Why are seniors being left out of clinical studies?
April 3, 2000 -- (Great Falls, Mont.) -- A mammogram revealed a small
cancerous tumor in Opal Addison's breast, and she opted for a lumpectomy. When
her oncologist recommended that she enroll in a clinical trial of an
experimental drug to prevent further cancer, Addison (not her real name)
readily agreed. She did it to help herself and possibly others. ''If I was 21,
I probably wouldn't do it,'' says the 70-year-old Illinois woman. ''But now, if
I can help anybody, I'm glad to.''
Now completing the first year of the five-year study, she takes a daily
pill, visits her doctor for blood tests every three months, and has a mammogram
every six. So far, she's been free of side effects such as nausea or night
sweats, which she says would have to be ''pretty severe before I would drop
In Nora Ephron's best-selling book, I Feel Bad About My Neck, she
laments the sorry state of her 60-something neck: "Our faces are lies and our
necks are the truth. You have to cut open a redwood tree to see how old it is,
but you wouldn't have to if it had a neck," she writes.
"Every so often I read a book about age, and whoever's writing it says it's
great to be old. It's great to be wise and sage and mellow; it's great to be at
the point where you understand just what matters in life. I...
Older volunteers can help increase overall knowledge about the effectiveness
of cancer drugs. But patients older than 65 are woefully underrepresented in
cancer treatment trials, according to a study published in the December 30,
1999 issue of the New England Journal of Medicine.
The Scope of the Problem
Oncologist Laura Hutchins, M.D., of the University of Arkansas for Medical
Sciences in Little Rock, led the study that looked at 16,396 patients enrolled
in 164 cancer treatment trials. Only 25% were older than 65, even though 63% of
all cancer patients are in that group. When it comes to breast cancer in
particular, only 9% of the patients in clinical trials were past 65 -- though
half of all cancer cases occur in women that age and older.
Complicating the issue, health experts predict a "pandemic'' of cancer
as baby boomers age. ''When that happens, we're going to be totally unprepared
for dealing with cancer in the elderly," says medical oncologist Charles
Coltman, MD, of the University of Texas Health Science Center in San Antonio,
and another study co-author.
It's not enough, experts say, to study cancer treatment drugs in the young.
Aging immune systems and organs affect the way drugs are absorbed and
eliminated. Many elderly patients already take medications for diseases such as
high blood pressure that could interfere with the needed new treatments. And
sometimes cancers run a different course in elderly patients.
Why the Lack of Seniors?
Many seniors may miss out on clinical trials because their oncologists are
simply reluctant to refer them. A study published in the Journal of Clinical
Oncology in 1991 found that 80% of oncologists surveyed thought that
patients have better outcomes when they get clinical trial treatments, but half
added that they had sometimes declared patients unsuitable for the trials on
the basis of age alone.
Economics may also play a role. The rules about Medicare reimbursement for
patients participating in clinical trials are ambiguous, according to a recent
report from the federal Institute of Medicine. The institute recently urged the
Health Care Financing Administration, which administers Medicare, to issue
clear rules on reimbursement for participation in trials.
Because clinical trials require additional medical visits, lack of
transportation, or its cost, may be another obstacle.