Underrepresentation of patients 65 years of age or older in cancer-treatment trials.

Background: Studies have documented the underrepresentation of women and bl acks in clinical trials, and their recruitment is now federally mandated. H owever, little is known about the level of participation of elderly patient s. We determined the rates of enrollment of patients 65 years of age or old er in trials of treatment for cancer. Methods: We analyzed data on 16,396 patients consecutively enrolled in 164 Southwest Oncology Group treatment trials between 1993 and 1996 according t o sex, race (black or white), and age under 65 years or 65 or older. These rates were compared with the corresponding rates in the general population of patients with cancer, derived from the 1990 U.S. Census and from the Nat ional Cancer Institute's Surveillance, Epidemiology, and End Results Progra m for the period from 1992 through 1994. Fifteen types of cancer were inclu ded in the analysis. Results: The overall proportions of women and blacks enrolled in Southwest Oncology Group trials were similar to or the same as the estimated proporti ons in the U.S. population of patients with cancer (women, 41 percent and 4 3 percent; blacks, 10 percent and 10 percent, respectively). In contrast, p atients 65 years of age or older were underrepresented overall (25 percent vs. 63 percent, P < 0.001) and in trials involving all 15 types of cancer e xcept lymphoma. The underrepresentation was particularly notable in trials of treatment for breast cancer (9 percent vs. 49 percent, P < 0.001). The f indings were similar when data on patients who were 70 years of age or olde r were analyzed, when 15 trials that excluded older patients were eliminate d from the analysis, and when community-based enrollment was analyzed separ ately from enrollment at academic centers. Conclusions: There is substantial underrepresentation of patients 65 years of age or older in studies of treatment for cancer. The reasons should be c larified, and policies adopted to correct this underrepresentation. (N Engl J Med 1999;341:2061-7.) (C)1999, Massachusetts Medical Society.