Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement
Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement
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DOI：
10.1200/jco.2015.63.0319
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发表时间：
2015-11-10
影响因子：
45.3
通讯作者：
Cohen, Harvey J.
中科院分区：
文献类型：
--
作者：
Hurria, Arti;Levit, Laura A.;Cohen, Harvey J.
美国临床肿瘤学会（ASCO）召集了一个小组委员会，针对医学研究所确定的一项关键需求，就改善老年癌症患者治疗的证据基础制定相关建议。大多数癌症诊断和死亡发生在老年人身上，而且老年人也占癌症幸存者的大多数。老年人也是美国人口中增长最快的部分。然而，针对这一人群治疗的证据基础薄弱，因为老年人在临床试验中的代表性不足，而且专门针对老年人设计的试验很少。结果是，临床医生在如何治疗占癌症患者大多数的老年人方面缺乏证据。在制定治疗方案时，临床医生和患者被迫从在更年轻、更健康的人群中进行的试验中推断。这导致在普通老年患者的毒性风险以及对老年人重要的关键终点方面知识匮乏。美国临床肿瘤学会提出了五项建议，以改善这一人群的证据生成：（1）利用临床试验来改善老年癌症患者治疗的证据基础；（2）利用研究设计和基础设施来生成老年癌症患者的证据；（3）增加美国食品药品监督管理局的权力，以激励和要求开展涉及老年癌症患者的研究；（4）提高临床医生招募老年癌症患者参加临床试验的比例；（5）利用期刊政策来改善研究人员对研究参与者年龄分布和健康风险状况的报告。（C）2015年美国临床肿瘤学会版权所有
The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants. (C) 2015 by American Society of Clinical Oncology