A trials fund reserved for older and multimorbid patients
Most people with cancer are over 65, but most trial patients are younger and fitter. A dedicated fund would pay for trials designed for the patients we actually treat.
Public and charitable funders create a standing fund for trials with inclusive eligibility (age, kidney function, performance status, comorbidity), geriatric assessment-guided dosing, and endpoints that matter to older adults (function, independence, time at home). Trials would test dose reductions, shorter courses and de-escalation of standard regimens in patients over 70, where retrospective data suggest toxicity and discontinuation are far higher than in trials. Industry has little incentive to run these because they mostly test less drug.
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.
Pages like this
not linked directly; found by shared links- IdeaParallel real-world cohorts for sicker patients alongside every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Trials do not represent the people who get cancer.
- IdeaA mandatory over-70s cohort with geriatric assessment in every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Trials do not represent the people who get cancer.
- IdeaMandatory real-world reporting for patients excluded from pivotal trials
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Trials do not represent the people who get cancer.
- IdeaGeriatric assessment by default for every older patient, and trials that admit them
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Trials do not represent the people who get cancer.
- IdeaGeriatrician co-management for older patients having cancer surgery
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaStop screening by life expectancy, not birthday, with a tool in the record
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaPragmatic trials in patients over 75 with function, not just survival, as the primary endpoint
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaA defined pathway for patients with both dementia and cancer
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.