An international online survey to improve training in geriatric oncology for undergraduates: Trainees´ interests and preferred teaching strategies

An international online survey to improve training in geriatric oncology for undergraduates: Trainees´ interests and preferred teaching strategies | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An international online survey to improve training in geriatric oncology for undergraduates: Trainees´ interests and preferred teaching strategies Ruth Zickermann, Mexhid Ferati, Ningbo Fan, Evelyn Plamper, Rabi Datta, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6579897/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Age is a critical driver of the worldwide increasing cancer incidence rates, and with the growing number of older adults diagnosed with cancer, there is a rising need for specialized care. However, geriatric oncology (GO) education remains underrepresented in medical curricula. The gap between demand and adequately trained providers requires the development of more robust GO training programs. This study examined the current state of GO education, and the areas of interest within GO and the preferred teaching methods for this specialized content. Methods A multi-center international online survey aimed at assessing the awareness and perceived significance of GO among early-career medical students and nursing trainees were conducted. Results There was a significant lack of awareness of GO among trainees in the early years of their professional education (56%) and a scarcity of GO content allocation in geriatrics curricula, with 84% of participants receiving less than 20% of their geriatrics education focused on GO. Despite this, most trainees recognized the potential of GO to enhance patient care, particularly in improving the quality of life (QoL; 81%), optimizing therapeutic strategies (65%), and reducing treatment toxicity (55%). Key areas of interest among trainees included mental health, quality of life, and palliative care. Additionally, seminars and bedside teaching were identified as preferred methods for learning GO content. Conclusion This survey highlights the need for better GO education, emphasizing curricular integration and interactive teaching. Trainees seek more exposure, and findings can guide the development of effective GO curricula for older adults with cancer. Geriatric oncology education geriatric assessment virtual reality artificial reality Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCATION Older adults with cancer are a growing, heterogeneous and particularly vulnerable patient population, presenting a unique set of challenges to healthcare professionals that requires specialized approaches. Due to the demopgraphic shift towards an ageing population, we expect 24 million new cases of cancer worldwide by 2035, an increase of approximately 170% compared to 2012 (14 million). Older patients with cancer are estimated to account for more than 50% of the global cancer incidence burden in 2035 1 . Given the increasing number of oncogeriatric patients, there is a pressing need for greater expertise and a more highly trained medical workforce to deliver optimal care. Therefore, expanding and enhancing geriatric oncology (GO) education within medical training is crucial for addressing this growing demand. Oncogeriatric patients are more likely to be frail and suffer from comorbidities which can complicate their care. Oncogeriatric health conditions include cognitive impairment, declined physiological functions, reduced organ, especially renal, function which can increase the risk of complications from locoregional and systemic anticancer treatments 2 , 3 , 4 . Due to their various health conditions GO patients are often subject to polypharmaceutical intervention which is associated with an increased risk of unwanted drug interactions, toxicities, and poor compliance 5 . As a result oncogeriatric patients are frequently excluded from clinical trials, limiting the external validity of the evidence to guide treatment decisions and recommendations 6 . To overcome the barriers in oncogeriatric care, the cancer workforce requires upskilling to enable sophisticated and effective treatment decisions and medical care for GO patients 7 . However, training in GO is often underrepresented in medical teaching and curricula 8 , 9 . In the US, GO was reported to be the least oncology-related discipline that was included into the oncology fellowship curriculum with merely 32% of the teaching programs including GO formally into their oncology curriculum 10 . In accordance, a 2017 survey sent to hematology-oncology fellows in the US reported that over 50% had not participated in GO lectures and had overall low knowledge in clinical practice and experience with GO patients. Similarly, 66.1% of UK oncology trainees reported to never have received training on the particular needs of GO patients. While more than 80% felt confident in treating younger patients, only approximately 27% were confident in balancing risks and in making treatment recommendations for older adults with cancer 11 . To improve the care for older adults with cancer, stakeholders and caregivers have implemented different approaches. Institutions like International Society of Geriatric Oncology (SIOG) have put forward different initiatives to improve GO education, including webinars, online workshops and conferences 12 , 13 . In addition, the Cancer and Aging Research Group (CARG) aims to oncogeriatric researchers across the nation in a collaborative effort of designing and implementing clinical trials to improve the care of older adults with cancer. ASCO and ESMO have made available recommendations for a global GO curriculum 14 . However, implementation of GO training still faces many obstacles, including limited resources or access to GO training 12 . Since 2020, a EUniWell ‘onco-aging’ working group was initiated with a seed funding support. The aim is to initiate a pilot program which will bridge the gap between patient needs and usual care by bringing the most urgent challenges for cancer care in advanced age to the attention of students within the fields from healthcare. The target group of this project are students from medicine, nursing science, life science, social work and associated disciplinaries. To support and guide the various efforts to improve knowledge and training in GO we conducted a study survey to collect interests and preferred teaching strategies for geriatric oncology. This study explored the awareness and knowledge of GO and its current significance in medical teaching, in particular in the training of medical students and nursing trainees. Furthermore, it aimed at assessing current teaching strategies applied in GO teaching and relating it to the needs reported by medical students and nurses to successfully expand their expertise in GO. METHODS Study design and ethical approval The study was conducted in accordance with the Declaration of Helsinki and was approved by the ethic committee of Medical Faculty of University of Cologne (ID: 21-1169). In this study, researchers designed a comprehensive survey consisting of 12 main questions that branched into a total of 31 queries to capture nuanced data regarding participants’ experiences and attitudes towards taking a course on geriatric or oncological related medicine. Participants Participants were fully informed about the nature and purpose of the survey, and their responses were collected anonymously in 2022. Particiapants could enter the survey with a link ( https://survey.lnu.se/Survey/29809 ) and QR code that were widely distributed by Linnaeus University. Survey The survey 15 employed various question formats to ensure depth and breadth in responses. Multiple-choice questions, which consisted most of the survey, along with yes/no and 5-scale Likert scale questions were utilized to assess the intensity or frequency related to participants’ experiences or attitudes. Additionally, open-ended questions offered respondents the opportunity to elaborate on their choices. The survey’s demographic section was brief, covering age, gender, year of study, and institution, ensuring the focus remained on participants’ experiences with GO courses. Before participation, all respondents reviewed an informed consent document outlining the study’s purpose, voluntary participation, confidentiality, and the right to withdraw without penalty. To promote transparency, participants could optionally provide their email to receive the published article. The survey was distributed via email, social media, and web-based channels, including support from the Linnaeus University Informatics Department. The target group includes medical students and nursing trainees in their early stage of education. A full list of questions is provided in the Supplementary material . RESULTS A total of 158 participants responded to the multi-center online survey, which was accessible via a QR code and a web link. Participants were predominantly aged between 18 and 25 (102; 64.6%) or between 25 and 35 (33; 21.0%; Fig. 1 A) and female (102; 64.6%; Fig. 1 B). Most participants were medical students (88; 55.7%) or enrolled in nursing training programs (49; 31.0%; Fig. 1 C), mostly from Cologne, Murcia, or Tongji University. Lack of GO training into medical and nursing education curricula 54 (36.5%) of all 158 participants had taken courses in oncology during their education. Of these 54 participants, 9 (16.7%) reported the inclusion of GO into their oncology courses(Fig. 2 A-C). 31 participants (19.6%) had taken classes in geriatric medicine or medicine of ageing(Fig. 2 D). Of these, 15 (48.4%) reported the inclusion of GO into their classes(Fig. 2 E). Participants who reported to have participated in courses, including GO topics, reported that GO was allocated minor content in classes. Participants who reported the inclusion of GO into their geriatric’s curricula estimated that less than 20% of the content was dedicated to GO, where less than 20% was the minimal option possible to select in the survey(Fig. 2 F,G). All participants ranked the importance of GO inclusion into their curricula 5 or higher on a scale from 0 to 10, including 50 participants (31.7%) who ranked the importance 10 out of 10. Of the participants who already had classes in geriatrics, 27 (87.1%) confirmed the need for the inclusion of GO training into curricula(Fig. 2 H). In the group of participants without previous training in geriatrics, 71 (55.9%) had an awareness of GO. 17 (10.8%) and 24 (15.2%) of all 158 participants were aware of SIOG and CARG, respectively. Area of focus for GO training Participants with training experience in geriatric medicine ranked their satisfaction with the current geriatric curriculum mostly with a 3 on a scale from 0 to 5. With respect to geriatric assessment (GA), 25 participants (80.7%) with training in geriatrics confirmed the potential of GA to improve the quality of life (QoL) of geriatric patients and the majority, 20 participants (64.5%) considered GA an effective tool to support the guidance of a therapeutic strategy. Approximately half of the participants (51.6%, 16 participants) assigned GA a role in helping to detect frailty or dealing with toxicity in therapy decisions(Fig. 2 I). With regard to learning objectives in GO training, participants with and without prior geriatrics training were especially interested in learning how to address mental health problems in elderly adults with cancer. In accordance with that, participants indicated a learning interest in topics addressing hospice, palliative care or improving the quality of care(Fig. 3 ). Discrepancy between applied and expected teaching strategies The group with previous training in geriatrics (n = 31) reported that most teaching was conducted as a series of lectures or seminars and workshops. 8 (25.8%) participants reported training in bedside teaching and only 6 (19.4%) participants in E-learning(Fig. 4 A). The group with no previous geriatrics training (n = 127) reported to expect seminars and workshops (93; 73.2%) as well as bedside teaching (75; 59.0%) as primary teaching strategies. Additionally, 58 (45, 67.0%), participants would expect lectures in GO teaching(Fig. 4 B). Virtual Reality (VR) or Augmented Reality (AR) were only rarely applied. 5 (16.23%) and 4 participants (12.9%), respectively, reported the inclusion of VR or AR into teaching. Of these 5 participants with experience in AR or VR, 4 participants (80.0%) would expect more VR or AR in teaching. VR or AR application was expected from 41 participants (32.3%) and only 18 participants (14.2%) expected E-learning in GO teaching. Additionally, participants without previous experience in geriatric medicine (n = 127) reported that they would expect more international learning experiences (81; 63.8%). Yet, 40 participants (31.5%) also reported that they were unsure about expectations for international learning in GO(Fig. 4 C-H). Willingness to participate in improving GO curricula To optimally design GO classes, participants were asked for their willingness to give feedback to teachers. The majority of participants (91; 57.6%) reported to be willing to give course feedback, mostly in a frequency of once a semester (42; 26.6%) or once a year (21; 13.3%). 17 participants (10.8%) indicated that they would like to be flexible in the frequency of giving course feedback(Fig. 5 A,B). Furthermore, almost half (78; 49.4%) of the participants stated that they were willing to volunteer in GO patient support. However, 29 (18.4%) were not willing to participate in GO patient support and approximately a third (51; 32.4%) were not sure whether they wanted to contribute to GO patient support(Fig. 5 C). Of those indicating that they were willing to help in GO patient support, most participants liked to contribute once a semester (23; 29.5%), followed by 20 participants (25.6%) who preferred to be flexible(Fig. 5 D). DISCUSSION This multi-center, international online survey explored the awareness of GO among medical and nursing students and their preferences for GO training strategies as well as topics of particular interest. We found that GO is rarely included in medical curricula and, if taught, underrepresented in classes. Yet, the demand for GO training among medical students, with and without prior education in GO, is high. Furthermore, participants, having received training in GO, are confident that GO training can improve the care of older adults with cancer. Participants indicated that they were especially interested in learning about topics addressing mental health, QoL as well as hospice and palliative care with seminars and bedside teaching as preferred teaching strategies. Our findings fit into existing literature that highlights the paucity of GO training and the increasing demand for improving the training in oncogeriatric care. The global shortage of GO training has been described earlier, for example in a 2017 review about achievements and challenges of GO which acknowledged a ubiquitous incapacity to adequately manage the needs of elderly patients with complex chronic conditions 13 . For example, the review listed that the majority of geriatrics fellowship positions (56%) remained unfilled and only half of the geriatricians recertified in their subspecialty board in the US. While acknowledging that many has been done for improving the acceptance and increasing interest in geriatrics, e.g. by creating shorter fellowship programs and recognizing geriatrics as subspecialty, less than half of the countries reported the inclusion of geriatrics into medical school curricula. Furthermore, in a qualitative study with interviews of first- and senior-year fellows in hematology/oncology, participants perceived a general lack of dedicated formal GO training. They remarked that specific GO training might not be perceived as necessary by teachers because fellows were treating GO patients frequently in their daily routine as a doctor and could thus learn based on their personal experience 16 . In addition to underscoring the global scarcity of GO training, this study contributes to existing literature by focusing on the needs of trainees in early stages of their education and by including their perspective on possible strategies to improve GO training. So far, most literature has evaluated GO training in fellowship programs, in particular in hematology and oncology fellowship programs 17 . Consistent with our results, Maggiore et al. (2014) found that hematology/oncology fellows rated GO training as “very important” on a Likert scale 16 . Yet only 19% of the fellows reported that their institution had a specific GO training program. In addition, Maggiore et al. (2014) showed that hematology/oncology fellows were lacking GO knowledge, for example regarding geriatric assessment (GA) or predictors of chemotherapy toxicity. Interestingly, there was no association between prior GO training and the frequency of correct answers in tests about GO knowledge which highlights the need to make GO training more valuable and effective 16 . To make GO training more accessible and successful, this study investigated topics of interest in GO training and preferred teaching strategies of trainees. This can contribute to a re-evaluation of topics and applied teaching strategies in GO training. The results of this survey indicate that participants were mostly interested in addressing mental health issues, palliative care and improving the QoL in GO patients. While the recommended curriculum by ESMO/ASCO for oncology includes geriatrics and supportive and palliative care, it does not account for the relation of QoL and geriatrics in GO patients 14 . Fellows in oncology who evaluated rotations in GO in interviews suggested that among others there was a need to address QoL and transitioning to palliative care discussions in teaching. Thus, psychological knowledge and skills were included into the GO curriculum based on the needs assessment 18 . Proficient teaching strategies are key to successful knowledge transmission. In order to overcome the challenge of a general lack of experts in GO, organizations such as ASCO and ESMO have developed e-modules 19 . While e-modules have the potential to make knowledge globally accessible to many trainees without the need of many experts generating content, accessibility can also be limited by costs of content creation and maintenance 19 . Offering GO e-learning to a price might reduce participation. For example, the participation in an ASCO GO e-module with cost was with < 1% between 2012–2013 very low, despite an enrollment into the corresponding fellowship program of 849 fellows 16 . In our study, we found that students reported little e-learning methods and use of novel teaching strategies such as AR and VR. In addition, participants without prior geriatrics training ranked VR, AR and e-learning as least expected teaching strategies, prioritizing workshops and seminars as well as bedside teaching. This might indicate that not only possible payments for e-learning can challenge knowledge transmission, but possibly a preference for teaching methods that rely on personal interaction. In accordance with this, hematology/oncology fellows have reported that more clinical experience with older adults with cancer and “hands-on” practice 16 . Yet, despite low in number, participants with VR or AR GO training expected more VR and AR applications in GO training. This study indicates that participants were rather willing to contribute to GO course evaluation and participate in GO patient volunteer for GO patient support. However, many participants were also unsure whether they would want to contribute to course feedback or GO patient support. Most participants were willing to offer their support once a semester, once a year or at a flexible rate. These results might imply that participants are generally willing but unsure whether they should fully commit and take responsibility for providing course feedback or patient support. Maggiore et al. (2014) documented that many fellows perceived time as a major barrier for doing GA with patients, but also for GO training. Fellows were also worried about time constraints regarding integration of more learning content and an extension of the curriculum in order to include GO as a specialty in their already existing curriculum 16 . In our study, participants might have been worried about the implications on schedules and the time it would take to commit to providing course feedback or to volunteer in GO patient support. This study has limitations regarding the response rate, the methodology as well as the sample number and composition. The link and QR code needed to participate in the survey were widely distributed by Linnaeus University via EUniWell alliance and networks. We cannot identify how often the link was opened in total. Therefore we cannot provide a response rate for the survey. However, recent studies question the significance of response rates to detect bias such as nonresponse bias 20 . In the case of this survey, we acknowledge that we are not able to assess a potential bias created by the fact that we only capture answers of people willing to respond and we are not able to show their proportion of the sample. Yet, we are convinced that the results of this study can still show important trends that should be shared with the wider scientific community. Since, the survery was conducted from end of 2021 we did not follow the Consensus -Based Checklist for Reporting of Survey Studies 21 which may limit the standardization and comprehensive reporting of survey methodology and findings. Because the participant collective with prior education in geriatric medicine is small, the statistical significance is limited in questions regarding this collective. Since participants were primarily trained in universities from Cologne (Germany), Shanghai (China) and Murcia (Spain) the informative value is limited to these training centers. While it can add new information to existing literature, the focus on trainees in the first years of their education might be questionable because GO goes hand in hand with a high degree of specialization which is usually part of the advanced educational pathway. In addition, the pre-selection of topics of interest and teaching formats could introduce a bias in the analysis. However, we are still convinced that the outcomes of the study should be shared with the community and can motivate and guide further efforts to improve GO training. CONCLUSIONS This survey provides valuable insights into the current state of GO education, underscoring the need for comprehensive curricular integration of GO content. The findings highlight a desire among trainees for increased exposure to GO, as well as the need for interactive, hands-on teaching approaches. This information can inform future efforts to develop and implement more effective GO curricula that better address the needs of older adults with cancer. Abbreviations GO: geriatric oncology; QoL: Quality of Life ; VR: virtual reality; AR: artificial reality; CARG: Cancer and Aging Research Group; SIOG: International Society of Geriatric Oncology; ASCO: American Society of Clinical Oncology; ESMO: European Society of Medical Oncology; GA: geriatric assessment Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and was approved by the ethic committee of Medical Faculty of University of Cologne (ID: 21-1169). The informed consent to participate was obtained from all of the participants in the study. Consent for publication Not applicable. Availability of data and materials The data of this study are available under a transfer agreement from the corresponding author based on a reasonable request. There will be limitations on how data can be used or how long data will be available for. Competing Interests N.M.L.B.: Advisory board: Pfizer, Abbott, Sanofi, Astellas; travel grants: Exact Sciences, Pfizer, Lilly, Novartis; speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead, AstraZeneca, Lilly, Exact Sciences K.P.L.: Consultant: Pfizer and Seagan; Honoraria: Pfizer V.G.: Astra Zeneca, AbbVie, Novartis, Merck, Norgine, Berlin Chemie The remaining authors declare that they have no competing interests. Funding The project was partly funded by EuniWell seed funding project. Authors' contributions R.Z., M.F., and Y.Z. wrote the main manuscript text. R.Z. and NB.F. prepared the figures. E.P., R.D., N.M.L.B., V.G., M.P., and Y.Z. made contributions to the conception. M.F. and NB.F. made contributions to the analysis. R.Z., M.F., NB.F., N.H., and L.P. made contributions to the methodology. M.F., N.H., J.L., L.P.,HX.S. and Y.Z. contributed to the investigation. 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Sharma, A., Minh Duc, N. T., Luu Lam Thang, T., Nam, N. H., Ng, S. J., Abbas, K.S., Huy, N. T., Marušić, A., Paul, C. L., Kwok, J., Karbwang, J., de Waure, C., Drummond,F. J., Kizawa, Y., Taal, E., Vermeulen, J., Lee, G. H. M., Gyedu, A., To, K. G., …Karamouzian, M. (2021). A Consensus-Based Checklist for Reporting of Survey Studies(CROSS). Journal of General Internal Medicine, 36(10), 3179–3187. https://doi.org/10.1007/s11606-021-06737-1. Additional Declarations Competing interest reported. Competing interests N.M.L.B: Advisory board: Pfizer, Abbott, Sanofi, Astellas; travel grants: Exact Sciences, Pfizer, Lilly, Novartis; speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead, AstraZeneca, Lilly, Exact Sciences K.P.L: Consultant: Pfizer and Seagan; Honoraria: Pfizer V.G.: Astra Zeneca, AbbVie, Novartis, Merck, Norgine, Berlin Chemie The remaining authors declare that they have no competing interests. Supplementary Files GOsupplement.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Jan, 2026 Reviews received at journal 16 Jan, 2026 Reviewers agreed at journal 04 Jan, 2026 Reviews received at journal 29 Nov, 2025 Reviewers agreed at journal 18 Nov, 2025 Reviewers agreed at journal 16 Nov, 2025 Reviewers agreed at journal 27 Jun, 2025 Reviewers agreed at journal 27 Jun, 2025 Reviews received at journal 21 Jun, 2025 Reviewers agreed at journal 13 Jun, 2025 Reviewers invited by journal 13 Jun, 2025 Editor assigned by journal 11 Jun, 2025 Editor invited by journal 20 May, 2025 Submission checks completed at journal 19 May, 2025 First submitted to journal 19 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6579897","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471606269,"identity":"51f73759-00d5-440a-87d8-83cf316192ae","order_by":0,"name":"Ruth Zickermann","email":"","orcid":"","institution":"University Hospital of Cologne","correspondingAuthor":false,"prefix":"","firstName":"Ruth","middleName":"","lastName":"Zickermann","suffix":""},{"id":471606271,"identity":"413d4e92-b16e-4159-b410-b5c30893b133","order_by":1,"name":"Mexhid Ferati","email":"","orcid":"","institution":"Linnaeus University","correspondingAuthor":false,"prefix":"","firstName":"Mexhid","middleName":"","lastName":"Ferati","suffix":""},{"id":471606273,"identity":"b0613c7c-8a08-479e-9c0d-61c143b6171b","order_by":2,"name":"Ningbo Fan","email":"","orcid":"","institution":"University Hospital of Cologne","correspondingAuthor":false,"prefix":"","firstName":"Ningbo","middleName":"","lastName":"Fan","suffix":""},{"id":471606278,"identity":"27bc01f9-d0f5-4f6b-a5d7-656d3fae72be","order_by":3,"name":"Evelyn Plamper","email":"","orcid":"","institution":"University Hospital of Cologne","correspondingAuthor":false,"prefix":"","firstName":"Evelyn","middleName":"","lastName":"Plamper","suffix":""},{"id":471606279,"identity":"7c4ef219-a096-4e89-8e66-304ecc060ad1","order_by":4,"name":"Rabi Datta","email":"","orcid":"","institution":"University Hospital of Cologne","correspondingAuthor":false,"prefix":"","firstName":"Rabi","middleName":"","lastName":"Datta","suffix":""},{"id":471606280,"identity":"183dad5c-45e9-4e41-b140-86dfd5e1a05c","order_by":5,"name":"ZiCheng Lyu","email":"","orcid":"","institution":"University Hospital of Cologne","correspondingAuthor":false,"prefix":"","firstName":"ZiCheng","middleName":"","lastName":"Lyu","suffix":""},{"id":471606281,"identity":"3a9ae0ee-8b68-422e-8866-ae69fbb5d916","order_by":6,"name":"Nellie. Horstmann","email":"","orcid":"","institution":"University of Cologne","correspondingAuthor":false,"prefix":"","firstName":"Nellie.","middleName":"","lastName":"Horstmann","suffix":""},{"id":471606282,"identity":"7233390f-5d57-43cd-8f28-132b25600a09","order_by":7,"name":"Judith Lohmann","email":"","orcid":"","institution":"Kinderkrankenhaus Amsterdamer Straße","correspondingAuthor":false,"prefix":"","firstName":"Judith","middleName":"","lastName":"Lohmann","suffix":""},{"id":471606283,"identity":"1f274905-f6a8-4c3f-939b-d0503ac50079","order_by":8,"name":"Lena. Pickert","email":"","orcid":"","institution":"University of Cologne, University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Lena.","middleName":"","lastName":"Pickert","suffix":""},{"id":471606285,"identity":"22704649-9209-4372-b35f-2cfdaa302f3d","order_by":9,"name":"Kah Poh Loh","email":"","orcid":"","institution":"University of Rochester Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kah","middleName":"Poh","lastName":"Loh","suffix":""},{"id":471606286,"identity":"e670ff5e-332a-4f5a-9e10-d0a342ad8e09","order_by":10,"name":"Nicolò Matteo Luca Battisti","email":"","orcid":"","institution":"The Royal Marsden Hospital NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Nicolò","middleName":"Matteo Luca","lastName":"Battisti","suffix":""},{"id":471606287,"identity":"2f295ee8-b26b-4f7d-b7c9-bbd87b79d74f","order_by":11,"name":"HuiXia Shen","email":"","orcid":"","institution":"Tongji University School of Medicine, International Education \u0026 Cooperation Office","correspondingAuthor":false,"prefix":"","firstName":"HuiXia","middleName":"","lastName":"Shen","suffix":""},{"id":471606289,"identity":"22063c2e-ec55-4658-b38f-c32b8f904916","order_by":12,"name":"Valentin Göde","email":"","orcid":"","institution":"St. Marien-Hospital","correspondingAuthor":false,"prefix":"","firstName":"Valentin","middleName":"","lastName":"Göde","suffix":""},{"id":471606294,"identity":"2b36feef-5129-42f2-9f0f-5f940c181867","order_by":13,"name":"David Iyú","email":"","orcid":"","institution":"University of Murcia","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Iyú","suffix":""},{"id":471606295,"identity":"6970e6b3-02f6-4f81-98c8-e3ef5504599f","order_by":14,"name":"Christiane Bruns","email":"","orcid":"","institution":"University Hospital of Cologne","correspondingAuthor":false,"prefix":"","firstName":"Christiane","middleName":"","lastName":"Bruns","suffix":""},{"id":471606296,"identity":"3001da26-84ce-42bf-bc7b-1e01c210175b","order_by":15,"name":"M. Cristina. Polidori","email":"","orcid":"","institution":"University of Cologne, University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"M.","middleName":"Cristina.","lastName":"Polidori","suffix":""},{"id":471606297,"identity":"453d54c0-19c4-4df2-993b-6e5dc067f615","order_by":16,"name":"Yue Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIie2PsQrCMBCGLxQ6BV1bkOojnBQsgvgslkJcBAcXwcGIEBcfoI/RIohjpEOXPkBGuzg72kmrTi6xo0O+5biQj/8/AIPhXyEcoA32e3bqHZspLv8otLmCsqmCKpKkOo09X7EJiZcjGoCVXvQKm4BbRP5AMUmSgtEhtxfaGFQzhL6wwqOa7qpSZBQlHTh6ZX6DUKzDQzzlpBSPlxLcf6QAnEUWJk5dLBXynaIz6jOueN6I3HeKa31+EVHM7IW2WCuPyrISK6+9Y0j2y7GH+Ta96ZSeBJDfT5a2FkCX//hgMBgMBngCJfxMYc1vbN0AAAAASUVORK5CYII=","orcid":"","institution":"University Hospital of Cologne","correspondingAuthor":true,"prefix":"","firstName":"Yue","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2025-05-02 16:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6579897/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6579897/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84812060,"identity":"48ee7152-a3b5-43ee-b777-f4deb813f483","added_by":"auto","created_at":"2025-06-17 14:57:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":547661,"visible":true,"origin":"","legend":"\u003cp\u003eSurvey participants. (A) Most participants were aged between 18-25 years. (B) Approximately two thirds of participants were female. (C) Most participants were part of a medical or nursing educational program.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6579897/v1/d1d09911f3972a0cb9ac7818.png"},{"id":84810703,"identity":"cf0c4cfe-469e-4f75-9bb8-103f99029615","added_by":"auto","created_at":"2025-06-17 14:49:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":947365,"visible":true,"origin":"","legend":"\u003cp\u003ePaucity and demand for GO training. (A) Approximately a third of participants had completed an oncology course. (B) 20% of the participants with completed oncology course reported the inclusion of GO into the course. (C) All participants ranked the importance of GO 5 or higher on a scale of 0-10. (D) 31 of 158 participants had completed a course in geriatrics (blue color scheme). E) Approximately half the participants with education in geriatrics reported the inclusion of GO into their training. (F) The majority (ca. 56%) of participants without prior geriatrics education (red color scheme) were aware of GO in general. (G) GO courses are in 85% (n= 31) of the cases only allocated \u0026gt;20% of the teaching content. (H) 87% (= 31) participants confirm that there is a need for GO training. (I) The majority of participants with geriatrics training suggest that geriatric assessment can improve the quality of life (QoL; 81%), support the guidance/definition of a therapeutic strategy (65%), reduce the risk of severe toxicity on cancer treatment (55%), help to detect frailty (52%).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6579897/v1/d9074b587777e30cd93a9283.png"},{"id":84810704,"identity":"210159e5-ff91-477a-8c8e-5f2fe97b601e","added_by":"auto","created_at":"2025-06-17 14:49:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":770276,"visible":true,"origin":"","legend":"\u003cp\u003eParticipants are predominantly interested in addressing mental health problems, palliative and hospice care as well as improving the QoL of GO patients. (A) Participants without prior GO training ranked mental health, palliative care, cancer rehabilitation and psychological and social aspects of cancer in older patients as most interesting subjects for GO training. The comparison between the care of younger and older patients with cancer and clinical trails for older patients with cancer was ranked as area of low interest. (B) Participants with prior GO training ranked mental health, individualizing treatment for older patients with cancer and learning about how to improve the quality of care for older patients with cancer as most interesting GO topics. (C) Participants without prior geriatrics training were mostly interested in palliative care, hospice care and geriatric screening tools. (D) Participants with prior geriatrics training ranked their satisfaction with the current geriatrics’ curriculum mostly a 3 out of 5.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6579897/v1/c6b5d6f67f0ab36f33a7873e.png"},{"id":84812065,"identity":"5aacd83c-5886-4006-add2-d3b98849e36a","added_by":"auto","created_at":"2025-06-17 14:57:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":702078,"visible":true,"origin":"","legend":"\u003cp\u003eTeaching strategies in GO training. (A) Lectures were the most frequently applied teaching strategies in GO training. (B) Seminars and Workshops were the most frequently expected teaching strategies. (C) and (D) AR and VR were only used in 4 and 5 cases, respectively. (E) VR and AR were in 4 out of 5 cases expected teaching strategies by participants who had previously received AR or VR GO training. (F) VR and AR were also expected teaching strategies in the pool of participants without prior VR and AR (G) The majority of participants (61.29%) with prior GO training expected international learning approaches in GO training. 10 of 31 participants were not sure whether to expect international learning. (H) The majority of participants without prior GO training (81 of 127) expected international learning GO training.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-6579897/v1/90b221f812eb8457986a6dfa.png"},{"id":84810714,"identity":"f287b71d-3c00-43f8-8b26-a6ec6b128172","added_by":"auto","created_at":"2025-06-17 14:49:52","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":603813,"visible":true,"origin":"","legend":"\u003cp\u003eWillingness to support the improvement of GO curricula. (A) Most participants were either willing to contribute to course feedback or not sure about their willingness to contribute to course feedback. (B) Most participants were willing to contribute once a semester, once a year or at flexible times to GO course feedback. (C) The majority of participants were willing to volunteer in oncogeriatric patient support. 51 of 158 (32.37%) were not sure and 29 (18.35%) were not willing to contribute to GO patient support. (D) Of the participants willing to contribute to GO patient support, most participants were willing to contribute once a semester, once a year or at flexible times.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-6579897/v1/b8ac29163719900a7be1545a.png"},{"id":84812714,"identity":"08eb36bd-645a-4098-844f-f11318ff3e95","added_by":"auto","created_at":"2025-06-17 15:05:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4248470,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6579897/v1/d0b6360c-568f-4a79-a7d9-ea3d3ed256b7.pdf"},{"id":84810696,"identity":"5add7baa-ff2e-41ee-81c2-2b72f380f1b7","added_by":"auto","created_at":"2025-06-17 14:49:52","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":25822,"visible":true,"origin":"","legend":"","description":"","filename":"GOsupplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-6579897/v1/df877ea67a071896570e3749.docx"}],"financialInterests":"Competing interest reported. Competing interests\nN.M.L.B: Advisory board: Pfizer, Abbott, Sanofi, Astellas; travel grants: Exact Sciences, Pfizer, Lilly, Novartis; speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead, AstraZeneca, Lilly, Exact Sciences\nK.P.L: Consultant: Pfizer and Seagan; Honoraria: Pfizer\nV.G.: Astra Zeneca, AbbVie, Novartis, Merck, Norgine, Berlin Chemie\nThe remaining authors declare that they have no competing interests.","formattedTitle":"An international online survey to improve training in geriatric oncology for undergraduates: Trainees´ interests and preferred teaching strategies","fulltext":[{"header":"INTRODUCATION","content":"\u003cp\u003eOlder adults with cancer are a growing, heterogeneous and particularly vulnerable patient population, presenting a unique set of challenges to healthcare professionals that requires specialized approaches. Due to the demopgraphic shift towards an ageing population, we expect 24\u0026nbsp;million new cases of cancer worldwide by 2035, an increase of approximately 170% compared to 2012 (14\u0026nbsp;million). Older patients with cancer are estimated to account for more than 50% of the global cancer incidence burden in 2035\u003csup\u003e1\u003c/sup\u003e. Given the increasing number of oncogeriatric patients, there is a pressing need for greater expertise and a more highly trained medical workforce to deliver optimal care. Therefore, expanding and enhancing geriatric oncology (GO) education within medical training is crucial for addressing this growing demand.\u003c/p\u003e \u003cp\u003eOncogeriatric patients are more likely to be frail and suffer from comorbidities which can complicate their care. Oncogeriatric health conditions include cognitive impairment, declined physiological functions, reduced organ, especially renal, function which can increase the risk of complications from locoregional and systemic anticancer treatments\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Due to their various health conditions GO patients are often subject to polypharmaceutical intervention which is associated with an increased risk of unwanted drug interactions, toxicities, and poor compliance\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. As a result oncogeriatric patients are frequently excluded from clinical trials, limiting the external validity of the evidence to guide treatment decisions and recommendations\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTo overcome the barriers in oncogeriatric care, the cancer workforce requires upskilling to enable sophisticated and effective treatment decisions and medical care for GO patients\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. However, training in GO is often underrepresented in medical teaching and curricula\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. In the US, GO was reported to be the least oncology-related discipline that was included into the oncology fellowship curriculum with merely 32% of the teaching programs including GO formally into their oncology curriculum\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In accordance, a 2017 survey sent to hematology-oncology fellows in the US reported that over 50% had not participated in GO lectures and had overall low knowledge in clinical practice and experience with GO patients. Similarly, 66.1% of UK oncology trainees reported to never have received training on the particular needs of GO patients. While more than 80% felt confident in treating younger patients, only approximately 27% were confident in balancing risks and in making treatment recommendations for older adults with cancer\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTo improve the care for older adults with cancer, stakeholders and caregivers have implemented different approaches. Institutions like International Society of Geriatric Oncology (SIOG) have put forward different initiatives to improve GO education, including webinars, online workshops and conferences\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. In addition, the Cancer and Aging Research Group (CARG) aims to oncogeriatric researchers across the nation in a collaborative effort of designing and implementing clinical trials to improve the care of older adults with cancer. ASCO and ESMO have made available recommendations for a global GO curriculum\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. However, implementation of GO training still faces many obstacles, including limited resources or access to GO training\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Since 2020, a EUniWell \u0026lsquo;onco-aging\u0026rsquo; working group was initiated with a seed funding support. The aim is to initiate a pilot program which will bridge the gap between patient needs and usual care by bringing the most urgent challenges for cancer care in advanced age to the attention of students within the fields from healthcare. The target group of this project are students from medicine, nursing science, life science, social work and associated disciplinaries. To support and guide the various efforts to improve knowledge and training in GO we conducted a study survey to collect interests and preferred teaching strategies for geriatric oncology.\u003c/p\u003e \u003cp\u003eThis study explored the awareness and knowledge of GO and its current significance in medical teaching, in particular in the training of medical students and nursing trainees. Furthermore, it aimed at assessing current teaching strategies applied in GO teaching and relating it to the needs reported by medical students and nurses to successfully expand their expertise in GO.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and ethical approval\u003c/h2\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki and was approved by the ethic committee of Medical Faculty of University of Cologne (ID: 21-1169). In this study, researchers designed a comprehensive survey consisting of 12 main questions that branched into a total of 31 queries to capture nuanced data regarding participants\u0026rsquo; experiences and attitudes towards taking a course on geriatric or oncological related medicine.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eParticipants were fully informed about the nature and purpose of the survey, and their responses were collected anonymously in 2022. Particiapants could enter the survey with a link (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://survey.lnu.se/Survey/29809\u003c/span\u003e\u003cspan address=\"https://survey.lnu.se/Survey/29809\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) and QR code that were widely distributed by Linnaeus University.\u003c/p\u003e\n\u003ch3\u003eSurvey\u003c/h3\u003e\n\u003cp\u003eThe survey\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e employed various question formats to ensure depth and breadth in responses. Multiple-choice questions, which consisted most of the survey, along with yes/no and 5-scale Likert scale questions were utilized to assess the intensity or frequency related to participants\u0026rsquo; experiences or attitudes. Additionally, open-ended questions offered respondents the opportunity to elaborate on their choices. The survey\u0026rsquo;s demographic section was brief, covering age, gender, year of study, and institution, ensuring the focus remained on participants\u0026rsquo; experiences with GO courses. Before participation, all respondents reviewed an informed consent document outlining the study\u0026rsquo;s purpose, voluntary participation, confidentiality, and the right to withdraw without penalty. To promote transparency, participants could optionally provide their email to receive the published article. The survey was distributed via email, social media, and web-based channels, including support from the Linnaeus University Informatics Department. The target group includes medical students and nursing trainees in their early stage of education. A full list of questions is provided in the \u003cb\u003eSupplementary material\u003c/b\u003e.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 158 participants responded to the multi-center online survey, which was accessible via a QR code and a web link. Participants were predominantly aged between 18 and 25 (102; 64.6%) or between 25 and 35 (33; 21.0%; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA) and female (102; 64.6%; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Most participants were medical students (88; 55.7%) or enrolled in nursing training programs (49; 31.0%; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC), mostly from Cologne, Murcia, or Tongji University.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eLack of GO training into medical and nursing education curricula\u003c/h3\u003e\n\u003cp\u003e54 (36.5%) of all 158 participants had taken courses in oncology during their education. Of these 54 participants, 9 (16.7%) reported the inclusion of GO into their oncology courses(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-C). 31 participants (19.6%) had taken classes in geriatric medicine or medicine of ageing(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD). Of these, 15 (48.4%) reported the inclusion of GO into their classes(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE). Participants who reported to have participated in courses, including GO topics, reported that GO was allocated minor content in classes. Participants who reported the inclusion of GO into their geriatric\u0026rsquo;s curricula estimated that less than 20% of the content was dedicated to GO, where less than 20% was the minimal option possible to select in the survey(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eF,G). All participants ranked the importance of GO inclusion into their curricula 5 or higher on a scale from 0 to 10, including 50 participants (31.7%) who ranked the importance 10 out of 10. Of the participants who already had classes in geriatrics, 27 (87.1%) confirmed the need for the inclusion of GO training into curricula(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eH). In the group of participants without previous training in geriatrics, 71 (55.9%) had an awareness of GO. 17 (10.8%) and 24 (15.2%) of all 158 participants were aware of SIOG and CARG, respectively.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eArea of focus for GO training\u003c/h2\u003e \u003cp\u003eParticipants with training experience in geriatric medicine ranked their satisfaction with the current geriatric curriculum mostly with a 3 on a scale from 0 to 5. With respect to geriatric assessment (GA), 25 participants (80.7%) with training in geriatrics confirmed the potential of GA to improve the quality of life (QoL) of geriatric patients and the majority, 20 participants (64.5%) considered GA an effective tool to support the guidance of a therapeutic strategy. Approximately half of the participants (51.6%, 16 participants) assigned GA a role in helping to detect frailty or dealing with toxicity in therapy decisions(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eI). With regard to learning objectives in GO training, participants with and without prior geriatrics training were especially interested in learning how to address mental health problems in elderly adults with cancer. In accordance with that, participants indicated a learning interest in topics addressing hospice, palliative care or improving the quality of care(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDiscrepancy between applied and expected teaching strategies\u003c/h3\u003e\n\u003cp\u003eThe group with previous training in geriatrics (n\u0026thinsp;=\u0026thinsp;31) reported that most teaching was conducted as a series of lectures or seminars and workshops. 8 (25.8%) participants reported training in bedside teaching and only 6 (19.4%) participants in E-learning(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA). The group with no previous geriatrics training (n\u0026thinsp;=\u0026thinsp;127) reported to expect seminars and workshops (93; 73.2%) as well as bedside teaching (75; 59.0%) as primary teaching strategies. Additionally, 58 (45, 67.0%), participants would expect lectures in GO teaching(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eVirtual Reality (VR) or Augmented Reality (AR) were only rarely applied. 5 (16.23%) and 4 participants (12.9%), respectively, reported the inclusion of VR or AR into teaching. Of these 5 participants with experience in AR or VR, 4 participants (80.0%) would expect more VR or AR in teaching. VR or AR application was expected from 41 participants (32.3%) and only 18 participants (14.2%) expected E-learning in GO teaching. Additionally, participants without previous experience in geriatric medicine (n\u0026thinsp;=\u0026thinsp;127) reported that they would expect more international learning experiences (81; 63.8%). Yet, 40 participants (31.5%) also reported that they were unsure about expectations for international learning in GO(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC-H).\u003c/p\u003e\n\u003ch3\u003eWillingness to participate in improving GO curricula\u003c/h3\u003e\n\u003cp\u003eTo optimally design GO classes, participants were asked for their willingness to give feedback to teachers. The majority of participants (91; 57.6%) reported to be willing to give course feedback, mostly in a frequency of once a semester (42; 26.6%) or once a year (21; 13.3%). 17 participants (10.8%) indicated that they would like to be flexible in the frequency of giving course feedback(Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA,B). Furthermore, almost half (78; 49.4%) of the participants stated that they were willing to volunteer in GO patient support. However, 29 (18.4%) were not willing to participate in GO patient support and approximately a third (51; 32.4%) were not sure whether they wanted to contribute to GO patient support(Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC). Of those indicating that they were willing to help in GO patient support, most participants liked to contribute once a semester (23; 29.5%), followed by 20 participants (25.6%) who preferred to be flexible(Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eD).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis multi-center, international online survey explored the awareness of GO among medical and nursing students and their preferences for GO training strategies as well as topics of particular interest. We found that GO is rarely included in medical curricula and, if taught, underrepresented in classes. Yet, the demand for GO training among medical students, with and without prior education in GO, is high. Furthermore, participants, having received training in GO, are confident that GO training can improve the care of older adults with cancer. Participants indicated that they were especially interested in learning about topics addressing mental health, QoL as well as hospice and palliative care with seminars and bedside teaching as preferred teaching strategies.\u003c/p\u003e \u003cp\u003eOur findings fit into existing literature that highlights the paucity of GO training and the increasing demand for improving the training in oncogeriatric care. The global shortage of GO training has been described earlier, for example in a 2017 review about achievements and challenges of GO which acknowledged a ubiquitous incapacity to adequately manage the needs of elderly patients with complex chronic conditions\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. For example, the review listed that the majority of geriatrics fellowship positions (56%) remained unfilled and only half of the geriatricians recertified in their subspecialty board in the US. While acknowledging that many has been done for improving the acceptance and increasing interest in geriatrics, e.g. by creating shorter fellowship programs and recognizing geriatrics as subspecialty, less than half of the countries reported the inclusion of geriatrics into medical school curricula. Furthermore, in a qualitative study with interviews of first- and senior-year fellows in hematology/oncology, participants perceived a general lack of dedicated formal GO training. They remarked that specific GO training might not be perceived as necessary by teachers because fellows were treating GO patients frequently in their daily routine as a doctor and could thus learn based on their personal experience\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition to underscoring the global scarcity of GO training, this study contributes to existing literature by focusing on the needs of trainees in early stages of their education and by including their perspective on possible strategies to improve GO training. So far, most literature has evaluated GO training in fellowship programs, in particular in hematology and oncology fellowship programs\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Consistent with our results, Maggiore et al. (2014) found that hematology/oncology fellows rated GO training as \u0026ldquo;very important\u0026rdquo; on a Likert scale\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Yet only 19% of the fellows reported that their institution had a specific GO training program. In addition, Maggiore et al. (2014) showed that hematology/oncology fellows were lacking GO knowledge, for example regarding geriatric assessment (GA) or predictors of chemotherapy toxicity. Interestingly, there was no association between prior GO training and the frequency of correct answers in tests about GO knowledge which highlights the need to make GO training more valuable and effective\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. To make GO training more accessible and successful, this study investigated topics of interest in GO training and preferred teaching strategies of trainees. This can contribute to a re-evaluation of topics and applied teaching strategies in GO training.\u003c/p\u003e \u003cp\u003eThe results of this survey indicate that participants were mostly interested in addressing mental health issues, palliative care and improving the QoL in GO patients. While the recommended curriculum by ESMO/ASCO for oncology includes geriatrics and supportive and palliative care, it does not account for the relation of QoL and geriatrics in GO patients\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Fellows in oncology who evaluated rotations in GO in interviews suggested that among others there was a need to address QoL and transitioning to palliative care discussions in teaching. Thus, psychological knowledge and skills were included into the GO curriculum based on the needs assessment\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eProficient teaching strategies are key to successful knowledge transmission. In order to overcome the challenge of a general lack of experts in GO, organizations such as ASCO and ESMO have developed e-modules\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. While e-modules have the potential to make knowledge globally accessible to many trainees without the need of many experts generating content, accessibility can also be limited by costs of content creation and maintenance\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Offering GO e-learning to a price might reduce participation. For example, the participation in an ASCO GO e-module with cost was with \u0026lt;\u0026thinsp;1% between 2012\u0026ndash;2013 very low, despite an enrollment into the corresponding fellowship program of 849 fellows\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In our study, we found that students reported little e-learning methods and use of novel teaching strategies such as AR and VR. In addition, participants without prior geriatrics training ranked VR, AR and e-learning as least expected teaching strategies, prioritizing workshops and seminars as well as bedside teaching. This might indicate that not only possible payments for e-learning can challenge knowledge transmission, but possibly a preference for teaching methods that rely on personal interaction. In accordance with this, hematology/oncology fellows have reported that more clinical experience with older adults with cancer and \u0026ldquo;hands-on\u0026rdquo; practice\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Yet, despite low in number, participants with VR or AR GO training expected more VR and AR applications in GO training.\u003c/p\u003e \u003cp\u003eThis study indicates that participants were rather willing to contribute to GO course evaluation and participate in GO patient volunteer for GO patient support. However, many participants were also unsure whether they would want to contribute to course feedback or GO patient support. Most participants were willing to offer their support once a semester, once a year or at a flexible rate. These results might imply that participants are generally willing but unsure whether they should fully commit and take responsibility for providing course feedback or patient support. Maggiore et al. (2014) documented that many fellows perceived time as a major barrier for doing GA with patients, but also for GO training. Fellows were also worried about time constraints regarding integration of more learning content and an extension of the curriculum in order to include GO as a specialty in their already existing curriculum\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In our study, participants might have been worried about the implications on schedules and the time it would take to commit to providing course feedback or to volunteer in GO patient support.\u003c/p\u003e \u003cp\u003eThis study has limitations regarding the response rate, the methodology as well as the sample number and composition. The link and QR code needed to participate in the survey were widely distributed by Linnaeus University via EUniWell alliance and networks. We cannot identify how often the link was opened in total. Therefore we cannot provide a response rate for the survey. However, recent studies question the significance of response rates to detect bias such as nonresponse bias\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. In the case of this survey, we acknowledge that we are not able to assess a potential bias created by the fact that we only capture answers of people willing to respond and we are not able to show their proportion of the sample. Yet, we are convinced that the results of this study can still show important trends that should be shared with the wider scientific community.\u003c/p\u003e \u003cp\u003eSince, the survery was conducted from end of 2021 we did not follow the Consensus -Based Checklist for Reporting of Survey Studies\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e which may limit the standardization and comprehensive reporting of survey methodology and findings. Because the participant collective with prior education in geriatric medicine is small, the statistical significance is limited in questions regarding this collective. Since participants were primarily trained in universities from Cologne (Germany), Shanghai (China) and Murcia (Spain) the informative value is limited to these training centers. While it can add new information to existing literature, the focus on trainees in the first years of their education might be questionable because GO goes hand in hand with a high degree of specialization which is usually part of the advanced educational pathway. In addition, the pre-selection of topics of interest and teaching formats could introduce a bias in the analysis. However, we are still convinced that the outcomes of the study should be shared with the community and can motivate and guide further efforts to improve GO training.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis survey provides valuable insights into the current state of GO education, underscoring the need for comprehensive curricular integration of GO content. The findings highlight a desire among trainees for increased exposure to GO, as well as the need for interactive, hands-on teaching approaches. This information can inform future efforts to develop and implement more effective GO curricula that better address the needs of older adults with cancer.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGO: geriatric oncology; QoL: Quality of Life ; VR: virtual reality; AR: artificial reality; CARG: Cancer and Aging Research Group; SIOG: International Society of Geriatric Oncology; ASCO: American Society of Clinical Oncology; ESMO: European Society of Medical Oncology; GA: geriatric assessment\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and was approved by the ethic committee of Medical Faculty of University of Cologne (ID: 21-1169). The informed consent to participate was obtained from all of the participants in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data of this study are available under a transfer agreement from the corresponding author based on a reasonable request. There will be limitations on how data can be used or how long data will be available for.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN.M.L.B.: Advisory board: Pfizer, Abbott, Sanofi, Astellas; travel grants: Exact Sciences, Pfizer, Lilly, Novartis; speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier, Gilead, AstraZeneca, Lilly, Exact Sciences\u003c/p\u003e\n\u003cp\u003eK.P.L.: Consultant: Pfizer and Seagan; Honoraria: Pfizer\u003c/p\u003e\n\u003cp\u003eV.G.: Astra Zeneca, AbbVie, Novartis, Merck, Norgine, Berlin Chemie\u003c/p\u003e\n\u003cp\u003eThe remaining authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project was partly funded by EuniWell seed funding project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.Z., M.F., and Y.Z. wrote the main manuscript text.\u003c/p\u003e\n\u003cp\u003eR.Z. and NB.F. prepared the figures.\u003c/p\u003e\n\u003cp\u003eE.P., R.D., N.M.L.B., V.G., M.P., and Y.Z. made contributions to the conception.\u003c/p\u003e\n\u003cp\u003eM.F. and NB.F. made contributions to the analysis.\u003c/p\u003e\n\u003cp\u003eR.Z., M.F., NB.F., N.H., and L.P. made contributions to the methodology.\u003c/p\u003e\n\u003cp\u003eM.F., N.H., J.L., L.P.,HX.S. and Y.Z. contributed to the investigation.\u003c/p\u003e\n\u003cp\u003eC.B., M.F., and Y.Z. contributed to the supervision.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreacited the dissemination of the survey via international offices of EUniWell alianed Universities as well as the support from Cancer and Aging Research Group (CARG) and the International Society of Geriatric Oncology (SIOG).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePilleron S, Sarfati D, Janssen-Heijnen M, Vignat J, Ferlay J, Bray F, Soerjomataram I. 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L., Kwok, J., Karbwang, J., de Waure, C., Drummond,F. J., Kizawa, Y., Taal, E., Vermeulen, J., Lee, G. H. M., Gyedu, A., To, K. G., \u0026hellip;Karamouzian, M. (2021). A Consensus-Based Checklist for Reporting of Survey Studies(CROSS). Journal of General Internal Medicine, 36(10), 3179\u0026ndash;3187. https://doi.org/10.1007/s11606-021-06737-1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Geriatric oncology, education, geriatric assessment, virtual reality, artificial reality","lastPublishedDoi":"10.21203/rs.3.rs-6579897/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6579897/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAge is a critical driver of the worldwide increasing cancer incidence rates, and with the growing number of older adults diagnosed with cancer, there is a rising need for specialized care. However, geriatric oncology (GO) education remains underrepresented in medical curricula. The gap between demand and adequately trained providers requires the development of more robust GO training programs. This study examined the current state of GO education, and the areas of interest within GO and the preferred teaching methods for this specialized content.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA multi-center international online survey aimed at assessing the awareness and perceived significance of GO among early-career medical students and nursing trainees were conducted.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was a significant lack of awareness of GO among trainees in the early years of their professional education (56%) and a scarcity of GO content allocation in geriatrics curricula, with 84% of participants receiving less than 20% of their geriatrics education focused on GO. Despite this, most trainees recognized the potential of GO to enhance patient care, particularly in improving the quality of life (QoL; 81%), optimizing therapeutic strategies (65%), and reducing treatment toxicity (55%). Key areas of interest among trainees included mental health, quality of life, and palliative care. Additionally, seminars and bedside teaching were identified as preferred methods for learning GO content.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis survey highlights the need for better GO education, emphasizing curricular integration and interactive teaching. Trainees seek more exposure, and findings can guide the development of effective GO curricula for older adults with cancer.\u003c/p\u003e","manuscriptTitle":"An international online survey to improve training in geriatric oncology for undergraduates: Trainees´ interests and preferred teaching strategies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 14:49:47","doi":"10.21203/rs.3.rs-6579897/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-20T06:51:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T10:11:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166400378531931644485554988249760520539","date":"2026-01-04T15:31:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-29T09:28:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316659026850595602903056061526150055836","date":"2025-11-18T19:46:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85683437009429432086028924473221897499","date":"2025-11-16T20:53:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142468292926481074957604178915398277609","date":"2025-06-27T18:25:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339134613175379633261511305732348446088","date":"2025-06-27T07:50:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-21T18:46:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217423029901671300795662486257276734433","date":"2025-06-13T16:08:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-13T05:57:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-11T12:16:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-20T04:53:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-19T15:25:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-05-19T15:22:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bee06ceb-99e8-4c6d-9f13-7325c84d755f","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-10T19:09:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 14:49:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6579897","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6579897","identity":"rs-6579897","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}