Examining the Evidence: A Systematic Review of the Inclusion and Analysis of Older Adults in Randomized Controlled Trials

Zulman, Donna M.; Sussman, Jeremy B.; Chen, Xisui; Cigolle, Christine T.; Blaum, Caroline S.; Hayward, Rodney A.

doi:10.1007/s11606-010-1629-x

Cited by 325 publications

(246 citation statements)

References 33 publications

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“…28 The treatment of breast cancer in older patients is still not evidence-based because older patients are often not included in clinical trials on account of restrictions of age, comorbidities, and physical function. 29 This leads to a large diversity of treatment strategies and poor adherence to guidelines among treating specialists. 30 Consequently, breast cancer-specific mortality increases with age, even amid competing causes of death in older patients.…”

Section: Discussionmentioning

confidence: 99%

Physical activity and survival of postmenopausal, hormone receptor–positive breast cancer patients: Results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study

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Fontein

Bastiaannet

et al. 2014

Cancer

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BACKGROUND: Physical activity has been related to improved breast cancer outcomes. Especially in the older breast cancer population, physical activity may be important because old age is associated with comorbidities and decreased physical function. The purpose of this study was to investigate the relation between physical activity and overall survival, breast cancer-specific survival, and recurrence in several age groups of postmenopausal breast cancer patients. METHODS: The Tamoxifen Exemestane Adjuvant Multinational Lifestyle study was a side study of the Tamoxifen Exemestane Adjuvant Multinational trial and prospectively investigated lifestyle habits of postmenopausal, hormone receptor-positive breast cancer patients. The relations between prediagnosis and postdiagnosis physical activity and overall survival, breast cancer-specific survival, and recurrence-free survival were assessed with Cox regression and competing risk regression models. RESULTS: Among 521 patients, high levels of physical activity before and after the diagnosis were associated with better overall survival (the multivariate hazard ratios were 0.50 [95% confidence interval 5 0.26-0.98] and 0.57 (95% confidence interval 5 0.26-1.40] for patients who were very active before and after the diagnosis, respectively, in comparison with inactive patients). This was most evident in patients who were 65 years old or older. Physical activity was not significantly associated with breast cancer-specific survival or the relapse-free period. CONCLUSIONS: Overall survival was better for patients who were active before and after the diagnosis. In contrast with previous studies, breast cancer survival and the risk of recurrence were not significantly associated with physical activity. These findings confirmed the need for more studies investigating the use of physical activity to supplement breast cancer treatment in older patients. Cancer 2014;120:2847-54.

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Section: Discussionmentioning

confidence: 99%

Physical activity and survival of postmenopausal, hormone receptor–positive breast cancer patients: Results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study

Glas

Fontein

Bastiaannet

et al. 2014

Cancer

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“…This will require that clinical effectiveness studies include, or even oversample, patients with comorbidities, and researchers examine potential differential treatment effects by comorbidity type and overall health status. 69,70 There is also an opportunity to enhance clinical care for multimorbid patients by encouraging discussions about how patients' comorbidities interact and affect their self-management practices and overall well-being. For example, patients with multiple conditions may more readily accommodate a new treatment if their provider encourages them to link it to their care for a comorbid condition.…”

Section: Research and Clinical Carementioning

confidence: 99%

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

et al. 2013

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Multimorbidity-the presence of multiple chronic conditions in a patient-has a profound impact on health, health care utilization, and associated costs. Definitions of multimorbidity in clinical care and research have evolved over time, initially focusing on a patient's number of comorbidities and the associated magnitude of required care processes, and later recognizing the potential influence of comorbidity characteristics on patient care and outcomes. In this article, we review the relationship between multimorbidity and quality of care, and discuss how this relationship may be mediated by the degree to which conditions interact with one another to generate clinical complexity (comorbidity interrelatedness). Drawing on established theoretical frameworks from cognitive engineering and biomedical informatics, we describe how interactions among conditions result in clinical complexity and may affect quality of care. We discuss how this comorbidity interrelatedness influences the value of existing quality guidelines and performance metrics, and describe opportunities to quantify this construct using data widely available through electronic health records. Incorporating comorbidity interrelatedness into conceptualizations of multimorbidity has the potential to enhance clinical and research efforts that aim to improve care for patients with multiple chronic conditions.

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“…In keeping with previous research suggesting that randomised studies seldom include older patients [28], the group acknowledged that the strength of the evidence base for providing practice recommendation in this group of patients is sometimes limited. Some of the topics (see Table A) will therefore be addressed as 'pro-con debates' between experts (for example, dialysis modality selection [29] and optimising dialysis adequacy [30]).…”

Section: Future Stepsmentioning

confidence: 81%

Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults

et al. 2016

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2 Abstract PurposeTo identify and prioritize potential topics to be addressed in the development of European, multidisciplinary guidelines on the management of chronic kidney disease stage 3b to 5 in older patients. MethodsWe composed a list of 47 potential guideline topics by reviewing the literature, consulting online 461 nephrologists and 107 geriatricians, and obtaining expert input. A multidisciplinary panel of twelve experts then prioritized the topics during a face-toface consensus meeting, following a Nominal Group Technique structure with two voting rounds. Topics were rated on a 9-point scale ranging from 1 ('not at all important') to 9('critically important'). ResultsThe highest rating (median; range) was assigned to 'Screening and referral' (8.5; 2.0). Eight topics shared the second highest rating with a median priority score of 8.0 (2.0), and included 'Starting dialysis or not' and 'Accurate assessment of renal function'.

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Examining the Evidence: A Systematic Review of the Inclusion and Analysis of Older Adults in Randomized Controlled Trials

Cited by 325 publications

References 33 publications

Physical activity and survival of postmenopausal, hormone receptor–positive breast cancer patients: Results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study

Physical activity and survival of postmenopausal, hormone receptor–positive breast cancer patients: Results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults

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