Age Not a Key Factor in Cancer Survival So Why are
Seniors Excluded from Clinical Trials?
60% of cancer patients are senior citizens, but
elderly are 'systematically excluded' from treatment studies
Nov. 6, 2008 A new study has found that, although
60 per cent of cancers occur in senior citizens over 65, age is not a
factor in determining survival chances with cancer. Still, seniors are
systematically excluded from clinical trials that study cancer
treatment.
Age is not an independent factor in cancer survival
rates and should not influence decisions about how to treat older
patients, according to a study in the November issue of IJCP, the
Independent Journal of Clinical Practice.
A team of hospital and University-based researchers
from Barcelona, Spain, carried out a detailed study of more than 200
patients diagnosed with cancer.
"We found that there were a number of factors that
influence survival rates including physical quality of life and how
far the cancer had spread but age was not one of them" says lead
researcher Dr Eva Domingo from Hospital Vall d'Hebron.
"Despite this fact, and the challenges that
clinicians face from an ageing population, there has been little
research into how to treat older cancer patients, who often have complex
medical needs because of other health issues.
"They have been systematically excluded from
clinical trials for cancer treatments. Although 60 per cent of cancers
occur in patients over 65, their participation in clinical trials does
not exceed 25 per cent.
"This has made it difficult to predict how older
patients will tolerate and respond to the latest cancer treatments and
has provided an obstacle to making evidence-based clinical decisions."
Dr Domingo and her colleagues teamed up with
researchers from the University of Barcelona to look at 224 patients
diagnosed with cancerous tumours.
The patients ranged from 32 to 92 years of age and
three-quarters of them were male.
Thirty-nine per cent of the patients were under 65
and 61 per cent were 65 or over.
The most common tumors were respiratory (43 per
cent) and gastrointestinal (29 per cent). 42 per cent of the patients
had a localized tumor.
Just under two-thirds of the patients (62 per cent)
died during the one-year follow-up period.
The data from each patient, which included body
mass index and quality of life scores as well as various clinical tests,
was subjected to a detailed analysis.
This showed that there were four independent
factors that played a significant role in predicting whether a patient
survived. These were:
Metastatic dissemination, which measures how
widely the cancer has spread. The level of functional impairment the
patient experienced, as measured by the Karnofsky Performance Status
Scale. The patient's physical quality of life, as measured by the
eight criteria on the Short Form 36 questionnaire. Serum albumin
levels, a major protein that is produced in the liver and is essential
for maintaining pressure in the vascular system.
Patients had better survival rates if they had a
good physical quality of life and fewer problems with functional
impairment. High serum albumin levels were also important, as were a
lack of metastatic dissemination.
"The patient's age was not an independent factor
that predicted how likely they were to survive cancer" stresses Dr
Domingo. "Because of this, age, in itself, should not be used to limit
diagnostic or therapeutic decisions."
The number of older cancer patients is rising as
the worldwide population ages. But not enough it being done to meet
their needs, argue the authors.
"Consciously or unconsciously, age often becomes a
decisive element when diagnostic or therapeutic strategies are designed"
says Dr Domingo.
"Older people tend to have more complex health
needs, such as other illnesses, and that is one of the reasons that has
frequently been put forward for not treating their cancers aggressively.
However our study found that comorbidity, like age, was much less
significant than factors like physical quality of life.
"Other reasons given include the limited long-term
benefits, compared with younger patients, and the lack of financial,
logistical and social support."
The authors expressed hope that their research will
reduce the focus that other clinicians put on age when they treat older
patients with cancer.
"We would like to see less decisions taken on the
basis of age and more research that explores the complex needs of older
people, so that they can be treated more effectively and enjoy a better
quality of life" concludes Dr Domingo.
Keep up with the latest news for senior citizens, baby
boomers
Nov. 6, 2008 A new study has found that, although
60 per cent of cancers occur in senior citizens over 65, age is not a
factor in determining survival chances with cancer. Still, seniors are
systematically excluded from clinical trials that study cancer
treatment.