Elderly patients are underrepresented in clinical trials, but that doesn’t mean their experiences and outcomes have been lost or forgotten.
Just ask Sharon Giordano, M.D., associate professor in MD Anderson’s Department of Breast Medical Oncology.
She’s used data from the SEER-Medicare database — a collaboration between the Surveillance, Epidemiology and End Results (SEER) cancer registries data and Medicare enrollment and claims files — as the basis for more than a dozen studies.
The database offers clues, she says, to how older patients fare during certain cancer treatments.
She’s also interested in the late effects of cancer treatment, and the considerable database of 3.5 million cancer survivors is a font of information on both.
“It shows real-life patterns of care in a population that’s been massively underrepresented in clinical trials,” she says. “For example, what can we learn about long-term toxicities by studying how these patients fare years after treatment?”
Studies reveal late effects, risks of under-treatment
She cites a study on the long-term cardiac safety of adjuvant anthracyclines, a class of drugs used in chemotherapy. The study found a higher-than-expected risk of heart failure in older breast cancer patients, which seemed to increase as they aged.
Another of her studies found that intravenous bisphosphonates, which increase bone mineral density, are underused in women ages 65-75 with metastatic breast cancer.
Not all of her research concerns breast cancer. One study measured the survival of older patients with stage III colon cancer in relationship to whether they’d been referred to a medical oncologist.
These high-risk patients were more likely to receive chemotherapy — and to survive — if they’d received such a referral.
“Although these studies need validation, they’re provocative and should encourage further research,” Giordano says.
She also notes that the SEER database shows a surprisingly wide variation in practice patterns throughout the United States.
‘Though it’s ‘standard of care,’ treatment on the East Coast might differ from that on the West Coast and in the Midwest,” she says. “We need to identify populations who aren’t receiving these standards of care, so we can improve care for everyone.”