Optimising treatment of elderly patients with ovarian cancer - Improving their enrolment in clinical trials

The aging population is the fastest growing segment of our population. Over the last century, the average life expectancy has increased by 25 years. The incidence of ovarian carcinoma, seen primarily in postmenopausal women, is, therefore, expected to increase. The current standard treatment of ovarian cancer has been determined on the basis of prospective, randomised clinical trials carried out by cooperative groups. Sixty-one percent of new cancer cases occur in women > 65 years of age. Despite this fact, enrolment in clinical trials has been exceedingly low. In turn, this causes suboptimal treatment for a very fatal disease. The aetiology of this is multifactorial, and strategies for improvement are lacking. Elderly patients may be barred from participation based on physician biases alone. Elderly patients may have limited access to academic centres where clinical trials are conducted or be excluded on the basis of unrealistic inclusion criteria. As physicians, it is our duty to understand the elderly patient and the comorbidities in this age group that may influence the tolerability and toxicity of conventional therapies. Therefore, it is imperative that we make a conscious effort to examine ways in which we may improve enrolment of elderly women with ovarian cancer in clinical trials.