Small gains made in studying treatment of elderly
Tuesday, May 19, 2009
Plain Dealer Reporter
"The traditional ways in which cancer is studied — by clinical trials focusing on younger, healthier patients — has left us devoid of useful data with which to treat older patients in an evidenced-based fashion."
These words from an article on geriatric oncology in the May 2007 Journal of Clinical Oncology speak to the woefully inadequate representation of elderly patients in clinical trials.
"There has been a failure to include older patients in clinical trials, so we don’t have evidence [of a treatment’s effectiveness in that group of people] and that’s what we’re struggling against," said Dr. Cynthia Owusu, director of the Geriatric Oncology Clinic at University Hospitals Case Medical Center.
Despite that omission, some small gains are being made.
A clinical trial conducted last year at the Ohio State University Comprehensive Cancer Center enrolled 33 patients, ages 60 to 83, for a study on acute myeloid leukemia, which mostly affects people over age 60.
The study’s preliminary findings, presented in December at the annual American Society of Hematology meeting, suggest that decitabine, a chemotherapy that is less toxic and whose doses are more spread out than standard intensive chemotherapy, is much more effective in treating AML.
A study conducted by researchers at the Memorial Sloan-Kettering Cancer Center in New York concentrated on types of treatment given to patients 65 and older with glioblastoma, the most common and aggressive type of brain tumor.
Using data on more than 4,000 patients diagnosed between 1994 and 2002, the study showed that age was the most significant factor in predicting whether a patient received treatment (older patients were less likely to receive radiation or chemotherapy). In an article published in January in Annals of Neurology, researchers suggested further study on shorter courses of treatment and less toxic chemotherapy for these patients.
Just last week, the New England Journal of Medicine published a study that shows that combination therapies, instead of the standard treatment of a single oral drug, improved survival in patients aged 65 and older.
The study, one of the first to target older women with early-stage breast cancer, was conducted with 600 women through the Cancer and Leukemia Group B of the National Cancer Institute’s Clinical Trials Cooperative Group Program.
Of course, elderly patients can’t be enrolled in clinical trials if they’re not being treated for cancer. Sometimes, it’s the patients who deny themselves that option.
"They say, Hey. I’m 75 years old. I don’t have too many years ahead of me. I don’t think I should have this treatment,’ " Owusu says.
But that patient in otherwise good health could live a dozen years or more — information that Owusu doesn’t hesitate to tell her patients.
Sometimes it works, as it did with her patient Lucy Williams — although a couple of Williams’ relatives were less certain about the then-81-year-old’s ability to tolerate the treatment.
Other times, Owusu said, "There are others who never agree, and we just let them be."