Orshe

One thing health-care practitioners know about treating the elderly is that they don’t know enough about treating the elderly.

The point is underscored today by Richard C. Frank, a doctor who writes in a WSJ.com guest column about a 83-year-old patient with heart problems seeking aggressive treatment to fight non-Hodgkin’s lymphoma. The cancer is often curable but there is precious little information about how much an elderly patient with a weak heart — or other serious conditions, for that matter — can handle the normal rigors of anti-cancer treatment. Frank writes:

Clinical trials for cancer treatments usually enroll patients with few if any major health problems besides cancer. And patients in their 70s, 80s and 90s are notoriously underrepresented in trials, even though cancer is much more common in the elderly.

We know that older, sicker people are at higher risk of harmful side effects from cancer treatments, but we don’t know how best to vary those treatments to accommodate the wide range of health problems common in the elderly.

Of course, the fact that the elderly are underrepresented in much research has been well-known for a long time. In a 1997 analysis published in BMJ, researchers looked at a group of published studies and concluded that more than a third excluded elderly people without justification.

A 1999 study in the New England Journal of Medicine found those 65 years and older represented 63% of the population with cancer in the U.S. but they accounted for only 25% of people in cancer-treatment trials. There are some signs of change, however; an NEJM study published earlier this year looked only at women 65 and above who were at risk for a recurrence of breast cancer.

As for Frank’s lymphoma patient, the doctor came up with a treatment plan and the cancer has been in remission for two years. But Frank says of the patient: “Knowing that he received less-than-ideal therapy, I continue to worry about his cancer returning.”

Photo: Associated Press

More here:
The Need for New Research to Include Old Patients