Less than 5% of all adult patients with cancer are treated on clinical trials.1 What makes this even more amazing is that a majority of children with cancer are treated on clinical trials. A major reason for this discrepancy is that children have fewer issues that result in ineligibility based on selection criteria. Other contributing factors are more patients with cancer are adults, entering patients on a clinical trial is labor intensive, and location of where cancer treatment is received may limit patients’ ability to participate in clinical trials, as approximately 85% of all cancer patients in the United States are treated in community cancer treatment facilities.2
Many patients claim a lack of endorsement to participate on the part of their treating oncologists.3,4 More than half of all patients have said their oncologists never mentioned clinical trials to them or actively discouraged them from participating. Oncologists who did recommend clinical trials to patients were usually investigators themselves or recommended a trial at their own institution. Another issue of trial participation is inconvenience in regards to travel, cost, and missing work and/or time with family.3,4
A more practical issue often mentioned by patients is the fear that placebo means they will receive no treatment, even though providing the current standard of care is an ethical requirement of cancer trials. Patients are often reluctant to have their treatment selected by a computer based on the need for unbiased selection, even when they are selected to receive the treatment.
I left the university setting in 2002, and joined a community cancer treatment practice in rural West Virginia. I quickly discovered that initiating clinical research outside a university setting could be very difficult, if not impossible. These difficulties were greatly mitigated, however, by participating in what was known as the Hoosier Oncology Group (now called Hoosier Cancer Research Network), which provided a successful conduit for accessing clinical trials.