AOJ-1 - Comprehensive Approach for Clinical Trials in Elderly Cancer Patients in an Aging Society of Korea

Abstract

Background: As the population of elderly cancer patients steadily increases, it is important to evaluate the feasibility of clinical trial in these patients to direct future care standard treatments and resource allocation. Elderly patients are very heterogeneous because the aging process is a highly individualized one and chronological age can't predict the changes involved in the aging process. The definition of elderly or fragile patients varies based on the different considerations such as disease-specific issue, risk of complications, estimation of life expectancy, and physician's view. With this heterogeneity, elderly patients have been underrepresented in both clinical trials and standard chemotherapy.Methods: Treatment of resectable colon cancer patients after age 70 of years were analyzed retrospectively focusing on clinical variables. The efficiency of adjuvant chemotherapy was evaluated in elderly colon cancer patients after a match by the propensity score method.Results: The elderly patients with resectable colon cancer received surgical treatment in more than 95% of cases regardless of their age or year of diagnosis. On the other hand, the proportion of patients who received adjuvant treatment increased among those who were diagnosed more recently, but it decreased abruptly with the increment of age. Recruitment of older patients into cancer clinical trial could be improved by (1) designing study grouped by age; (2) assessing patients to better distinguish the “well” older patients from the “frail” older patients.Conclusion: Currently, a comprehensive geriatric assessment (CGA) of elderly cancer patient has been recommended for the selection of proper treatment by predicting functional age and defining fragility including comorbidities. More personalized risk stratification of patients may be useful to elderly patients for optimal cancer treatment.