Research Priorities in Geriatric Oncology: Addressing the Needs of an Aging Population
Authors: Arti Hurria, Supriya Gupta Mohile, William Dale
Journal: Journal of the National Comprehensive Cancer Network (2012)

The number of older adults with cancer is rising, and the United States population is aging.In 2011, the "baby boom" generation began turning 65, and the U.S. population aged 65 and older is expected to double by 2030.Because cancer is a disease associated with aging, this trend is anticipated to increase the incidence of cancer among older adults by 67%. 1 Despite this, enrollment in cancer clinical trials favors a younger population, 2-4 and few trials specifically focus on the unique issues that affect older patients.Consequently, little evidence-based data are available on the care of the growing number of older adults with cancer.To bridge this gap, a U13 conference grant, "Geriatric Oncology Research to Improve Clinical Care," brought together multidisciplinary investigators from geriatrics and oncology to identify the areas of highest research priorities in cancer and aging.The first U13 Conference, "Biological, Clinical, and Psychosocial Correlates at the Interface of Aging and Cancer Research," established a collaboration among the Cancer and Aging Research Group (CARG), the National Institute of Aging, and the National Cancer Institute.The first conference was designed to identify research goals and factors that would help shape geriatric oncology research.As part of this conference, participants with expertise in cancer and aging were asked to list the 5 most important areas of research in oncology/hematology and geriatrics.Here, we review their responses and the rationale for these research directions.Cancer Therapeutics in the Oldest Adults (Ages 75 and Older) Among FDA-approved treatments for cancer, only 9% of patients enrolled in registration trials were 75 years or older, whereas 31% of patients with cancer are within that age group. 3Therefore, clinicians have inadequate data on which to base drug dosing or anticipate therapeutic side effects for almost a third of patients with cancer.Furthermore, aging is associated with a steady decline in physiologic function, and several studies have shown that older age is a risk factor for chemotherapy toxicity. 5,6Although the rationale for studying treatments specifically in this population is well established, 7 the mechanism for doing so is not in place.Ideally, for cancers predominantly associated with aging, the FDA should mandate that studies include older adults, to inform the geriatric usage section of package inserts.This would ultimately ensure adequate research for cancer therapeutics used in older adults.Cancer Therapeutics in Frail/Vulnerable Individuals (Independent of Age) Patients of any age with a poor performance status are often excluded from cancer clinical trials.Furthermore, comorbid conditions are common exclusion criteria.However, the interaction among cancer, treatments, and comorbidities pose significant treatment and survivorship issues for older adults and their treating clinicians.Even in a relatively younger population (ages 65 and older), factors other than age often identify which patients are at risk for chemotherapy toxicity, and these factors have proven to be better predictors than conventionally used oncology performance status measures. 6,8Specific studies of treatment algorithms are needed for patients who would otherwise be considered ineligible or unfit for most current treatment protocols. Development of a Geriatric Assessment ToolWide heterogeneity characterizes the aging process.Factors other than, or in addition to, chronologic age can determine an older adult's "functional age."Geriatric assessment includes evaluating independent predictors of morbidity and mortality in older adults, such as functional status, comorbid medical conditions, psychological state, cognitive function, nutritional status, and social support.Geriatric assessment