Universitair Ziekenhuis Brussel

The average global life expectancy is predicted to increase to approximately 80years by 2040 [1]. Cancer is an ageing-related disease, and its prevalence will also increase with this ageing of the population [2]. This rise in older adults living with cancer will demand innovation in service delivery, multidisciplinary collaboration, and a renewed focus on compassionate, patient-centred care. We are therefore compelled to rethink how we approach cancer diagnosis, treatment, and survivorship. This white paper explores the potential realities and challenges through a multidimensional lens, addressing the intersection of demographic shifts, rapid technological advancements, and the evolving needs of older adults living with cancer. Key areas examined include the integration of precision medicine and digital health tools, the adaptation of healthcare delivery models, and the implications for workforce training and resource allocation. The discussion highlights disparities in care, the importance of personalised interventions, and strategies to enhance quality of life for older adults with cancer. By anticipating these developments, the paper offers critical insights for policymakers (who set the rules and goals and allocate funding), health system leaders (who manage the day-to-day operations), clinicians and allied health professionals (who are patient-facing), and patients and caregivers, aiming to promote equity, innovation, quality and resilience in the care of older adults with cancer as we approach the next decade. The paper seeks to consolidate and clarify the diverse issues and opportunities that will emerge as the global population ages and the burden of cancer among older adults rises. With average life expectancy predicted to approach 80years by 2040, and cancer recognised as a disease closely linked to ageing [3], the paper brings together expert perspectives to provide a sector-wide synthesis of the impending challenges. Its purpose is not to offer a conventional systematic review, but rather to serve as a strategic resource for policymakers, health system leaders, clinicians, allied health professionals, patients, and caregivers, informing the response to demographic shifts, technological advances and evolving patient needs. By consolidating insights on disparities in care, the necessity for personalised interventions, and strategies to enhance quality of life, the paper aims to inform and inspire innovation, equity and resilience in geriatric oncology as we approach the next decade.

Prescribing an adequate intraperitoneal dialysate volume is essential in peritoneal dialysis (PD) to balance optimal solute and fluid removal against the risk of increased intraperitoneal pressure (IPP) and to prevent increased reabsorption and mechanical complications. Since the description of manual hydrostatic IPP measurement (IPPM) in children in 1996, a few small observational studies in children and adults have provided limited evidence on the acceptable upper limit of IPP and associated complications. We conducted a practice survey across European pediatric dialysis centers, which showed that of the responding 47 centers, 68% routinely perform IPPM, but the frequency, mode of measurement, accepted upper limit of IPP, and interpretation of IPPM results vary considerably. In this narrative review, we present the current knowledge on IPP and the rationale for a standardized three-point IPPM, a prerequisite to obtain valid scientific data on the relation of IPP with patient outcome, e.g., by means of registries and adequately powered prospective studies. To date, the role of IPPM in improving outcomes for children on PD is uncertain. Advanced, continuous IPPM technologies providing precise, large-scale IPP data together with PD efficiency and tolerability data will improve our understanding of the impact of IPP on patient outcomes.

Abstract Injuries of the triangular fibrocartilage complex (TFCC), particularly those involving the foveal insertion, may lead to significant ulnar-sided wrist pain, grip weakness, dysfunction, and progressive degenerative changes within the distal radioulnar joint (DRUJ). Arthroscopic repair is the preferred surgical approach for peripheral TFCC tears requiring intervention. Multiple techniques have been described to address the peripheral and/or foveal attachments of the TFCC. This report presents an arthroscopic repair method that concurrently addresses both foveal and peripheral TFCC tears using a single combined suture construct. This approach has the potential to enhance the stability of TFCC fixation and improve overall DRUJ stability.

Paediatric gonadotoxic treatments can compromise male fertility, yet prospective data systematically tracking pubertal development are scarce. Immature testicular tissue banking (TTB) has been introduced as an experimental fertility preservation option for (pre-)pubertal boys, but its long-term safety and interaction with gonadotoxic treatment are not fully understood. This single-centre prospective cohort study systematically followed 23 boys, treated for malignant or non-malignant conditions, between 2017 and 2025 [median 4.0 (0.1-6.9) years], including 15 who underwent TTB. Unlike previous studies, this research combined repeated assessments of pubertal staging, testicular volumes, parenchymal integrity, reproductive hormones, and bone age and density, enabling a multidimensional evaluation of pubertal development. Gonadotoxic treatments, particularly myeloablative conditioning, were associated with reduced post-pubertal testicular volumes and altered hormone profiles, including elevated luteinising hormone and follicle-stimulating hormone, and reduced inhibin B, while anti-Müllerian hormone remained largely stable. Puberty occurred spontaneously and testosterone production was preserved in all patients. The testicular parenchyma appeared unaffected by the biopsy, and although some biopsied testes showed lower volumes, similar reductions could be observed in non-biopsied testes. These results support the safety of TTB, with no evident adverse effects on testicular structure or function; however, larger multicentric prospective studies are needed to confirm these findings.

Diminished ovarian reserve (DOR) is common in women with infertility and is associated with poorer in vitro fertilization (IVF) outcomes. Testosterone is widely used off-label in this patient group, although evidence for its efficacy and safety is limited. To address this, we conducted a triple-blind, placebo-controlled, randomized clinical trial evaluating whether transdermal testosterone gel prior to IVF improves clinical pregnancy rates in women with DOR. Females aged 18-43 with infertility and DOR according to the Bologna criteria were recruited at 10 fertility clinics in Europe between April 2015 and November 2022. Of 316 assessed for eligibility, 290 were enrolled and randomized. Two were excluded from the primary analysis as their treatment coincided with the onset of the COVID-19 pandemic, and they did not start ovarian stimulation, leaving 288 participants. Participants were randomized to 5.5 mg of transdermal testosterone or matching placebo once daily for ~9 weeks prior to ovarian stimulation. All participants received ovarian stimulation in a long GnRH-agonist cycle with 300IU/day of highly purified human menopausal gonadotropin; fresh embryo transfer was performed if an embryo was available. The primary outcome was clinical pregnancy rate following fresh embryo transfer, defined as an intrauterine gestational sac with an embryo demonstrating cardiac activity at ≥7 weeks' gestation. Of the 288 participants, 134 were randomized to testosterone and 154 to placebo. Clinical pregnancy rates did not differ significantly, occurring in 21 women (15.7%) in the testosterone group and 23 (14.9%) in the placebo group (risk ratio (RR), 1.05; 95% confidence interval (CI) 0.61 to 1.81, p = 0.86). The study was terminated for futility at the prespecified interim analysis based on a conditional power calculation once 70% of the target sample size were randomized. In this study, transdermal testosterone did not improve clinical pregnancy rates compared with placebo in patients with infertility and DOR. Trial Registration: ClinicalTrials.gov: NCT02418572, EudraCT: 2014-001835-35.

People with advanced cancer often experience a range of symptoms and reduced well-being. Experience sampling methods, which involve completing multiple smartphone-based questionnaires per day over several days, may offer detailed insights into how these experiences unfold in daily life. To evaluate feasibility and acceptability of experience sampling methods in advanced cancer, and its potential to uncover moment-to-moment symptom and well-being fluctuations. Observational study including baseline measurement, a 7-day experience sampling period with up to 10 assessments per day of symptoms and well-being, and follow-up measurement. We evaluated feasibility through response data and acceptability through a follow-up questionnaire measuring burden, ease-of-use, instruction clarity, and measurement reactivity. We analyzed fluctuations using within-person standard deviations. We invited 79 people with advanced breast or lung cancer via two Belgian hospitals; 40 (51%) enrolled. Thirty-seven participants provided 1703 valid (71% of 2400 scheduled) experience sampling assessments. On 7-point scales, participants reported low burden (M = 2.1, SD = 0.8), high ease-of-use (M = 5.6, SD = 1.2) and instruction clarity (M = 6.5, SD = 0.5), and minimal measurement reactivity (M = 1.3, SD = 0.3). On 0-100 scales, we observed the greatest means of within-person fluctuations across days for tiredness (MiSD = 16.7, SD = 7.7), feeling relaxed (MiSD = 13.0, SD = 7.3), and activity limitations (MiSD = 12.4, SD = 9.9). Higher mean symptom intensity generally corresponded with greater within-person fluctuations. Experience sampling methods proved feasible and acceptable for people with advanced cancer, effectively capturing individuals' unique symptom and well-being fluctuations in daily life. The methods are a promising avenue to enhance personalized care and improve quality of life by revealing the mechanisms behind individuals' fluctuations.

To compare dual triggering versus hCG-only triggering in poor responders undergoing controlled ovarian stimulation with a GnRH antagonist protocol in ART cycles. A systematic review and meta-analysis was performed. The primary outcome was the number of mature oocytes (MII). The number of oocytes retrieved, clinical pregnancy, and miscarriage rates were analyzed as secondary outcomes. Subgroup analyses were conducted according to the Bologna and POSEIDON classifications. Ten studies were included. Dual triggering significantly increased the number of retrieved and mature oocytes in patients classified according to the Bologna criteria, but not in those classified by the POSEIDON criteria. Age-related differences across studies appeared to influence the efficacy of dual triggering. A borderline improvement in clinical pregnancy rates was observed among Bologna-defined patients. Miscarriage rates did not differ significantly between the groups. Dual triggering appears to improve oocyte yield and maturity in Bologna-defined patients, but this effect is unlikely to apply uniformly across all phenotypes. Persistent heterogeneity in poor responder definitions limits the understanding of the benefits of dual triggering in this population. Well-designed prospective studies with rigorous phenotypic stratification are warranted to identify which patients are most likely to benefit from dual triggering.