Older Adults and Clinical Trials
Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work
MAY 17, 2018
This is definitely not good. I have been aware of the low level of participation, and even of the exclusion, of non-whites and women in clinical trials. This article from The New York Times discusses a similar situation with older people, usually meaning those 70 and above. The first given example is a study of salt intake. Especially since doctors frequently advise older patients to reduce the salt/sodium in their diets, it seems nuts not to include them in a study that looks at this very issue.
Since our shared topic is cancer, it is important to think a little about the increasing number of older people who are actively treated for cancer. If older people have not been included in clinical trials for cancer drugs, how can we possibly know how the impact on them?. There is a large and growing specialty of geriatric oncology, and many more people in their 80s or even their 90s receive chemotherapy or radiation. We know that cancer is considered a disease of aging (a fact that seems disproved when you look around our waiting or infusion rooms), but it has long been true that older people have often been excluded from many treatments given to those who are younger. As many people live longer and stay sturdy and healthy for most of those years, oncologists have reconsidered what is possible. If someone is otherwise in pretty good health and likely has a number of years left to live, it is only ethical and wise to offer them the same kinds of options that their younger counterparts would receive. Yes, doses might need to be reduced or other changes might need to be made, but treatment can often be safely and successfully delivered.
Here is the start and a link to read more:
The Clinical Trial Is Open.
The Elderly Need Not Apply.
By Paula Span
Dr. Ken Covinsky, a geriatrician and researcher, was sitting in his office at the San Francisco VA Medical Center last month,
browsing through a medical journal on his computer. When he came across a study of sodium excretion, he waded into the
The research team, mostly based at the Centers for Disease Control and Prevention, had used 24‑hour urine collections to
estimate how much salt Americans take in each day.
Salt matters to geriatricians. It’s associated with conditions many older people contend with, particularly high blood pressure, but
also swelling and heart failure.
Though doctors frequently urge older patients to reduce salt in their diets, it’s not clear how much reduction is necessary to
improve health, or even how much salt most people actually consume.
“There’s a lot of controversy, but that’s why we need the data,” said Dr. Covinsky. So he read on, until he reached the paragraph
explaining that the study used “randomly selected, nonpregnant participants aged 20 to 69 years.”
He did a double‑take. Once again, the population probably most affected — older adults — had been left out of an important study.
“How is this possible? Unacceptable!” Dr. Covinsky protested on Twitter. “I can think of no good rationale for this exclusion. This
has got to stop.”