Based on the survey results, the researchers found that PCPs are less likely to refer their older patients living with cancer to oncologists than their younger patients. While 86% of PCPs would refer older patients with early stage, potentially curable cancers to oncologists, only 65% said they would refer older patients with advanced, potentially incurable cancers.

Despite the fact that patients over the age of 65 represent more than half of all cancer patients, researchers found this population to be underrepresented among patients using cancer care services. (Cancer care services included a range of services, including visits to the oncologist and participation in clinical trials.)

The factors that influenced a PCP's decision to refer a patient to an oncologist included the type and stage of cancer, the patient's symptoms, and the patient's desire to be referred. Factors such as age, social support, socioeconomic status, educational level, and accessibility of cancer specialists did not influence the PCP's decisions, according to the study's findings.

To address this issue, the researchers recommended better education of PCPs who care for older patients. "If patients were better educated by their primary care physicians, perhaps some would make different health-care decisions," said lead researcher Carol Townsley, MD. "Some patients may be missing opportunities to receive medical intervention for their cancer based on a preconceived notion that there may not be any treatment available."

In a separate study looking at cancer care in the older population, researchers at the U.S. Food and Drug Administration (FDA) found that older patients are not taking advantage of some of the promising treatments being evaluated in clinical trials.

The researchers analyzed data from more than 29,000 patients enrolled in clinical trials. They compared the proportion of older patients for each type of cancer with the percentage of older patients enrolled in clinical trials for each cancer.

Their findings showed:

• 49% of all breast cancers are diagnosed in older patients, but only 45% of patients enrolled in breast cancer clinical trials are over the age of 65.
• 67% of all lung cancers are diagnosed in older patients, but only 35% of patients enrolled in lung cancer clinical trials are over the age of 65.
• 70% of all colorectal cancers are diagnosed in older patients, but only 41% of patients enrolled in colorectal cancer clinical trials are over the age of 65.
• 71% of all pancreatic cancers are diagnosed in older patients, but only 33% of patients enrolled in pancreatic cancer clinical trials are over the age of 65.
• 44% of all ovarian cancers are diagnosed in older patients, but only 31% of patients enrolled in ovarian cancer clinical trials are over the age of 65.
• 54% of all leukemias are diagnosed in older patients, but only 24% of patients enrolled in leukemia clinical trials are over the age of 65.

Among patients who were 75 years and older, clinical trial participation rates were even lower.

The researchers encourage the development of strategies to increase the enrollment of older patients in clinical trials, as well as to increase the number of clinical trials designed specifically for older individuals.

"Health-care providers should evaluate older cancer patients for enrollment in clinical trials on the basis of their health status, cognitive function, and socioeconomic support, rather than by their chronological age," concluded Lilia Talarico, MD, lead author of the study.

What Does This Mean For Patients?

People living with cancer need to establish an open line of communication with their physicians, so that they are able to actively participate in decisions regarding their treatment options. In particular, patients should ask about the standard of care for their type of cancer and what clinical trials may be available to them.

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