Heidi D. Klepin, MD, MS, reflects on her journey in geriatric oncology, a field dedicated to improving cancer care for older adults. After completing medical training and a geriatrics fellowship at Wake Forest University School of Medicine, Dr. Klepin realized the significant challenges older oncology patients face, particularly regarding personalized treatment for leukemia. Motivated to bridge geriatrics and oncology, she pursued additional training and research focused on applying geriatric principles to oncology practice.
In 2006, Dr. Klepin met the late Dr. Arti Hurria, a pioneer in cancer and aging research. This encounter led to a collaboration and the foundation of the Cancer and Aging Research Group (CARG). Dr. Klepin’s early research, despite initial setbacks, established the feasibility and clinical value of geriatric assessment in identifying vulnerabilities and predicting outcomes for older adults with acute myeloid leukemia. Her work contributed to the development of chemotherapy toxicity prediction tools and informed the 2018 ASCO guideline recommending geriatric assessments for patients aged 65 and older undergoing chemotherapy.
Older adults represent the majority of cancer patients but are underrepresented in clinical trials. Aging introduces wide biological and functional diversity, making chronological age an unreliable treatment guide. Many older patients lack tailored data to inform their care, highlighting the urgent need for targeted research and clinical tools.
The 2021 GAP70+ study demonstrated that providing oncologists with geriatric assessment findings and management recommendations significantly reduced serious chemotherapy toxicity by 21% without affecting survival. This evidence supported the 2023 ASCO guideline update, which advocates geriatric assessments for all older adults starting systemic therapy. Tools like the Practical Geriatric Assessment Toolkit have been developed to facilitate implementation in community oncology settings.
Despite guideline advances, barriers such as limited time, resources, and training impede widespread adoption. Dr. Klepin is actively involved in implementation research to encourage integration of geriatric assessment in everyday oncology practice and advocates for increased enrollment of older adults in clinical trials. National organizations emphasize the necessity of innovative trial designs, inclusion of aging-relevant endpoints, and geriatric expertise in research teams.
Dr. Klepin’s mission centers on improving the lives of older adults with cancer through clinical care, research, education, and advocacy. As a professor at Wake Forest University and a co-lead of CARG, she has authored over 180 publications and held national leadership roles, including past Chair of the ASCO Cancer Research Committee and membership on the FDA Oncology Drug Advisory Committee. Her work emphasizes the importance of translating evidence into practice and ensuring older adults receive care informed by robust clinical data.
This article is based on Dr. Klepin’s lecture at the ASCO 2025 Annual Meeting, where she received the B.J. Kennedy Geriatric Oncology Award. The award honors Dr. B.J. Kennedy’s legacy in advancing cancer care for the elderly and supporting the development of leaders in geriatric oncology.
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