OPERATIONAL AND STRUCTURAL BARRIERS
The obvious first step for a patient to be eligible for a cancer clinical trial is to be treated at a cancer clinic where trial participation is offered. This may not be so easy, as factors such as transportation availability and costs, insurance coverage, and childcare often play a role.
Once the patient is able to take that first step, the next barrier to overcome is finding an available clinical trial applicable to the patient’s particular type and stage of cancer. If that is accomplished, the patient then has to agree to participate. In one study at the University of California Davis Cancer Center, a clinical trial for the site and stage of disease in 91 of 276 patients was available.3 Although 76 of the patients met eligibility criteria for one particular trial, only 39 agreed to participate. In the end, the overall accrual rate was only 14% (39/276).3
The most common reasons patients gave for not participating were they wanted other treatment (34%), the distance from the cancer center was too great (13%), and insurance was denied (8%).3 Eleven percent of patients would not give a reason for not participating. As other studies have shown, patients with government-funded insurance tended to enroll in clinical trials more than those patients who had private insurance.3
CLINICAL TRIAL ADVANTAGES
The patient population that enrolls in the most cancer clinical trials has historically been children younger than 15 years, and mortality rates for that age group have been on the decline since the 1970s.2 Now is the time to apply that same successful model to older patients with cancer.
There are a number of valid reasons to pursue the clinical trial course. It is the fastest and most direct route toward the newest treatments for every stage of cancer, often years before they are available to the general public. Those treatments are often offered at reduced cost or even no cost at all.
Paul Sabbatini, MD, deputy physician-in-chief for clinical research at MSKCC, advises, “While concerns regarding clinical trials are understandable, it is critical that the cancer community address common myths and misunderstandings around issues like effectiveness, safety, use of placebo — they’re used in very few studies — and at which point in treatment a trial should be considered.”
Patients may wish to participate in a clinical trial to benefit themselves, or they may choose to be altruistic and help future patients. In any case, it is time to break down those barriers.
Do you have a method for encouraging patients to enroll in clinical trials? Please share your comments.
Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey.
1. Despite pressing need, survey finds most Americans unlikely to enroll in clinical trials. Memorial Sloan Kettering Cancer Center web site. https://www.mskcc.org/press-releases/despite-pressing-need-survey-finds-most-americans-unlikely-enroll-clinical-trials. May 23, 2016. Accessed June 28, 2016.
2. Unger JM, Cook E, Tai E, Bleyer A. The role of clinical trial participation in cancer research: barriers, evidence, and strategies. Am Soc Clin Oncol Educ Book. 2016;35:185-98. doi:10.14694/EDBK_156686.
3. Lara PN Jr, Higdon R, Lim N, et al. Prospective evaluation of cancer clinical trial accrual patterns: identifying potential barriers to enrollment. J Clin Oncol. 2001;19(6):1728-1733.