Older adult participation in cancer clinical trials: A systematic review of barriers and interventions.
Older adult participation in cancer clinical trials: A systematic review of barriers and interventions.
复制标题
DOI：
10.3322/caac.21638
复制
发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Cancer and Aging Research Group (CARG)
中科院分区：
文献类型：
--
作者：
Sedrak MS;Freedman RA;Cohen HJ;Muss HB;Jatoi A;Klepin HD;Wildes TM;Le-Rademacher JG;Kimmick GG;Tew WP;George K;Padam S;Liu J;Wong AR;Lynch A;Djulbegovic B;Mohile SG;Dale W;Cancer and Aging Research Group (CARG)
癌症是一种老年病，随着世界人口老龄化，患有癌症的老年人数量正在增加，并将在几乎每个国家的肿瘤学人口中占越来越大的比例。尽管如此，在制定癌症治疗标准的研究中，老年患者的代表性仍然很低。因此，我们对癌症治疗的大部分了解都是基于在更年轻、更健康的患者中进行的临床试验，而改善老年癌症患者参与临床试验的有效策略仍然很少。这项系统综述评估了已发表的关于参与障碍和干预措施以提高老年人参与癌症试验的研究。现有证据的质量很低，尽管有文献描述了多方面的障碍，但只有一项干预研究旨在增加老年人参加试验的人数。我们的发现明显放大了缺乏基于证据的有效策略来改善这一代表性不足的人群参与癌症试验的情况。在这些限制范围内，我们就如何修改当前的癌症研究基础设施以适应老年患者的需求提出了我们的看法。我们提供了几个未得到充分利用的解决方案，以扩大临床试验，将患有癌症的老年人包括在内。然而，按照目前的结构，仅靠这些建议不能解决老年肿瘤学中的证据缺口，需要努力通过扩大专门为这一人群设计的临床试验和利用现实世界的数据来满足老年人和虚弱的成年人的需求。
Cancer is a disease of aging and, as the world’s population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinical trial participation of older adults with cancer remain sparse. This systematic review evaluated published studies regarding barriers to participation and interventions to improve participation of older adults in cancer trials. The quality of the available evidence was low and, despite a literature describing multifaceted barriers, only one intervention study aimed to increase enrollment of older adults in trials. Our findings starkly amplify the paucity of evidence-based effective strategies to improve participation of this underrepresented population in cancer trials. Within these limitations, we provide our opinion on how the current cancer research infrastructure must be modified to accommodate the needs of older patients. We offer several underutilized solutions to expand clinical trials to include older adults with cancer. However, as currently constructed, these recommendations alone will not solve the evidence gap in geriatric oncology, and efforts are needed to meet older and frail adults where they are by expanding clinical trials designed specifically for this population and leveraging real-world data.
登录
查看更多内容
影响因子：
28.4
作者：
Dueck AC;Mendoza TR;Mitchell SA;Reeve BB;Castro KM;Rogak LJ;Atkinson TM;Bennett AV;Denicoff AM;O'Mara AM;Li Y;Clauser SB;Bryant DM;Bearden JD 3rd;Gillis TA;Harness JK;Siegel RD;Paul DB;Cleeland CS;Schrag D;Sloan JA;Abernethy AP;Bruner DW;Minasian LM;Basch E;National Cancer Institute PRO-CTCAE Study Group
通讯作者：
National Cancer Institute PRO-CTCAE Study Group
影响因子：
45.3
作者：
Goldberg, Richard M.;Tabah-Fisch, Isabelle;Sargent, Daniel J.
通讯作者：
Sargent, Daniel J.
影响因子：
10.3
作者：
Guida, Jennifer L.;Ahles, Tim A.;Hurria, Arti
通讯作者：
Hurria, Arti
影响因子：
--
作者：
Clark, James M;Heifetz, Laurence J;David, Elizabeth A
通讯作者：
David, Elizabeth A
影响因子：
6.2
作者：
Extermann, Martine;Boler, Ivette;Balducci, Lodovico
通讯作者：
Balducci, Lodovico