National Coalition Works to Include More Elderly in Cancer Clinical Trials
Although cancer is largely a disease occurring in older people, the representation of older people in cancer clinical trials is far below the incidence rate.
—Richard Schilsky, MD
About 50 researchers and clinicians who specialize in all facets of the relatively new field of geriatric oncology gathered in Chicago in late September to strategize about developing and improving clinical care for older adults with cancer.
The Cancer and Aging Research Group meeting was led by William Dale, MD, PhD, section chief for geriatrics and palliative medicine at The University of Chicago, Arti Hurria, MD, director of the City of Hope Cancer and Aging Research Program in Duarte, California, and Supriya Gupta Mohile, MD, MS, assistant professor of medicine at the James Wilmot Cancer Center in Rochester, N.Y.
The meeting was the first in a series of three conferences funded through a partnership grant from the National Cancer Institute (NCI) and the National Institute on Aging (NIA).
“Although cancer is largely a disease occurring in older people, the representation of older people in cancer clinical trials is far below the incidence rate,” said Richard Schilsky, MD, section chief of hematology/oncology at UChicago.
The NIA estimates that the population of Americans aged 65 and older will double by 2030 to approximately 72 million people, equivalent to 1-in-5 Americans.
Dr. Dale established the Specialized Oncology Care & Research in the Elderly (SOCARE) clinic at UChicago in 2006 and has devoted his career to caring for older adults with cancer. His passion deepened when his elderly father was diagnosed with a rare form of lung cancer in 2009.
“The number of questions that he had about cancer and being older, and my inability to answer so many of those questions, helped motivate me to work even harder on this project,” said Dr. Dale.
The stages of aging are usually categorized as Fit (excellent or good condition), Vulnerable (good or fair condition), and Frail (poor condition). The group agreed that it is much easier to categorize and create a treatment strategy for the “fit” or “frail” patient, but research has shown that it is the “vulnerable” patient who is the most likely to enter a clinical trial.
In addition to identifying the need for a formal definition for a “vulnerable” patient, the group recommended development of a comprehensive geriatric assessment that includes a patient’s functional status, comorbid medical conditions (such as arthritis, diabetes, or obesity), cognition, nutritional status, psychological status, social support, and geriatric syndromes. These factors could play a role in the patient’s response to treatment and quality of life.
They also recommended developing a matrix to assist with practical interventions for improved cancer outcomes and treatment tolerance, as well as the creation of communications strategies to help increase awareness about the availability of cancer clinical trials for the elderly.
The next steps in the process will include continuations of the conference in California and New York, as well as the development of a consensus document that may set the stage for a new national standard of care for elderly cancer patients.
Members of the UChicago team at the meeting were (from left) Saleha Sajid, MD, geriatric oncology fellow, William Dale, MD, PhD, section chief for geriatrics and palliative medicine and co-director of the Specialized Oncology Care & Research in the Elderly (SOCARE) clinic, Gini Fleming, MD, professor of medicine, Richard Schilsky, MD, section chief of hematology/oncology, Jim Wallace, MD, co-director of the SOCARE clinic, and Ron Maggiore, MD, geriatric oncology fellow.