An unlikely partnership could make more cancer patients eligible for clinical trials—and improve lives. That’s no small matter: across the board, patients with cancer who participate in a clinical trial — any clinical trial — have significantly better outcomes than patients who don’t.
The key is more accurately assessing patient frailty, since so many people are judged too frail to participate in clinical trials. But those assessments, until now, have been subjective and even unscientific. A research partnership between a physicist and an oncologist at the University of Southern California may have led to a much better approach.
Experts designing clinical trials want to minimize variables so they can easily see whether the new therapy works, and having frail patients in the mix can confound the data. Even outside clinical trials, frailty is often grounds for opting against treatment. One study in California found that 32% of lung cancer patients received no treatment — mainly because they were considered too frail to tolerate it.
At the American Association for Cancer Research’s recent annual meeting, two USC researchers — Jorge Nieva, an oncologist, and physicist Peter Kuhn — described efforts to replace the current subjective clinical assessment with a quantitative digital one for more accurate results. Most decisions about a patient’s frailty take place in the doctor’s office, with the physician observing how easily the patient gets out of a chair and onto an exam table. Not surprisingly, the physician’s assessment of a patient’s frailty is at odds with that patient’s self-assessment in the majority of cases, Nieva said.
Kuhn and Nieva aimed to replace this flawed system with a data-driven approach. They started with a camera mounted in the doctor’s office that tracked energy and acceleration as the patient moved from the chair to the exam table. Their clinical study of this method found that it accurately quantified the measure of frailty.
But the pair wanted to do more. Kuhn noted that cancer patients typically see their doctors for 15 minutes every three weeks. Measuring frailty only during these encounters, he reasoned, misses out on the 30,000 minutes between appointments. So he developed a tracking device that patients could bring home to generate data on their physical activity.
The physicist/physician duo recently launched a clinical trial to study how data from these tracking devices can be used to better assess a patient’s true level of frailty. With more accurate evaluations, even frail patients could be admitted to clinical trials for new cancer therapies because it would allow scientists to stratify patients by frailty level without confusing the data about a therapy’s effectiveness. Today, only about 3% of cancer patients participate in clinical trials. If the USC team can remove frailty as a reason to exclude patients, that number could rise significantly, potentially leading to better outcomes for many patients who would otherwise have no trial
