New EORTC perspective calls for patient preferences to become a standard part of cancer trials for older adults

As people are living longer and the number of older adults continues to increase, more people are being diagnosed with cancer later in life. However, older adults remain largely underrepresented in clinical trials. A new perspective paper¹ from the EORTC Older Adult Council (OAC) and the EORTC Quality of Life Group (QLG) highlights the need to better understand what matters most to older adults when considering cancer treatments and calls for the systematic inclusion of patient preferences in cancer research.

Published in the European Journal of Cancer, the paper led by Pierluigi Bonomo reflects a growing collaboration between the EORTC Older Adult Council and the EORTC Quality of Life Group, bringing together expertise in geriatric oncology, patient-reported outcomes and quality of life research. The authors argue that clinical trials should not only measure survival, treatment toxicity and quality of life, but also assess how older adults value these outcomes and the trade-offs they are willing to make between them.

Looking beyond survival 

Older adults may have different priorities from younger patients. For many, maintaining independence, daily activities and quality of life may be just as important as extending survival. Understanding these trade-offs is particularly important in this population, as some patients may be willing to accept a shorter survival if it allows them to preserve their quality of life, while others may prioritise extending survival despite potential side effects that may impact their quality of life. However, current clinical trials rarely capture these preferences in a systematic way. The authors suggest that integrating patient preference studies alongside traditional survival, toxicity and quality of life endpoints would provide a more complete picture of treatment benefits and risks, helping ensure that research outcomes better reflect what matters most to patients.

“No two older adults experience cancer in exactly the same way. The only way to understand what matters most to patients is to ask them directly. By incorporating patient preferences into research, clinical trials can better reflect the real priorities, concerns and expectations of people living with cancer. This could make clinical trials more attractive for older adults to participate in,” said Pete Wheatstone, patient representative and co-author of the paper.

A new opportunity for cancer research 

According to the authors, embedding patient preference research within clinical trials could help generate evidence that is more relevant to older adults and support the development of more patient-centred treatment strategies.

“Clinical trials already tell us whether a treatment works and what side effects it causes,” said Dr Pierluigi Bonomo, lead author of the paper. “What they often do not tell us is whether patients consider those benefits worth the burden of treatment. Integrating patient preferences can help answer that question.”

An EORTC commitment 

The paper reflects EORTC’s commitment to advancing patient-centred cancer research and to ensuring that the patient voice is considered throughout the research process. The EORTC Older Adult Council and EORTC Quality of Life Group are actively exploring rigorous ways to capture these preferences within future clinical trials alongside survival, toxicity and quality of life measures.

“The future of cancer research is not only about measuring outcomes, but also about understanding how patients value those outcomes,” said Dr Jaap Reijneveld, Chair of the EORTC Quality of Life Group and co-author of the paper. “By integrating patient preferences alongside survival, toxicity and quality of life measures, we can ensure that future research better reflects what matters most to older adults.”

“This paper highlights the value of collaboration between the EORTC Older Adult Council and the EORTC Quality of Life Group,” added Prof. Paolo Bossi, Chair of the EORTC Older Adult Council. “By bringing together expertise in older adults, quality of life and patient-centred research, we can help ensure that future clinical trials generate evidence that is more relevant to older adults with cancer.”

The integration of patient preferences into cancer research is a key component of EORTC’s broader commitment to improving outcomes for older adults with cancer. Explore EORTC’s work in this area:

• EORTC Older Adults Task Force: https://www.eortc.org/scientific-strategy/older-adults/
• World Cancer Day 2025 – EORTC’s commitment to older patients: https://www.eortc.org/blog/2025/02/04/world-cancer-day-2025/

¹ Pierluigi Bonomo, Lissandra Dal Lago, Luigi Lim et al., Integrating patient preferences into clinical trial outcomes for older adults with cancer: A perspective from the EORTC Older Adult Council and Quality of Life Group,European Journal of Cancer,Volume 246,2026,116983,ISSN 0959-8049, https://doi.org/10.1016/j.ejca.2026.116983.

About EORTC 

The European Organisation for Research and Treatment of Cancer (EORTC) is a non-governmental, non-profit organisation, which unites clinical cancer research experts, throughout Europe, to define better treatments for cancer patients to prolong survival and improve quality of life. Spanning from translational to large, prospective, multi-centre, phase III clinical trials that evaluate new therapies and treatment strategies as well as patient quality of life, its activities are coordinated from EORTC Headquarters, a unique international clinical research infrastructure, based in Brussels, Belgium. 

About the Quality of Life Group 

The EORTC Quality of Life Group (QLG) strives to improve health-related quality of life (HRQoL) of cancer patients, through dedicated research and the use of HRQoL measures within cancer clinical trials and clinical practice. HRQoL constitutes an important aspect of cancer research and care: it gives a voice to patients, putting their experience at the forefront. The QLG is part of the European Organisation for Research and Treatment of Cancer (EORTC).

About the Older Adult Council 

The Older Adult Council (OAC) is a think-tank to actively promote clinical and translational research in older adults with cancer both within EORTC and beyond. It will identify and define older adult research questions, address methodological questions (like frailty, quality of life, treatment toxicities, patient preferences, etc.), and guide the development of international initiatives that improve outcomes for older patients.

Contact

Caroline Hance (EORTC Quality of Life Group Communications)
caroline.hance@eortc.org