Pragmatic trials in patients over 75 with function, not just survival, as the primary endpoint
For a frail 80-year-old, staying independent may matter more than living a few months longer. Trials designed for older patients should measure what they care about.
Standard oncology endpoints do not capture what matters most to many older patients: independence, cognition, and time at home. Pragmatic, embedded trials in routine care for patients over 75 with composite endpoints (survival free of functional decline, days alive and out of hospital) would produce decision-relevant evidence for the largest group of cancer patients. Cooperative groups have run a few such trials; a dedicated funding stream would create a portfolio.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
- Trial design, endpoints and cost · A phase 3 trial takes years and hundreds of millions of dollars, and often answers a question that has already moved on.
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.
Pages like this
not linked directly; found by shared links- IdeaGeriatrician co-management for older patients having cancer surgery
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaParallel real-world cohorts for sicker patients alongside every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaStop screening by life expectancy, not birthday, with a tool in the record
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaA defined pathway for patients with both dementia and cancer
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaA mandatory over-70s cohort with geriatric assessment in every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaMake sponsors justify every trial exclusion of older and multimorbid patients
Shares Older and multimorbid patients are excluded and undertreated, Trial design, endpoints and cost.
- IdeaHormone tablets instead of surgery for small breast cancers in the frail over-80s
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaMandatory real-world reporting for patients excluded from pivotal trials
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.