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Monthly Archives: March 2011
Two are the interwined issues to take into account when evaluating participation of the elderly in clinical trial: their ability to give informed consent and the risk of discrimination deriving from exclusion. The elderly patient is a very heterogeneous category which needs stratification and tailored assessment to form the basis of personalized therapy. Indeed, the elderly patient can be fit and able to receive an aggressive treatment as the adult, or unfit for aggressive treatment and able to receive only a lower dose of treatment, or frail and therefore more vulnerable and in need of palliative care and of a complex and multidisciplinarity management by both the geriatricians and the (haemato) oncologist. On the one hand, the frail patient has often associated co-morbidities such as senile dementia, and is therefore unable to consent to informed consent models as the ones prepared for the unfrail patient. On the other hand, labelling elderly patients per se as vulnerable and excluding them from clinical trials represent a discrimination and an injustice, which can and indeed has negative consequences on prognosis and treatment. Continue reading
Cancer care costs money, and deciding how to allocate resources to treat cancer is inevitably a moral as well as a political act. As the rationing of oncologic care is necessary, it is important to reflect on the decision making process about the allocation of resources, ie to address the questions “Who decides? And on what basis?”. As outlined in the review by Desaid and coauthors, the US and British systems of healthcare both have strengths and weaknesses in relation to cancer care. Continue reading