WEDNESDAY, April 11, 2007 (HealthDay News) -- A study of radiation therapy that bought elderly cancer patients a few extra months of life holds a lesson for the future of medicine, a French physician says.
"The importance is not in the results themselves," said Dr. Jean-Yves Delattre, chairman of the department of neurology at the Salpetriere Hospital in Paris, and lead author of a report in the April 12 issue of the New England Journal of Medicine.
"The importance is in the fact that caring for elderly people will be the future of medicine, and all evidence-based medicine is based on trials done in younger people. We don't know how good we are or how harmful we are when we deal with this (elderly) population," he said.
The trial included 85 participants, with an average age of 73, who were newly diagnosed with glioblastoma, a kind of brain cancer. As the journal report noted, "There is no community standard for the treatment of glioblastoma in patients 70 years or older."
In the trial, 42 patients received the usual supportive treatment aimed at making them as comfortable as possible. The other 39 received the supportive treatment as well as radiation therapy.
The trial was cut short when it became clear that those getting radiation therapy were doing much better. Their average survival time was 29.1 weeks, compared to 16.9 weeks for those getting supportive care.
"In this population, the key problem was, are we going to destroy the quality of life by giving radiotherapy?" Delattre said. "Was this life going to be worth living?" As it turned out, periodic evaluations showed the quality of life to be essentially the same in both groups. Radiation therapy did not damage mental function.
Delattre noted that age also dictates the kind of treatment offered to children. "We know we do not treat a 2-year-old child as we treat a 40-year-old man. I think that in the future, when many patients will be in their 80s or 90s, we will have to do specific medicine for them as we do with children," he said.
The altruism of the people in the trial was very helpful, too, Delattre said. "It was extraordinary how our patients were able to understand a difficult study," he said. "There was a comfort arm, in which we did not offer extra treatment, and those people did it for the sake of future patients."
The trial could be a step toward "evidence-based medicine for a segment of the population that so far has not been studied a lot," he said.
While 60 percent of people with cancer are older, they usually represent only 10 percent to 20 percent of patients enrolled for clinical trials, said Dr. Lillian L. Siu, an associate professor of medicine specializing in cancer at the University of Toronto, who wrote an accompanying editorial in the journal.
"The take-home message of my editorial is not focused on a specific cancer such as glioblastoma," Siu said. "The message is that, clearly, the population is aging, and we are not seeing the kind of representation in clinical trials that we need."
Siu said she has studied the barriers that prevent older people from being enrolled in clinical trials. "Many barriers do exist," she said. "For example, physicians can have an inherent bias, so older people are not approached for treatment in those trials at all."
In fact, she said, "many older patients have not even heard of clinical trials."
Siu now is looking more closely at the selection of patients for such trials. "There is hesitation about putting older patients in trials when the population is aging," she said. "That group will be more relevant in the next 10 to 20 years."
More information
The U.S. National Library of Medicine has more information on brain cancers such as glioblastoma.
