Bridging research gaps in geriatric oncology: unraveling the potential of pragmatic clinical trials.

IF 1.9 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES Current Opinion in Supportive and Palliative Care Pub Date : 2024-03-01 Epub Date: 2023-12-22 DOI:10.1097/SPC.0000000000000688

Carlos A Carmona-Gonzalez, Mateus T Cunha, Ines B Menjak

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Abstract

Purpose of review: This review examines the role of pragmatic clinical trials (PCTs) in addressing the underrepresentation of older adults with cancer (OAC) in clinical trials. Focusing on real-world evidence (RWE), it aims to provide a comprehensive overview of PCT utilization, emphasizing their potential to enhance treatment decisions and patient outcomes. Existing knowledge gaps in PCT implementation are also discussed.

Recent findings: PCTs are identified as effective tools to include OACs with comorbidities and complex conditions in research, bridging the representation gap. Despite their proven value in healthcare provision, their application in OAC contexts remains limited, hindering comprehensive understanding and inclusivity in clinical trials.

Summary: While randomized controlled trials (RCTs) are considered the gold standard in oncology research, OACs have historically been excluded, perpetuating underrepresentation. Furthermore, even in current oncology clinical development trials, this demographic continues to be underrepresented. PCTs offer a valuable avenue for the identification and evaluation of therapies within authentic RW contexts, encompassing various healthcare settings, such as hospitals, clinics, and physician practices. RCTs and PCTs complement one another, and the utilization of PCTs has the potential to inform clinical decision-making across the OACs entire treatment trajectory.

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缩小老年肿瘤学研究的差距：发掘实用临床试验的潜力。

综述目的：本综述探讨了实用临床试验（PCT）在解决老年癌症患者（OAC）在临床试验中代表性不足的问题方面所起的作用。该综述以真实世界证据（RWE）为重点，旨在全面概述PCT的使用情况，强调其在改善治疗决策和患者预后方面的潜力。此外，还讨论了在实施 PCT 方面现有的知识差距：PCT 被认为是将患有合并症和复杂病症的 OAC 纳入研究的有效工具，弥补了代表性方面的差距。摘要：尽管随机对照试验（RCT）被认为是肿瘤学研究的黄金标准，但 OAC 一直被排除在外，导致其代表性长期不足。此外，即使在目前的肿瘤临床开发试验中，这一人群的代表性也仍然不足。PCT 为在真实的 RW 环境中确定和评估疗法提供了宝贵的途径，它涵盖了各种医疗环境，如医院、诊所和医生诊所。RCT 和 PCT 相辅相成，利用 PCT 有可能为 OACs 整个治疗过程中的临床决策提供信息。

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Current Opinion in Supportive and Palliative Care HEALTH CARE SCIENCES & SERVICES-

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3.70

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0.00%

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期刊介绍： A reader-friendly resource, Current Opinion in Supportive and Palliative Care provides an up-to-date account of the most important advances in the field of supportive and palliative care. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including end-of-life management, gastrointestinal systems and respiratory problems. Current Opinion in Supportive and Palliative Care is an indispensable journal for the busy clinician, researcher or student.