Competing Risks in Older Patients With Cancer: A Systematic Review of Geriatric Oncology Trials
A partir d'une revue systématique des essais de phase II et III en oncologie gériatrique (7 864 patients inclus dans 41 essais), cette étude évalue la prise en compte des risques concurrentiels et des comorbidités dans les critères de jugement de l'efficacité d'une thérapie systémique chez les patients âgés atteints de cancer
Background : It is increasingly recognized that older adults with cancer represent a diverse cohort of patients and that other comorbidities may have an equal impact on survival and quality of life as any diagnosis of malignancy. Competing risk has consequently emerged as an important concept in the design and reporting of geriatric oncology trials.
Methods : We performed a systematic review of phase II and III oncology trials for systemic therapy in older patients with solid organ malignancy from the year 2000 until April 30, 2017. Forty-one trials including 7864 patients were identified for evaluation.
Results : Only 15 trials (36.6%) employed disease-related end points to account for death from other causes, and only one study used statistical analysis that addressed competing risk. Seventeen studies (41.5%) of trials included some assessment of comorbidity or frailty. Twenty-one trials (51.2%) included any assessment of quality of life.
Conclusions : This review demonstrates clear areas for improvement for future studies and highlights the need for careful consideration of trial design, data collection, and appropriate statistical methodology for reporting of competing risks in geriatric oncology trials.
Journal of the National Cancer Institute , résumé, 2017