Dr. Arti Hurria presented “Addressing the Evidence Gap for Older Adults With Cancer” at ASCO 2018. Below is a full transcript of the interview.
Hurria: Our U.S population and worldwide population is aging right now and because of that and the association of cancer with aging we have a steep rise in cancer incidence in particular in those patients who are over the age of 65.
Those individuals have been underrepresented in clinical research today, so there is a real opportunity to bridge this evidence gap.
Doximity: What are some consequences of the evidence gap that you’ve observed in your patients?
Hurria: When we're really sitting with an older adult with cancer, we don't have as much information about both the efficacy as well as the toxicity of those drugs within older adults.
Typically on the FDA registration trials that set the dosing and the schedule of the drug, there have been few individuals over the age of 75 in those studies. Hence there's less data about how should we really dose the drug in an older adult and what are the potential side effects that that individual might experience.
Furthermore, on these studies we typically now look at things like progression-free survival, overall survival—outcomes that are very important for people of all ages—but older adults are also interested in what is the impact of this treatment on my function, my memory, or what will my family need to prepare for. Those are real gaps in knowledge in our clinical trial infrastructure and trials today.
Doximity: How do you think this gap and cancer treatment will change as the population ages?
Hurria: I think this gap in cancer treatment and understanding these differences between how older adults do and younger adults do is only going to widen if we don't start to really do research that specifically is focusing on how to best care for this patient population. We know that the number of older adults is increasing and we know that the number of cancer cases and older adults is on the rise, so it is imperative that we really focus on research within these individuals now.
Doximity: How do you balance treatment with maintaining quality of life in older patients?
Hurria: For individuals who have cancers that are not curable, a key aspect of our treatment decision-making is actually to help maintain quality of life of those patients. That is really one of the key principles of why we are treating these patients.
At each step along the way the treatment, we have to really look at are the benefits of the treatment outweighing the risks: Is the toxicity really impacting their daily activities or affecting their quality of life? It's an integral part of our treatment decision-making process.
In terms of when do we have palliative care join us in these discussions: really what the data has shown is that early palliative care in the setting of metastatic cancer is very beneficial for our patients in so many ways. So partnering with palliative care early in the patient's course is really crucial.