Those who dig deep into research methodologies know well the inherent biases that riddle much scientific and medical research. (See my postscript reference below) Clinical trials are not exceptions to these biases and, as drug companies look to produce the best outcomes for their clinical trials, patient selection (IMO) stands as #1 in that category. In her interview, Dr. Morgans' highlight that specific bias. It seems near universal in PCa drug development, affecting both dosing protocols and expected outcomes/efficacy.
From the article's lead-in to the interview:
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Most men diagnosed with prostate cancer are older than 65. In clinical trials, however, the participants tend to be younger and more fit than real-world patients, noted authors of a review in the ASCO Educational Book.
"Therefore, despite the incidence of prostate cancer peaking in older age, it is not known whether older men derive the same benefit from the treatment strategies used in younger men," said Alicia Morgans, MD, MPH of Dana-Farber Cancer Institute and Harvard Medical School in Boston, and co-authors.
Given this, geriatric assessments to determine a patient's frailty or fitness and inform treatment decisions are important in prostate cancer patients older than 65. These assessments can help avoid overtreating frailer men or undertreating fitter ones, the authors explained.
In their review, the team covered evidence-based risk-assessment tools for older men with prostate cancer as well as intervention strategies to improve treatment tolerance.
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The full interview (with links to a review and expert commentary) is at the link below:
Alicia Morgans, MD, on Prostate Cancer in Older Men– Determining frailty or fitness will help guide treatment decisions, by Jeff Minerd , Contributing Writer, MedPage Today November 27, 2023
PS For those that want to understand the many challenges (frequently leading to flawed results) for scientific research, this Peter Attia interview with Stanford's John Ioannidis is a very good place to start.
The Peter Attia Drive Podcast #143 - John Ioannidis, M.D., D.Sc.: Why most biomedical research is flawed, and how to improve it
cannot be sure about fitness (they normally do not report it) but average and median age are usually reported in clinical trials…I remember a 99 year old man in a lutetium trial (if I remember correctly!) 🤣🤣
Thanks, Patrick. It is indeed a good presentation of the posted info, as she summarizes it well before the audience at ASCO.
Hope all is very well in the more western longitudes and higher elevations. Happy Holidays to you and yours and please give our FPC-community best to Nal if you chance upon him at some lunch spot around town. The loss of his valued contributions are still regularly noted here at HU.
It is what all healthcare providers should do.... Truly, see the patient ... There are treatment guidelines and tools to evaluate older patients, and providers want to utilize those, but the MD may not utilize those tools due to time limitations ... Healthcare has become a conveyor belt system, and too often, MD's just utilize the standard without looking to see if this is appropriate in that case... Considering how fast practice is changing, keeping up with changes in practice is hard as well. The statement might be that they see the patient, but do not REALLY see the patient as a whole. There are time limitations to practice, and clinical trials are no different ..
Also, when a trial is designed to enroll a number of patients, part of the challenge is to get the number of patients needed...
As a provider that is currently in an inactive status, I can tell you that the desire to return to practice is nonexistent.
I see some doctors actually going back to home practice as “functional medicine “
I love the idea of seeing a doc at his home, it reminds me of my dad taking the gang of kids in stages like 3 at a time to Dr Rapaport. I remember the cigar smell and how nice he was.
Initially, my father practiced medicine on the 1st floor, and the family lived in the upstairs when he started out. He used to make house calls for $5 in WV... He smoked cigars as well, so your reply brought up fond memories... Thanks...
I've stayed in touch with a fellow sailor from Sweden after he sold his sailboat and moved back to Stockholm. He was around 80 years old when COVID arrived and medical staff came to his home to vaccinate him. It was apparently SOC for at-risk people in Sweden throughout the pandemic.
BTW, Before retiring, I know that NPfisherman provided in-home care as a contract healthcare provider. The definition of a "true health care provder", IMHO. Saludo al pescador.
I did in home, hospital, clinics, nursing home... everything, but spa medicine and clinical trials... Free Clinic was the best... It was where I felt I did the most good...
So much agree, Fish. Voluntary medicine was by far the most satisfying of my career. 7 years in West Africa in my own organization; Two in Peruvian highlands; Cancer support in Mexico; And free clinics in Washington and Oregon. Would love to do more to the degree I am still able.
And aside from clinical trial implications, for each oof us as individuals at whatever age and status, frailty an debilitation must be fought and corrected by whatever means possible. We know what to do!
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