clinical trials

Patient participation in clinical trials for cancer patients has been in decline. Researchers determine the barriers prohibiting participation.

Randomized clinical trials are essential to testing whether a new treatment is better or worse than an existing one. Patients participating in clinical trials are typically randomly sorted into two groups: those receiving a new treatment under investigation or the standard treatment. Results are compared at the end of the study to determine whether the new treatment performed better or worse than the current standard. For a trial to be successful researchers must achieve a high participation rate and the patients recruited into the study should reflect the natural diversity of the population in age, race, and sex.

However, in recent years, the participation rates in clinical trials for cancer patients have been in decline. Only 2-3% of adult cancer patients in the United States and 2-11% in Australia participate in clinical trials. The under-representation of the elderly, ethnic minorities and those of lower socioeconomic statuses have also contributed to the problem. Clinical trials regularly close prior to meeting their recruitment targets or become significantly delayed in trying to recruit sufficient participants.

To investigate the cause of the low participation rates in clinical trials for cancer patients, researchers from Australia’s Priority Research Centre for Health Behavior surveyed 383 adult cancer patients from two different Australian cancer treatment centers. They looked specifically to identify barriers prohibiting participation in clinical studies. The results were recently published in BMC Cancer.

The research team found cancer treatment centers at the heart of the problem. The major barrier to patient participation in clinical trials was not because they were unwilling, but rather because they were not being invited to participate.

Over 40% of cancer patients were not offered a chance to participate in a clinical trial even when a physician deemed them eligible. However, of those who did receive an offer, an overwhelming majority – 93% of patients – agreed to participate. Of those, 89% reported that they would make the same decision if asked to participate in clinical trials again. The researchers also found that patients diagnosed over 12 months ago were particularly less likely to receive invitations for clinical trials, with overall odds of invitation decreasing with time. The treatment center a patient went to was a major factor for whether they would be invited to participate or not. Of the two treatment centers the researchers examined, one was about two to three times more likely to invite a patient to participate in a clinical trial.

These findings suggest that one way to increase clinical trial participation is to provide more resources in treatment centers with low recruitment rates. This could promote these sites to more actively recruiting cancer patients for a range of clinical trials. By ensuring all treatment centers are similarly inviting patients for trials, the programs can better ensure that all patients are receiving equal opportunities.

Written by Calvin J. Chan B. Sc.

Carey, M., Boyes, A.W., Smits, R., Bryant, J., Waller, A. and Olver, I. (2017) Access to clinical trials among oncology patients: results of a cross sectional survey. BMC Cancer. 17:653.

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