Current demographic changes in the US population have resulted in an increasing number of older subjects presenting for treatment of oncologic diseases. This trend is likely to continue for the foreseeable future. Older subjects are more often to have comorbid conditions, which has resulted observed higher rates of morbidity and mortality complicating therapy choices in subjects of advanced chronologic age. Age and co-morbid changes also require individualized modifications to standard therapies to enhance tolerability and safety. A number of disparate fitness and frailty tools used in geriatric medicine have been applied to older and unfit subjects undergoing chemotherapy, yet there are no robust guidelines on how, in whom and when to apply these assessment tools. Older adults are also disproportionately diagnosed with high-risk hematologic malignancies that are difficult to cure without the use of allogeneic hematopoietic cell transplantation (HCT). Several advances in recent years have enabled HCT to be applied to older and more comorbid adults. However, transplant-related toxicities and non-relapse mortality (NRM) remain particularly problematic in this population when analyzed as a congregate whole. At the same time, although increasing numbers of adults over the age of 60 years are undergoing HCT, many who may benefit are either not referred, or not receiving HCT, due to a wide perception that older age alone may be a disqualifying factor in transplantation. For example, Pidala published a physician survey which reflected patient age substantially influenced referral for allogeneic HCT. 1 Surprisingly, 21% considered age 60 years or less an upper age limit for referral and only 17% would refer a patient 70 years and older. The barriers for referral and/or utilization for HCT are complex including insurance status, patient health, access to a transplant center, disease control, donor availability, physician bias and/or patient perceptions.
|Effective start/end date||8/20/19 → 8/20/23|
- National Marrow Donor Program (Protocol #1704//U01HL69294)
- National Heart, Lung, and Blood Institute (Protocol #1704//U01HL69294)
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