{"entity":{"id":"idea-acc-pragmatic-trials-over-75-function-endpoints","kind":"idea","name":"Pragmatic trials in patients over 75 with function, not just survival, as the primary endpoint","aka":[],"tldr":"For a frail 80-year-old, staying independent may matter more than living a few months longer. Trials designed for older patients should measure what they care about.","summary":"Standard oncology endpoints do not capture what matters most to older patients: independence, cognition, and time at home. Pragmatic, embedded trials in routine care for patients over 75 with composite endpoints (survival free of functional decline, days alive and out of hospital) would produce decision-relevant evidence for the largest group of cancer patients. Cooperative groups have run a few such trials; a dedicated funding stream would create a portfolio.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Older and multimorbid patients are excluded and undertreated): Mohile et al., Evaluation of geriatric assessment and management on toxic effects of cancer treatment (GAP70+, Lancet 2021)","url":"https://doi.org/10.1016/S0140-6736(21)01789-X"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":["geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-aging-comorbidity","b-trial-design","b-trial-enrolment"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Pragmatic function-endpoint trials will change treatment recommendations for at least three common indications in older patients within five years, and will enrol faster per site than conventional trials.","rationale":"Older patients accept enrolment when the questions and endpoints are relevant to them; embedding in routine care reduces the burden that excludes them.","test":"Fund a portfolio of five pragmatic trials in the over-75s across common cancers with pre-specified composite functional endpoints and monitor accrual and guideline impact.","maturity":"early-clinical","actor":"research","cost":"large","horizonYears":5},"route":"/ideas/idea-acc-pragmatic-trials-over-75-function-endpoints/","neighbours":{"technology":[{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/"}],"bottleneck":[{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"},{"id":"b-trial-enrolment","kind":"bottleneck","name":"Trials enrol too few, too slowly","route":"/bottlenecks/b-trial-enrolment/"}]}}