Closing the Evidence Gap for Care of Seniors with Blood Cancer

Myelodysplastic syndromes (MDS) are cancers of hematopoietic stem cells (blood cell-producing cells in the bone marrow) that lead to low cell counts, e.g. anemia. There are few treatments for MDS that improve levels of hemoglobin, which is the oxygen-carrying molecule in red blood cells (RBCs). Many MDS patients require RBC transfusions on a regular basis. Since the body cannot offload iron, multiple transfusions can lead to iron overload, which shortens survival and promotes the progress to acute leukemia, a recognized complication of MDS that has few treatments in the elderly population. The median age of presentation of MDS patients in Canada is 76. It is estimated that between 2020 and 2050, the number of people over 80 will triple, which has implications for resource allocation, and for developing an approach to the >80 year-old population.
Treatments for blood cancers are based on results of clinical trials. Clinical trial patients are generally ~50-60 years of age and clinically robust. Unfortunately, >80 year-old patients do not have the reserves to tolerate the same treatments as younger patients, and there is virtually no evidence-based guidance on how to address this population.
OBJECTIVE: To establish evidence that would guide the care of elderly (>80 year old) patients with blood cancers such as MDS.
We propose a meeting to convene experts to design a research approach to define an evidence-based approach to treatment of blood cancers in elderly patients. This could include, for example, the design of a study of frailty screening in patients over 80 years of age with blood cancers, to identify those who would benefit from comprehensive geriatric assessment, and to identify beneficial interventions. In addition, we would wish to evaluate how iron overload could be managed in older (>80 years) patients with MDS.
FORMAT: Our meeting will include both lectures and Q&A sessions involving hematologists, geriatricians, nurses, pharmacists, researchers, trainees and patient partners who are in a position to share their lived experiences. The one-day meeting would be held at the UBC Robson Square campus in downtown Vancouver.
ANTICIPATED OUTCOMES: We expect that the discussion will identify research priorities, and establish the next steps to obtain the required evidence to inform treatment for elderly MDS patients. Input from patient partners will emphasize their perspectives (e.g. maintenance of independence and quality-of-life factors).