Older adult participation in cancer clinical trials: A systematic review of barriers and interventions.

Cancer is a disease of aging and, as the world's population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinical trial participation of older adults with cancer remain sparse. For this systematic review, the authors evaluated published studies regarding barriers to participation and interventions to improve participation of older adults in cancer trials. The quality of the available evidence was low and, despite a literature describing multifaceted barriers, only one intervention study aimed to increase enrollment of older adults in trials. The findings starkly amplify the paucity of evidence-based, effective strategies to improve participation of this underrepresented population in cancer trials. Within these limitations, the authors provide their opinion on how the current cancer research infrastructure must be modified to accommodate the needs of older patients. Several underused solutions are offered to expand clinical trials to include older adults with cancer. However, as currently constructed, these recommendations alone will not solve the evidence gap in geriatric oncology, and efforts are needed to meet older and frail adults where they are by expanding clinical trials designed specifically for this population and leveraging real-world data.

Cost-effectiveness analysis of telephone-based cognitive behaviour therapy compared to treatment as usual CBT for cancer patients: Evidence from a small, randomised controlled trial.

OBJECTIVE: A previous equivalence randomised trial indicated that Telephone-based Cognitive Behaviour Therapy (T-CBT) was not inferior to Treatment as Usual CBT (TAU-CBT) delivered face to face in terms of psychological benefit with both groups showing post-therapy improvements compared to pre-therapy baseline. The aim here is to clarify costs and benefits through an economic evaluation of the two therapy models. METHOD: The cost-effectiveness analysis (cost per quality-adjusted life year [QALY]) was derived from a single-centre (UK-based), two-arm randomised control trial. Data from 78 patients were available for the main analysis, which includes both an NHS cost perspective and a societal perspective which includes the cost of time off work and any additional private care. Sensitivity analyses were undertaken, which included patients only completing the four core therapy sessions (46 patients) and considering only patients taking both core and the additional therapy sessions which were optional (32 patients). RESULTS: The base-case analysis, adopting an NHS perspective, showed that T-CBT was associated with an incremental cost of £50 (95% CI: -£759 to £989) and a 0.03 QALY (95% CI: -0.09 to 0.03) decrement per patient when compared to TAU-CBT. The analysis adopting a societal perspective yielded similar results, with T-CBT providing an incremental cost of £171 (95% CI: -£769 to £1112) and a 0.03 QALY (95% CI: -0.08 to 0.03) decrement per patient in comparison to TAU-CBT. The first sensitivity analysis, considering patients only taking the core therapy sessions, showed that T-CBT provided an incremental cost of £100 (95% CI: -£945 to £1247) and yielded a decrement of 0.01 QALY (95% CI: -0.03 to 0.01) per patient compared to TAU-CBT. The second sensitivity analysis, which focused solely on patients who also underwent optional sessions, showed that T-CBT was associated with an incremental cost of £17 (95% CI: -£1307 to £1454) and a 0.04 QALY (95% CI: -0.11 to 0.03) decrement per patient when compared to TAU-CBT. CONCLUSIONS: Based on this single trial, T-CBT is not cost-effective as a therapy option for cancer patients with high psychological needs when compared to TAU-CBT.

Driving after use of alcohol and marijuana in college students.

Driving after use of marijuana is almost as common as driving after use of alcohol in youth (P. M. O'Malley & L. D. Johnston, 2003). The authors compared college students' attitudes, normative beliefs and perceived negative consequences of driving after use of either alcohol or marijuana and tested these cognitive factors as risk factors for substance-related driving. Results indicated that youth perceived driving after marijuana use as more acceptable to peers and the negative consequences as less likely than driving after alcohol use, even after controlling for substance use. Results of zero-inflated Poisson regression analyses indicated that lower perceived dangerousness and greater perceived peer acceptance were associated with increased engagement in, and frequency of, driving after use of either substance. Lower perceived likelihood of negative consequences was associated with increased frequency for those who engage in substance-related driving. These results provide a basis for comparing how youth perceive driving after use of alcohol and marijuana, as well as similarities in the risk factors for driving after use of these substances.