CHICAGO — Although cancer is usually a disease of the elderly, a large government review finds older people are often excluded from studies intended to discover better drugs to treat their disease.
Older people may be left out for legitimate reasons, such as having other serious illnesses along with their cancer. But experts contend that many more should be offered a chance to take part in these experiments, known as clinical trials.
The elderly could benefit from the experimental treatments, just as younger patients do, and their enrollment is essential for doctors to learn whether the drugs are safe and effective in people their age.
Furthermore, many top specialists say doctors should be more willing to offer state-of-the-art treatments to the elderly patients in day-to-day care. Instead, the most aggressive therapy is often reserved for younger patients.
"It's not just clinical trials. They are also less likely to get standard treatments," even such obvious therapies as radiation to ease pain, said Dr. Lilliam Siu of Princess Margaret Hospital in Toronto.
The underrepresentation of older people in drug studies was documented by the Food and Drug Administration, which reviewed data from 29,350 patients enrolled in studies of new cancer drugs, or new uses for older ones, since 1995.
While earlier studies have reached similar conclusions, Dr. Lilia Talarico said hers is the first to look at age differences in studies involving various kinds of medicine. For instance, she found that older women with breast cancer are just as likely as younger patients to enter studies of hormonal treatments, which typically have mild side effects. But they are much less likely to get into chemotherapy studies.
Overall, she found that while about 60 percent of all newly diagnosed cancer is in people over 65, they make up 36 percent of patients in drug studies.
While it may be unrealistic to expect studies to enroll older people in numbers reflecting their full cancer burden, "we want to make sure clinical trials contain an adequate number so we can answer whether the effect of treatment is the same as in younger patients," Talarico said.
She presented her data Saturday at the annual scientific meeting in Chicago of the American Society of Clinical Oncology.
Dr. Hyman Muss of the University of Vermont reviewed four large studies of breast cancer treatments involving 6,489 patients. Although just eight percent of the volunteers were over age 65, the studies taken together show that chemotherapy improved their survival equally as well as it did the younger women's.
"The job of the physician is to give the best treatment to their patients, period," said Muss. "Using age to minimize treatment is a bias. Age as a bias is wrong."