'A recipe for disaster'

November 30th, 2009

(PhysOrg.com) -- Geriatric oncologist Dr. Homayoon Sanati decries the underrepresentation of seniors in clinical trials. He's working with his UCI colleagues to provide a solution.

Across the country, myriad clinical trials of new cancer treatments are being conducted, but - according to a UC Irvine geriatric oncologist - relatively few older patients are involved.

This is egregious, says Dr. Homayoon Sanati, because cancer is the second-leading cause of death among the elderly. Furthermore, the chances of developing cancer increase as people age, and the number of Americans 65 and older is on the rise.

UCI is addressing this underrepresentation as part of the Cancer & Aging Collaborative Group, a multi-institution research effort.

"You have a growing older population with 10 times the incidence and mortality rate for cancer and almost no clinical trials for their treatment," says Sanati, a member of the multidisciplinary team at UCI's Chao Family Comprehensive Cancer Center. "It's a recipe for disaster."

Older adults with cancer require special care, he says. Many have other medical conditions or are taking medications that could interact with cancer drugs, and chemotherapy dosages may need to be adjusted because of diminished liver or kidney function.

Ironically, these same issues exclude many seniors from clinical trials, says Sanati, Orange County's only physician board-certified in both geriatrics and oncology. Others simply aren't referred by their doctors, who may presume they wouldn't be good candidates or interested in participating.

Consequently, clinical trials rarely yield data on how older cancer patients will tolerate a new treatment, despite the fact that they make up a large percentage of those needing it, says Sanati, who's also on staff at UCI's SeniorHealth Center.

For example, he says, the average age of a colorectal cancer patient is 70, but most people enrolled in related clinical trials are much younger. As for breast cancer, Sanati says: "No treatment recommendations exist for patients over 70, because of the 18,000 people in 47 breast cancer clinical trials, only 600 [3.3 percent] are over 70."

Members of the Cancer & Aging Collaborative Group are studying the usefulness of geriatric assessment before cancer treatment in those 65 and older. This involves screening patients for their risk of falling, depression, cognitive problems or dementia, and drug interactions.

"We want to determine whether the assessment can help predict side effects in older cancer patients," Sanati says. "If we know that someone is at risk of falling or has cognitive problems — which cancer treatment may heighten — we can anticipate those side effects and make decisions accordingly."

"Our goal is to provide superior care tailored to older adults with cancer," he adds. "Geriatric oncology is still a young field, but we're broadening our research to improve patients' survival rates and quality of life."

Provided by UC Irvine