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How do we improve cancer clinical trial participation?


Nearly 1.5 million people will be diagnosed with cancer this year, but only 3 to 5 percent will enroll in a clinical trials testing new cancer therapies. At this year's annual meeting of the American Society of Clinical Oncology, physicians, researchers, and industry officials gathered to discuss why few patients enter clinical trials and possible solutions to increase that percentage.While patients' reasons for not entering clinical trials are commonly cited--fear of getting a placebo, not understanding the trial, potential out-of-pocket costs, or fear of being a "guinea pig,"--the session also covered why many physicians don't discuss clinical trials with their patients and other stumbling blocks to clinical trial enrollment.Two interesting points came up in the talk: Many physicians do not bring up clinical trials to their patients, and strict eligibility requirements prevent many willing patients from entering clinical trials.Two reasons given why physicians do not offer clinical trials to their patients were lack of knowledge regarding specific clinical trials to offer and discomfort in talking with their patients about clinical trials. In a 1991 survey cited during the session, 55 percent of physicians questioned said they were uncomfortable discussing clinical trials with their patients. Hopefully, this has improved since then. Communication may also be an issue. In a 2008 survey, 14 percent of patients who were offered a clinical trial reported they were not offered one--obviously more than just chemobrain. Physicians must communicate better with their patients to make sure they understand the clinical trial being offered and the process. Once doctors interest their patients in clinical trials, strict eligibility requirements may still prevent them from enrolling. Some trials may have restrictions on age or call for a specific disease stage and subtype. Often patients could not have had a prior treatment of this or that or within a certain timeframe. Sometimes measurements of heart function or blood counts have to be in a specific range. For these reasons, and many more, many patients are excluded from trials. The panel at the ASCO session suggested that maybe some of these eligibility requirements could be a little more flexible, which may allow the clinical trials to reach accrual sooner. To drive this point home, there are studies testing promising treatments or combinations that are closed every year due to slow accrual of patients.Some survivor suggestions from Twitter (www.twitter.com/cure_magazine) echoed many of the panel's suggestions, including allowing minor exceptions for trial eligibility and better communication between patients and doctors about clinical trials. Empowering patients to find trials, including using a matching system where patients are notified of studies they would qualify for, could help patients bring up the topic with their oncologist.Fortunately, there are several websites that allow patients and survivors (and even people without a cancer diagnosis) to find clinical trials, in addition to http://www.clinicaltrials.gov and www.cancer.gov/clinicaltrials/search. TrialCheck (www.CancerTrialsHelp.org), a site sponsored by the Coalition of Cancer Cooperative Groups, not only provides information about the clinical trial process, but also allows a patient to search for trials they qualify for by answering a questionnaire about their cancer type, stage, and other information. It also allows patients to save their searches and set up a notification system to alert them when new trials open. Similarly, the Army of Women (www.armyofwomen.org), a site sponsored by the Dr. Susan Love Research Foundation and the Avon Foundation, is actively recruiting one million women for clinical trials focused on finding the causes of breast cancer and how to prevent it. The site provides a way for researchers to reach out to women interested in participating in these trials. Women who are not currently undergoing breast cancer treatment can sign up on the site and are then notified of select clinical trials, allowing them to choose whether to enroll or not. To date, the site has reached more than a quarter of its recruiting goal after launching in October 2008. For more on clinical trials, read "Before Treatment: Understanding Clinical Trials" from CURE's 2009 Cancer Resource Guide at http://www.curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1016.Poll: Did your medical team discuss participating in a clinical trial with you when you were diagnosed? Click here to take poll

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