title: Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement.
abstract: The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC. ahurria@coh.org.
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Levit
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: William
authors.initials: W
authors.lastname: Dale
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Hyman B
authors.initials: HB
authors.lastname: Muss
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Louis
authors.initials: L
authors.lastname: Fehrenbacher
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Allison
authors.initials: A
authors.lastname: Magnuson
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Lichtman
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Suanna S
authors.initials: SS
authors.lastname: Bruinooge
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Enrique
authors.initials: E
authors.lastname: Soto-Perez-de-Celis
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: William P
authors.initials: WP
authors.lastname: Tew
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Postow
authors.affiliation: Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P. Tew, and Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Hyman B. Muss, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; and Harvey J. Cohen, Duke University Medical Center, Durham, NC.
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002986:Clinical Trials as Topic / Q000379:methods / Q000592:standards*; D035081:Editorial Policies; D019317:Evidence-Based Medicine / Q000592:standards / Q000639:trends; D006801:Humans; D008495:Medical Oncology / Q000379:methods / Q000592:standards / Q000639:trends*; D009369:Neoplasms / Q000628:therapy*; D018579:Patient Selection; D010506:Periodicals as Topic / Q000592:standards; D012107:Research Design; D058028:Research Report / Q000592:standards*; D012955:Societies, Medical; D014481:United States; D014486:United States Food and Drug Administration