Geriatric hematologic care in Latin America: Results from a regional survey of hematology centers

Abstract

Abstract Background Older adults with cancer often face additional challenges in disease management. Limited awareness among medical professionals of their unique needs, combined with variable resources across regions, can negatively impact outcomes and quality of life. This study aimed to characterize the resources and practices for managing hematological malignancies in older adults in Latin America (LATAM), to inform future efforts tailored to the region's specific needs. Methods A cross-sectional survey-based study was conducted during July 2025.The survey targeted clinical hematology specialists practicing in LATAM in representation of their centers. The survey was distributed through the official channels and networks of the Latin American Study Group of Lymphoproliferative Disorders (GELL)— a regional collaborative network dedicated to advancing the care of lymphoid malignancies in LATAM. The questionnaire was developed by the research team and iteratively reviewed by experts from the GELL and modified until it was deemed representative and relevant. Data was collected anonymously through a secure online platform (RedCap). A descriptive analysis was performed. Results Responses from 73 centers across 16 countries was retrieved including: Bolivia (21%, n=15), Mexico (18%, n=13), Argentina (9.6%, n = 7), Colombia (8.2%, n=6), Cuba (6.8%, n=5), Brazil (5.5%, n=4), Guatemala (5.5%, n=4), Uruguay (5.5%, n=4), Paraguay (4.1%, n=3), Venezuela (4.1%, n=3), Chile (2.7%, n=2), Ecuador (2.7%, n=2), Peru (2.7%, n=2), El Salvador (1.4%, n=1), Honduras (1.4%, n=1), and Dominican Republic (1.4%, n=1). Most centers lacked a dedicated clinic for older adults with hematological malignancies (75%, n=53). Although 59% (n=43) had geriatricians available, only one center (2.3%) had them working within their department, and just 6 centers (8.2%) had a specialist in geriatric hematology or oncology. Among centers with geriatricians, 60% (n=25) referred patients based on age; other referral criteria included physician judgment (21%, n=9), comorbidities (12%, n=5), and patient or caregiver request (4.8%, n=2). Regarding specialized training availability, only 7 (9.6%) centers reported having available a training program, with only 4 of those being clinical fellowships. In patients who are not undergoing HCT the Clinical Frailty Scale was reported as the most frequently employed comprehensive geriatric assessment (CGA) (53%, n=39). Similar proportions of centers reported having (53%, n=39) or lacking (47%, n=34) adapted treatment protocols for older adults. Among centers conducting clinical research (60%, n=44), 22% (n=16) never included older adults, 22% (n=16) enrolled them only in elderly-focused studies, and 16% (n=12) always considered them for accrual. Of the 30 centers performing hematopoietic cell transplant (HCT), 56% (n=17) did not consider age a limiting factor. Among those that did, 70 years was the most common cutoff (44%, n=7); 2 centers used a higher limit (75 years) and 2 a lower one (60 years). Only 2 centers (6.7%) did not perform a CGA before HCT in older adults. Palliative care services were most commonly described as available only for “patients in terminal stages of their disease” (47%, n=34) and only in 17 centers (23%) they are available in early stages of the disease. Fourteen centers (19%) reported not having palliative care services in their center. When asked to rate from 1-10 the potential impact of implementing all surveyed actions, the median response was 9 (IQR 8–10). The most frequently selected action for greatest impact was establishing a dedicated clinic or team for older adults with hematological malignancies (47%, n=34), followed by routine comprehensive geriatric assessments (15%, n=11). Conclusions This study highlights wide variability in resources and practices for managing hematologic malignancies in older adults. Although geriatricians are present in many centers, integration with hematology is rare, and dedicated clinics are uncommon. Comprehensive geriatric assessments are frequent, but standardized protocols and early palliative care are limited. Age often restricts transplant eligibility. Potential response bias toward physicians more invested in research from centers with more resources is a limitation. These findings reveal critical gaps in geriatric care and training, warranting further evaluation of targeted interventions.