Simple SummaryThe increasing age-related cancer incidence being a major challenge in healthcare, the best approach for the management of cancer in the elderly relies on the structured cooperation among clinical oncologists, geriatricians, and other specialists. The diffusion of this special approach is, however, quite limited in high-income countries and is almost absent in those with lower incomes. This commentary aims to shed light on the complex reasons of the somewhat surprising lack of spread of programs for cancer in the elderly. The description of the many factors in dealing with the implementation of such programs might be useful in suggesting possible solutions.AbstractAn oncogeriatric interdisciplinary activity exists only in a minority of high-income countries, and it is almost absent in those with lower incomes. Considering topics, sessions, and tracks in the main meetings and conferences of the major Oncological Societies in Europe and worldwide, the USA excluded, little attention has thus far been paid to the problem of cancer in the elderly. Again, with the exception of the USA, the major cooperative groups, for example, the EORTC in Europe, have only dedicated marginal attention to the research of cancer in the elderly. Despite major shortcomings, professionals interested in geriatric oncology have taken a number of important initiatives to highlight the benefits of this particular activity, including the organization of an international society (Société Internationale de Oncogeriatrie, or SIOG). In spite of these efforts, the authors believe that the management of cancer in the older population is still encountering several important and generalized pitfalls. The main obstacle is the grossly inadequate number of geriatricians and clinical oncologists necessary to an integrated care of the ever-expanding aging population, but other hurdles have been reported. Additionally, the prejudice of ageism can lead to missing potential resources for the development of a generalized oncogeriatric approach.