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In Reply

Department of Interdisciplinary Oncology, Health and Outcomes Behavior, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL

Crean et al used our already-acknowledged limitation of the existing evidence to reassert a prevailing clinical myth that, if you are an older patient with cancer, treatment will likely harm you. Hence, by implication, you should stay away from such treatments or trials testing these treatments. To us, this position is more reckless and callous than highlighting the fact that the existing empirical evidence (notwithstanding its limitations) does not support exclusion of elderly from clinical trials.^1,2 Having said this, we wholeheartedly agree that better data are needed to assess safety and efficacy of treatments in elderly patients. We hope that our paper will discourage automatic mindless exclusion of patients older than 65 years from clinical trials. Only this way can we obtain reliable evidence to guide our management in elderly population, which carries majority of cancer burden.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Kumar A, Soares HP, Balducci L, et al: Treatment tolerance and efficacy in geriatric oncology: A systematic review of phase III randomized trials conducted by five National Cancer Institute–sponsored cooperative groups. J Clin Oncol 25:1272-1276, 2007[Abstract/Free Full Text]

2. Keime-Guibert F, Chinot O, Taillandier L, et al: Radiotherapy for glioblastoma in the elderly. N Engl J Med 356:1527-1535, 2007[Abstract/Free Full Text]

Related Correspondence

• Reliable Evidence of Safety and Efficacy of Elderly Patients in Randomized Clinical Trials Still Needed
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  JCO 2007 25: 4027-4028 [Full Text]

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