TABLE 1.

Recommendations for management of older patients with cancer during COVID‐19 pandemic.

Setting	Recommendation	Suggestion
General Considerations	Use CGA‐based prognostic scores to estimate risk of toxicity from chemotherapy & prevent toxicity	‐use supportive measures (i.e., G‐CSF in primary prophylaxis, treatment of underlying anemia, prevention of mucositis); ‐avoid using cytotoxic chemotherapy if risk of toxicity is higher than 40% and not preventable (i.e., by using prophylactic G‐CSF) ‐review and reconcile polypharmacy ‐If cytotoxic chemotherapy is highly indicated, use regimens with lower predicted toxicity if possible
	Prevent infections	‐Implement triage procedures ‐Engage with caregivers ‐Avoid giving treatment as inpatients ‐Limit patients’ travels (i.e., use oral drugs if possible; dispatch drugs at home if chronic and side effects verified; interact with home care services; switch to longer interval schedules if possible) ‐Consider watchful waiting/postponing treatment for low volume, biologically indolent tumors; ‐Consider use of local treatment when possible (i.e., radiation therapy) to avoid / delay systemic treatment ‐Vaccinate for influenza
Early‐stage disease	Use CGA‐based prognostic tools to identify patients who may derive benefit from (neo)adjuvant chemotherapy	If (neo)adjuvant treatment is indicated use supportive measures to prevent toxicity and infection
Advanced‐stage disease	Use prognostic tools to estimate prognosis of patients with advanced stage disease in decision‐making	Do not start any oncological treatment if patients have less than 3 months life expectancy, unless poor prognosis is mainly related to cancer and treatment is likely to have major impact on disease course with no severe toxicity expected
		Do not start second or further treatment lines if there was no benefit from prior interventions, and in the absence of possible disease‐modifying new agents with safe toxicity profile
	Assess the goals of treatment and discuss openly with patient	Use single‐agent therapy if goal is prolongation of survival; use combination therapy if goal is tumor shrinkage (for symptoms; for possible conversion to surgery) and if the above “General Considerations” are respected