Increasing accrual in cancer clinical trials with a focus on minority enrollment

Abstract

BACKGROUND: The authors reviewed changes in accrual to cancer clinical trials over the last 2 decades at their institution with a focus on minority participation after the implementation of a community clinical oncology program (CCOP) and an aggressive, education‐orientated minority outreach program (MOP). METHODS: Data on patient enrollment in clinical trials for the years 1988 to 2010 was obtained from the William Beaumont Hospital (WBH) Cancer Clinical Trials Office. The type and number of cancers diagnosed and treated during the same period were obtained from the WBH tumor registry data. The MOP was initiated in the fall of 2003 with a focus on culture‐specific cancer education. RESULTS: With the development of the CCOP, clinical trials accrual increased significantly by 10‐fold (P = .001). The primary service area for the CCOP consistently averaged an 85% to 90% Caucasian population. During the same period, the minority population for the service area remained stable between 8.8% and 10% and did not change significantly. From 1999 to 2004, the WBH tumor registry data demonstrated that minorities represented 8.6% of cancers registered, whereas the average yearly minority enrollment from 2002 to 2004 was 5.4%. After initiation of the MOP, minority accrual doubled to 11% by 2010 with stable minority demographics. CONCLUSIONS: The current findings support the importance of a CCOP in supporting the accrual of patients to national clinical trials and increasing access to state‐of‐the art research. These data also strongly support focusing additional energy and educational efforts on targeting minority representation in clinical trials. Cancer 2011;. © 2011 American Cancer Society.

Patient and physician factors associated with participation in cervical and uterine cancer trials: An NRG/GOG247 study

“…These findings bring a different dimension to the influence of race and cultural perspective in medical and clinical trial settings. [21,22] The relatively high percentage of enrollment among Black women in our study is consistent with a report by Wendler et al, however given our findings documenting the patient perspective on factors influencing enrollment, this should not be interpreted as evidence that barriers to non-white enrollment no longer exist and can be ignored. [23] It is likely there are culturally influenced issues of perceived benefit or risk of harm playing a role in a patient's decision to enter both this study and, more generally, clinical trials.…”

Impact of patient and public involvement on enrolment and retention in clinical trials: systematic review and meta-analysis

“…The PPI interventions were also diverse. Patients and/or members of the public were involved in different activities: eight studies involved patients or lay people in designing recruitment and retention strategies (for example, as community partners, members of a community advisory board, or focus group participants), 34 41 51 55 66 69 75 76 12 studies involved patients or lay people in developing patient-facing information (for example, patient information sheets, multimedia and online interventions, recruitment advertisements, and verbal messaging), 39 41 43 45 49 53 58 59 61 63 66 78 and 10 studies involved patients or lay people in directly recruiting or retaining participants (for example, hiring lay/community workers or asking existing participants to refer friends/relatives). 34 36 46 47 51 60 65 67 72 79 The extent of involvement ranged from one patient advocate acting as a panellist in a one-off educational seminar for recruiting clinicians, 59 to more than 80 people helping to develop a patient friendly online trials registry, 41 42 or community partners initiating and leading their own recruitment strategies.…”

Provider-Based Research Networks Demonstrate Greater Hospice Use for Minority Patients With Lung Cancer

“…Cancer-focused PBRNs increase minority participation in cancer clinical trials, facilitate diffusion of innovative therapies, and decrease cancer treatment disparities with the goal of improving cancer care quality. [22][23][24][25][26][27][28][29] As a result, one could expect higher rates of hospice enrollment for patients treated at PBRN practices. However, since PBRN patients are also more likely to participate in clinical trials, this could have a negative impact on end-of-life care.…”

“…37 Ideally, if hospice is presented as acceptable palliative therapy when curative treatment is no longer advantageous and is offered universally, minority patients may be more willing to enroll. 23,[38][39][40] In one study, Keating et al 41 found no difference in hospice enrollment by patient race or marital status in an integrated health care system that offers hospice services to participants. In a different study by Cowall et al 35 hospice enrollment differed on the basis of whether a patient was treated in a teaching or nonteaching hospital.…”

“…The Community Clinical Oncology Program (CCOP) and Minority-Based Community Clinical Oncology Program (MBCCOP) are provider-based research networks (PBRN) that aim to increase involvement of community physicians in cancerfocused clinical trials. [22][23][24] The CCOP is known for facilitating rapid adoption of advances in cancer therapy. 22,24 MBCCOPs, differing from CCOPs in having a population that is at least 30% minority or underserved, moderate racial disparity in clinical trial enrollment.…”