Geriatric assessment by default for every older patient, and trials that admit them
Most cancer patients are over 65, yet treatment is chosen by age and guesswork and trials exclude them. Assess fitness properly and design trials that include real older patients.
Geriatric assessment-guided management reduced serious toxicity without compromising survival in randomised trials (GAP70+, GAIN). Uptake remains low and trial populations are far younger and fitter than practice. The proposal is a default assessment (short validated screen with full assessment when triggered) embedded in the record for all patients over 70 starting systemic therapy, payment for the assessment, and a requirement from regulators and funders that pivotal trials include older and comorbid patients in proportion to the treated population, with pre-specified analyses.
- 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.
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.
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not linked directly; found by shared links- IdeaParallel real-world cohorts for sicker patients alongside every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Trials do not represent the people who get cancer.
- IdeaA mandatory over-70s cohort with geriatric assessment in every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Trials do not represent the people who get cancer.
- IdeaGeriatric assessment by default for every patient over 70 starting cancer treatment
Shares GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth, Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaDose-finding in older and frail patients, not extrapolation from fit ones
Shares GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth, 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, Trials do not represent the people who get cancer.
- IdeaGeriatrician co-management for older patients having cancer surgery
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaA trials fund reserved for older and multimorbid patients
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Trials do not represent the people who get cancer.
- IdeaStop screening by life expectancy, not birthday, with a tool in the record
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.