hainer J.
        • Butler R.N.
        • et al.
        Well elderly program: an intergenerational model in medical education.
        Gerontologist. 1988; 28: 409-413
        • Aud M.A.
        • Bostick J.E.
        • Marek K.D.
        • et al.
        Introducing baccalaureate student nurses to gerontological nursing.
        J Prof Nurs. 2006; 22: 73-78
        • Bailey S.W.
        The game of I am: Enhancing empathy and improving attitudes toward older adults in first-year master’s students training to become counselors and student support professionals.
        in: Dissertation Abstracts International Section A: Humanities and Social Sciences 79:No Pagination Specified. 2018
        • Beling J.
        Effect of service-learning on knowledge about older people and faculty teaching evaluations in a physical therapy class.
        Gerontol Geriatr Educ. 2003; 24: 31-46
        • Bernard M.A.
        • McAuley W.J.
        • Belzer J.A.
        • et al.
        An evaluation of a low-intensity intervention to introduce medical students to healthy older people.
        J Am Geriatr Soc. 2003; 51: 419-423
        • Besdine R.W.
        • Shield R.R.
        • McNicoll L.
        • et al.
        Integrating and evaluating geriatrics in medical school: a novel approach for the challenge.
        Gerontol Geriatr Educ. 2011; 32: 295-308
        • Birenbaum A.
        • Aronson M.
        • Seiffer S.
        Training medical students to appreciate the special problems of the elderly.
        Gerontologist. 1979; 19: 575-579
        • Blais K.
        • Mikolaj E.
        • Jedlicka D.
        • et al.
        Innovative strategies for incorporating gerontology into BSN curricula.
        J Prof Nurs. 2006; 22: 98-102
        • Bloom R.L.
        The effect of type of psychological training on nursing staff empathy and attitudes towards geriatric residents.
        (207 p-207 p)1994
        • Boswell S.
        “Old people are cranky”: helping professional Trainees’ knowledge, attitudes, aging anxiety, and interest in working with older adults.
        Educ Gerontol. 2012; 38: 465-472
        • Briscoe V.J.
        The effects of gerontology nursing teaching methods on nursing student knowledge, attitudes, and desire to work with older adult clients.
        Walden University, 2004
        • Brown K.M.
        • Bright L.M.
        Teaching caring and competence: student transformation during an older adult focused service-learning course.
        Nurse Educ Pract. 2017; 27: 29-35
        • Burbank P.M.
        • Dowling-Castronovo A.
        • Crowther M.R.
        • et al.
        Improving knowledge and attitudes toward older adults through innovative educational strategies.
        J Prof Nurs. 2006; 22: 91-97
        • Buttner A.D.M.
        Changes in students’ attitudes toward aging after a gerontological nursing course.
        in: Dissertation Abstracts International Section A: Humanities and Social Sciences. 69. 2009: 4456
        • Chen S.
        • Walsh S.M.
        Effect of a creative-bonding intervention on Taiwanese nursing students’ self-transcendence and attitudes toward elders.
        Res Nurs Health. 2009; 32: 204-216
        • Cobo C.M.S.
        • Pfeiffer C.C.
        Changing negative stereotypes in old age in nursing students.
        [Spanish] Gerokomos. 2015; 26: 10-12
        • Cohen H.L.
        • Sandel M.H.
        • Thomas C.L.
        • et al.
        Using focus groups as an educational methodology: deconstructing stereotypes and social work practice misconceptions concerning aging and older adults.
        Educ Gerontol. 2004; 30: 329-346
        • Corwin S.J.
        • Frahm K.
        • Ochs L.A.
        • et al.
        Medical student and senior participants’ perceptions of a mentoring program designed to enhance geriatric medical education.
        Gerontol Geriatr Educ. 2006; 26: 47-65
        • Cummings S.M.
        • Cassie K.M.
        • Galambos C.
        • et al.
        Impact of an infusion model on social work students’ aging knowledge, attitudes, and interests.
        J Gerontol Soc Work. 2006; 47: 173-186
        • Edwards H.
        • Nash R.
        • Sacre S.
        • et al.
        Development of a virtual learning environment to enhance undergraduate nursing students’ effectiveness and interest in working with older people.
        Nurse Educ Today. 2008; 28: 672-679
        • Gonzales E.
        • Morrow-Howell N.
        • Gilbert P.
        Changing medical students’ attitudes toward older adults.
        Gerontol Geriatr Educ. 2010; 31: 220-234
        • Halpin S.N.
        • Dillard R.L.
        • Idler E.
        • et al.
        The benefits of being a senior mentor: cultivating resilience through the mentorship of health professions students.
        Gerontol Geriatr Educ. 2017; 38: 283-294
        • Harper S.P.
        Instructional design for affective learning in online nursing education.
        Capella University, 2007
        • Heuer S.
        • Douglas N.
        • Burney T.
        • et al.
        Service-learning with older adults in care communities: measures of attitude shifts in undergraduate students.
        Gerontol Geriatr Educ. 2020; 41: 186-199
        • Intrieri R.C.
        • Kelly J.A.
        • Brown M.M.
        • et al.
        Improving medical students’ attitudes toward and skills with the elderly.
        Gerontologist. 1993; 33: 373-378
        • Jansen D.A.
        • Morse W.A.
        Positively influencing student nurse attitudes toward caring for elders: results of a curriculum assessment study.
        Gerontol Geriatr Educ. 2004; 25: 1-14
        • Jarvik L.F.
        • Ross C.
        • Klessig J.
        • et al.
        First-year medical students and the aging patient: a curricular model.
        J Am Geriatr Soc. 1981; 29: 135-138
        • Jeste D.V.
        • Avanzino J.
        • Depp C.A.
        • et al.
        Effect of short-term research training programs on medical students’ attitudes toward aging.
        Gerontol Geriatr Educ. 2018; 39: 214-222
        • Kaf W.A.
        • Barboa L.S.
        • Fisher B.J.
        • et al.
        Effect of interdisciplinary service learning experience for audiology and speech-language pathology students working with adults with dementia.
        • Kantor B.S.
        • Myers M.R.
        From saging--the Ohio State Senior Partners Program: longitudinal and experiential geriatrics education.
        Gerontol Geriatr Educ. 2006; 27: 69-81
        • King P.A.
        • Cobb M.
        Learning to care.
        J Gerontol Nurs. 1983; 9: 289-292
        • Laks J.
        • Wilson L.A.
        • Khandelwal C.
        • et al.
        Service-learning in communities of elders (SLICE): development and evaluation of an introductory geriatrics course for medical students.
        Teach Learn Med. 2016; 28: 210-218
        • LeBlanc P.A.
        Attitudes of nursing students toward the elderly as influenced by lecture-discussion with and without simulation.
        The University of Southern Mississippi, 1995
        • Leung A.
        • Chan S.
        • Kwan C.
        • et al.
        Service learning in medical and nursing training: a randomized controlled trial.
        Adv Health Sci Educ. 2012; 17: 529-545
        • Leung Y.C.G.
        • Soundararajan A.
        • Ng W.Q.
        • et al.
        Tri-generational homecare project: The effect of a student-initiated homecare programme on ageism and interpersonal skills among undergraduate healthcare students.
        Annals Acad Med Singapore. 2016; 45: S353
        • Lu W.-H.
        • Hoffman K.G.
        • Hosokawa M.C.
        • et al.
        First year medical students’ knowledge, attitudes, and interest in geriatric medicine.
        Educ Gerontol. 2010; 36: 687-701
        • Mount J.
        Effects of a practicum with well elderly on physical therapy Students’ attitudes towards older people and their intention to work with the elderly.
        Gerontol Geriatr Educ. 1993; 13: 13-24
        • Olson C.J.
        A curriculum module enhances students’ gerontological practice-related knowledge and attitudes.
        J Gerontol Soc Work. 2003; 38: 85-102
        • Pacala J.T.
        • Boult C.
        • Bland C.
        • et al.
        Aging game improves medical students’ attitudes toward caring for elders.
        Gerontol Geriatr Educ. 1995; 15: 45-57
        • Parchment Y.D.
        Nursing curriculum: Changing students’ knowledge and biases towards older adults, UMI dissertation services.
        ProQuest Information and Learning, Ann Arbor, MI2002
        • Pilkington W.J.
        Effects of a communication program on nursing home staff’s attitudes and communication skills and residents’ levels of life satisfaction.
        St. John’s University (New York), 1993
        • Puentes W.J.
        Effects of a reminiscence learning experience on registered nurses’ attitudes toward and empathy with older adults.
        (198 p)1995
        • Radu V.L.
        Examination of the effect of the GeroRich project in the BSW curriculum, UMI dissertation services.
        ProQuest Information and Learning, Ann Arbor, MI2007
        • Rose M.A.
        The importance of influencing nursing students’ attitudes toward older adults.
        Public Health Nurs. 1984; 1: 152-157
        • Ross L.
        • Williams B.
        Real engagement improving paramedic attitudes towards the elderly.
        Clin Teach. 2015; 12: 37-41
        • Schuldberg J.
        It is easy to make judgments if it’s not familiar: the use of simulation kits to develop self-awareness and reduce ageism.
        J Soc Work Educ. 2005; 41: 441-455
        • Varkey P.
        • Chutka D.S.
        • Lesnick T.G.
        The aging game: improving medical students’ attitudes toward caring for the elderly.
        J Am Med Dir Assoc. 2006; 7: 224-229
        • Alden J.
        • Toth-Cohen S.
        Impact of an educational module on occupational Therapists’ use of Elderspeak and attitudes toward older adults.
        Phys Occupat Ther Geriatr. 2015; 33: 1-16
        • Alexander K.
        • Banerjee S.C.
        • Manna R.
        • et al.
        Addressing communication challenges in older patients with cancer and geriatric syndromes: a communication skills training module for health care providers.
        European Ger Med. 2019; 10: 319-326
        • Fleisher F.I.
        • White L.J.
        • McMullen M.J.
        • et al.
        The geriatric obstacle course: a training session designed to help prehospital personnel recognize geriatric stereotypes and misconceptions.
        J Emerg Med. 1996; 14: 439-444
        • Halpin S.N.
        Evaluating the efficacy of a short aging simulation workshop for an interdisciplinary Group of Health-care Employees at a veterans affairs medical center.
        Educ Gerontol. 2015; 41: 207-215
        • Karner K.J.
        • Rheinheimer D.C.
        • DeLisi A.M.
        • et al.
        The impact of a hospital-wide experiential learning educational program on staff’s knowledge and misconceptions about aging.
        J Contin Educ Nurs. 1998; 29: 100-104
        • Sedrak M.S.
        • Freedman R.A.
        • Cohen H.J.
        • et al.
        Older adult participation in cancer clinical trials: a systematic review of barriers and interventions.
        CA Cancer J Clin. 2021; 71: 78-92
        • Guadagnoli E.
        • Shapiro C.
        • Gurwitz J.H.
        • et al.
        Age-related patterns of care: evidence against ageism in the treatment of early-stage breast cancer.
        J Clin Oncol. 1997; 15: 2338-2344
        • Di Rosa M.
        • Chiatti C.
        • Rimland J.M.
        • et al.
        Ageism and surgical treatment of breast cancer in Italian hospitals.
        Aging Clin Exp Res. 2018; 30: 139-144
        • Giovanazzi-Bannon S.
        • Rademaker A.
        • Lai G.
        • et al.
        Treatment tolerance of elderly cancer patients entered onto phase II clinical trials: an Illinois Cancer center study.
        J Clin Oncol. 1994; 12: 2447-2452
        • Kendal W.S.
        Age Bias in time from diagnosis comparisons of prostate cancer treatment.
        Am J Clin Oncol Cancer Clin Trials. 2018; 41: 402-408
        • Alibhai S.M.H.
        • Krahn M.D.
        • Cohen M.M.
        • et al.
        Is there age Bias in the treatment of localized prostate carcinoma?.
        Cancer. 2004; 100: 72-81
        • Austin D.
        • Russell E.M.
        Is there ageism in oncology?.
        Scott Med J. 2003; 48: 17-20
        • Estrella J.D.
        • Sanchez-Jurado P.M.
        • Abizanda P.
        • et al.
        Age discrimination in oncological treatments in elderly patients with colon and breast cancer. A case-control study. [Spanish].
        Revista Espanola de Geriatria y Gerontologia. 2005; 40: 78-84
        • Matsumoto Y.
        • Kimura K.
        • Zhou Q.
        • et al.
        Treatments and outcomes of older patients with esophageal cancer: comparison with younger patients.
        Mol Clin Oncol. 2019; 11: 383-389
        • Nadella P.C.
        • Hoshaw-Woodard S.
        • Kotur L.
        • et al.
        Older women with breast cancer are less likely to receive adjuvant chemotherapy: evidence of possible age bias.
        Breast Cancer Res Treat. 2003; 98: 1141-1149
        • Woodard S.
        • Nadella P.C.
        • Kotur L.
        • et al.
        Older women with breast carcinoma are less likely to receive adjuvant chemotherapy: evidence of possible age bias?.
        Cancer. 2003; 98: 1141-1149
        • Madan A.K.
        • Aliabadi-Wahle S.
        • Beech D.J.
        Age bias: a cause of underutilization of breast conservation treatment.
        J Cancer Educ. 2001; 16: 29-32
        • Madan A.K.
        • Aliabadi-Wahle S.
        • Beech D.J.
        Ageism in medical students’ treatment recommendations: the example of breast-conserving procedures.
        Acad Med. 2001; 76: 282-284
        • Johnson S.B.
        • Lester-Coll N.H.
        • Bledsoe T.J.
        • et al.
        Undertreatment of elderly men with high-risk prostate cancer.
        Int J Radiat Oncol Biol Phys. 2017; 99: E243
        • Greenfield S.
        • Blanco D.M.
        • Elashoff R.M.
        • et al.
        Patterns of care related to age of breast cancer patients.
        JAMA. 1987; 257: 2766-2770
        • Dharma-Wardene M.W.
        • De Gara C.
        • Au H.J.
        • et al.
        Ageism in rectal carcinoma? Treatment and outcome variations.
        Int J Gastrointest Cancer. 2002; 32: 129-138
        • Maccormick R.E.
        • Mackinnon K.J.
        Decision-making in cancer-treatment - age and socioeconomic-status as independent variables.
        Med Teach. 1990; 12: 353-355
        • Schroyen S.
        • Missotten P.
        • Jerusalem G.
        • et al.
        Ageism and caring attitudes among nurses in oncology.
        Int Psychogeriatr. 2016; 28: 749-757
        • Schechterly G.J.
        Oncology registered nurses’ knowledge about and attitudes toward the elderly, UMI dissertation services.
        ProQuest Information and Learning, Ann Arbor, MI2000
        • Kaplan R.M.
        • Saltzstein S.L.
        Reduced mammographic screening may explain declines in breast carcinoma in older women.
        J Am Geriatr Soc. 2005; 53: 862-866
        • Plavc G.
        • Ratosa I.
        • Zagar T.
        • et al.
        Explaining variation in quality of breast cancer care and its impact: a nationwide population-based study from Slovenia.
        Breast Cancer Res Treat. 2019; 175: 585-594
        • Velanovich V.
        • Gabel M.
        • Walker E.M.
        • et al.
        Causes for the undertreatment of elderly breast cancer patients: tailoring treatments to individual patients.
        J Am Coll Surg. 2002; 194: 8-13
        • Audisio R.A.
        • Osman N.
        • Audisio M.M.
        • et al.
        How do we manage breast cancer in the elderly patients? A survey among members of the British Association of Surgical Oncologists (BASO).
        Crit Rev Oncol Hematol. 2004; 52: 135-141
        • Pasetto L.M.
        • Falci C.
        • Basso U.
        • et al.
        Colorectal cancer treatment in elderly patients: results of a retrospective analysis addressed to the chiefs of medical oncology units in Italy.
        Anticancer Res. 2007; 27: 3601-3608
        • Oszvald A.
        • Guresir E.
        • Setzer M.
        • et al.
        Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age.
        J Neurosurg. 2012; 116: 357-364
        • Provencio M.
        • Camps C.
        • Alberola V.
        • et al.
        Lung cancer and treatment in elderly patients: the Achilles study.
        Lung Cancer. 2009; 66: 103-106
        • Peake M.D.
        • Thompson S.
        • Lowe D.
        • et al.
        Ageism in the management of lung cancer.
        Age Ageing. 2003; 32: 171-177
        • Kearney N.
        • Miller M.
        • Paul J.
        • et al.
        Oncology healthcare professionals’ attitudes toward elderly people.
        Ann Oncol. 2000; 11: 599-601
        • Schroyen S.
        • Missotten P.
        • Jerusalem G.
        • et al.
        Ageism among nurses in oncology.
        Int Psychogeriatr. 2015; 27: S75
        • Scott J.A.C.
        Nursing students’ service learning activities with older adults: Effect on ageism.
        in: Dissertation Abstracts International Section A: Humanities and Social Sciences 80:No Pagination Specified. 2019
        • Protiere C.
        • Viens P.
        • Rousseau F.
        • et al.
        Prescribers’ attitudes toward elderly breast cancer patients. Discrimination or empathy?.
        Crit Rev Oncol Hematol. 2010; 75: 138-150
        • Step M.M.
        • Siminoff L.A.
        • Rose J.H.
        Differences in oncologist communication across age groups and contributions to adjuvant decision outcomes.
        J Am Geriatr Soc. 2009; 57: s279-s282
        • Hamaker M.E.
        • Stauder R.
        • van Munster B.C.
        Exclusion of older patients from ongoing clinical trials for hematological malignancies: an evaluation of the National Institutes of Health clinical trial registry.
        Oncologist. 2014; 19: 1069-1075
        • Rocha Lima C.M.
        • Herndon J.E.
        • Kosty M.
        • et al.
        Therapy choices among older patients with lung carcinoma: an evaluation of two trials of the cancer and Leukemia Group B.
        Cancer. 2002; 94: 181-187
        • Hasak J.M.
        • Myckatyn T.M.
        • Grabinski V.F.
        • et al.
        Stakeholders’ perspectives on Postmastectomy breast reconstruction: recognizing ways to improve shared decision making.
        Plastic Reconstruct Surg Global Open. 2017; 5
        • Schroyen S.
        • Missotten P.
        • Adam S.
        • et al.
        Communication in oncology: is there ageism?.
        Eur J Cancer. 2016; 57: S134
        • Schoenborn N.L.
        • Massare J.
        • Park R.
        • et al.
        Clinician perspectives on Overscreening for Cancer in older adults with limited life expectancy.
        J Am Geriatr Soc. 2020; 68: 1462-1468
        • Rankin N.M.
        • Burggraf V.
        Innovative approaches in teaching gerontological nursing.
        Gerontol Geriatr Educ. 1986; 7: 67-73
        • Pallis A.
        • Fortpied C.
        • Wedding U.
        • et al.
        EORTC elderly task force position paper: approach to the older cancer patient.
        Eur J Cancer. 2010; 46: 1502-1513
        • Wildiers H.
        • Mauer M.
        • Pallis A.
        • et al.
        End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer–Alliance for Clinical Trials in Oncology–International Society Of Geriatric Oncology position article.
        J Clin Oncol. 2013; 31: 3711-3718
        • Bartlam B.
        • Crome P.
        • Lally F.
        • et al.
        The views of older people and carers on participation in clinical trials: the PREDICT study.
        Clin Investigat. 2012; 2
        • Puts M.
        • Hardt J.
        • Monette J.
        • et al.
        Use of geriatric assessment for older adults in the oncology setting: a systematic review.
        J Natl Cancer Inst. 2012; 104: 1134-1164
        • Versteeg K.
        • Konings I.
        • Lagaay A.
        • et al.
        Prediction of treatment-related toxicity and outcome with geriatric assessment in elderly patients with solid malignancies treated with chemotherapy: a systematic review.
        Ann Oncol. 2014; 25: 1914-1918
        • Mukerji N.
        • Rodrigues D.
        • Hendry G.
        • et al.
        Treating high grade gliomas in the elderly: the end of ageism?.
        J Neuro-Oncol. 2008; 86: 329-336
        • Samuelsson C.
        • Adolfsson E.
        • Persson H.
        The use and characteristics of elderspeak in Swedish geriatric institutions.
        Clin Linguist Phon. 2013; 27: 616-631
        • Kemper S.
        Elderspeak: speech accommodations to older adults.
        Aging Cognt. 1994; 1: 17-28
        • Kemper S.
        • Harden T.
        Experimentally disentangling what’s beneficial about elderspeak from what’s not.
        Psychol Aging. 1999; 14: 656
        • Shaw C.A.
        • Gordon J.K.
        Understanding elderspeak: an evolutionary concept analysis.
        Innov Aging. 2021; 5: igab023
        • Liu Y.-e.
        • While A.E.
        • Norman I.J.
        • et al.
        Health professionals’ attitudes toward older people and older patients: a systematic review.
        J Interprof Care. 2012; 26: 397-409
        • Album D.
        • Westin S.
        Do diseases have a prestige hierarchy? A survey among physicians and medical students.
        Soc Sci Med. 2008; 66: 182-188
        • Liu Y.-e.
        Norman IJ, While AE: Nurses attitudes towards older people: a systematic review.
        Int J Nurs Stud. 2013; 50: 1271-1282
        • Liu Y.E.
        • Norman I.J.
        • While A.E.
        Nurses’ attitudes towards older people and working with older patients: an explanatory model.
        J Nurs Manag. 2015; 23: 965-973
        • Trevino K.
        Strategies to identify and address ageism in ourselves, others, and institutions.
        in: Oncology ISoG. 2022
        • Sweetland J.
        • Volmert A.
        • O’Neil M.
        Finding the Frame, FrameWorks Research Report.
        FrameWorks Institute, Washington, DC2017
        • Gagliardi A.R.
        • Dobrow M.J.
        • Wright F.C.
        How can we improve cancer care? A review of interprofessional collaboration models and their use in clinical management.
        Surg Oncol. 2011; 20: 146-154
        • Weaver A.C.
        • Callaghan M.
        • Cooper A.L.
        • et al.
        Assessing interprofessional teamwork in inpatient medical oncology units.
        J Oncol Pract. 2015; 11: 19-22
        • Parks R.M.
        • Holmes H.M.
        • Cheung K.-L.
        Current challenges faced by cancer clinical trials in addressing the problem of under-representation of older adults: a narrative review.
        Oncol Ther. 2021; 9: 55-67
        • Hurria A.
        • Levit L.A.
        • Dale W.
        • et al.
        Improving the evidence base for treating older adults with cancer: American Society of Clinical Oncology statement.
        J Clin Oncol. 2015; 33: 3826-3833
        • Pulte D.
        • Redaniel M.T.
        • Lowry L.
        • et al.
        Age disparities in survival from lymphoma and myeloma: a comparison between US and England.
        Br J Haematol. 2014; 165: 824-831