No Trials for the Aging
Why are seniors being left out of clinical studies?
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.
Looking for Solutions
A variety of approaches -- such as paid advertisements to seek seniors, and clearer Medicare rules -- will probably be needed to draw more older patients to clinical trials, says Hutchins. For now, the scarcity of elderly patients in cancer treatment trials is reminiscent of the former under-representation of women and African-Americans in clinical trials. In the late 1980s and early 1990s, federal agencies established requirements that women and minorities must be adequately represented in clinical trials of cancer treatments.
A Senior's Story
Despite these obstacles, Ted Simms, like Opal Addison, did get into a trial, and he's glad he did. And that's another argument for including more seniors in clinical trials: Doing so can offer measurable benefits to the participants themselves. Four years ago, Simms (not his real name), at the age of 73, found a lump in a lymph node that turned out to be cancerous. Three weeks later, the Texas resident started receiving intravenous taxol every 21 days as part of a 6-month clinical trial.
He bore the cost of traveling 150 miles and staying in a motel the night before each treatment. The drug caused mouth blisters, weight loss, and sapped his energy. His fingertips and feet still feel numb from the treatment -- but the cancer is gone. "I was a guinea pig," he admits, "but I didn't mind. It was the best option available.''
Carol Potera is a journalist from Great Falls, Mont., who writes for WebMD, Shape magazine, and other publications.