Treatments of exclusion.

A SEER analysis published last week in JAMA Onc is generating lots of buzz. Among almost 750K cancer patients analyzed, a whopping 1 in 4 of those >65 years of age had a previous history of cancer (the majority of which were in a different site). Over 1 in 10 younger patients also held a prior cancer diagnosis. Maybe this isn’t so shocking considering the number of cancer survivors has quadrupled in the last 3 decades alone. This means: (1) the normal aging population carries more cancer histories and (2) there is more time to develop treatment-induced secondary malignancies. So what’s all the fuss about? Namely that this growing population is drastically underrepresented in clinical trials. This is even though, despite the urban legend, a prior cancer diagnosis does not appear to impact outcomes with a new one. We say if the ACA can make it happen, oncologists can too: it’s time to start enrolling patients regardless of pre-existing conditions.