Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement

Abstract

The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.

Elderly selection on geriatric index assessment

“…This may be due to the lack of recommendation and to the fact that there is no clear demonstration of the role of CGA on elderly cancer patients' prognosis or clinical outcomes. In line with this, ASCO recently identified a critical need for specific guidelines for the treatment of older cancer patients (11).…”

Investigators seek ways to involve more older adults in cancer research

“…1 Building on that point, the American Society of Clinical Oncology (ASCO) in July issued recommendations on how to achieve that goal. 2 "This is a prime time to improve our evidence base for this older population," says Arti Hurria, MD, director of the Cancer and Aging Research Program at the City of Hope in Duarte, California, and co-author of the position statement. "We're right in the midst of this major demographic shift and incredible growth of older adults with cancer."…”

Low Elderly Participation in Non-Small Cell Lung Cancer Clinical Trials

“…There simply is not enough data on the treatment of elderly NSCLC patients to form comprehensive evidence-based recommendations. This situation is not unique to NSCLC, and both the Institute of Medicine (IoM) and American Society of Clinical Oncology (ASCO) have issued position statements urging cancer researchers to improve the evidence for treating older adults [1,2]. ASCO, in a position statement published online ahead of print July 2015, identified inclusion of elderly patients in clinical trials a key point of action [2].…”

“…This situation is not unique to NSCLC, and both the Institute of Medicine (IoM) and American Society of Clinical Oncology (ASCO) have issued position statements urging cancer researchers to improve the evidence for treating older adults [1,2]. ASCO, in a position statement published online ahead of print July 2015, identified inclusion of elderly patients in clinical trials a key point of action [2]. Patients over the age of 70 have previously accounted for only 10% of participation in clinical trials [8], and although more recent data has suggested this may be improving, overall enrollment of the elderly in clinical trials and NSCLC clinical trials has continued to be unrepresentative [9][10][11].…”

“…Cancer in the aging population has attracted increasing attention in the United States related both to the growing percentage of individuals over the age of 65 years as well as the increased vulnerability of this aging population to morbidity and mortality [1][2][3][4]. Lung cancer, of which non-small cell lung cancer (NSCLC) comprises 85% [5], is an area of particular interest.…”