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.

中文翻译：

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老年人参与癌症临床试验：障碍和干预措施的系统评价

癌症是一种老龄化疾病，随着世界人口老龄化，患有癌症的老年人的数量正在增加，并将在几乎每个国家的肿瘤人口中占据越来越大的份额。尽管如此，在制定癌症治疗标准的研究中，老年患者的代表性仍然严重不足。因此，我们对癌症治疗的了解大部分是基于在年轻、健康的患者中进行的临床试验，而提高老年癌症患者临床试验参与度的有效策略仍然很少。在本系统评价中，作者评估了已发表的关于参与障碍和干预措施以提高老年人参与癌症试验的研究。现有证据的质量很低，尽管有文献描述了多方面的障碍，只有一项干预研究旨在增加老年人参与试验的人数。这些发现明显地证明了缺乏基于证据的有效策略来改善这一代表性不足的人群参与癌症试验的情况。在这些限制范围内，作者就如何必须修改当前的癌症研究基础设施以适应老年患者的需求提出了他们的意见。提供了几种未充分利用的解决方案来扩大临床试验以包括患有癌症的老年人。然而，根据目前的构建，仅凭这些建议并不能解决老年肿瘤学的证据差距，需要通过扩大专门为该人群设计的临床试验并利用真实数据来满足老年人和体弱成人的需求。