Public Attitudes Toward Participation in Cancer Clinical Trials

Abstract

These results indicate that the primary problem with accrual is not the attitudes of patients, but rather that the loss of potential participants is the result of the unavailability of an appropriate clinical trial and the disqualification of large numbers of patients. The pool of willing patients is further reduced by the reluctance of some physicians to engage in accrual.

The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies

“…Studies have found that a common reason for patient ineligibility to available protocols is narrow eligibility criteria. 3,14,21,22,23,24 Trial eligibility attempt to satisfy two opposing criteria. On the one hand, eligibility must be sufficiently narrow to produce a treatment effect that is approximately consistent across the cohort.…”

Recruitment and participation in clinical trials: Socio-demographic, rural/urban, and health care access predictors

“…Despite these advances in cancer prevention and patient care, only about 3-5% of cancer patients participate in clinical trials. 1,2 Assuring diversity in clinical trial participation is a national priority. In 1993, the most recent amendment to the National Institutes of Health (NIH) Revitalization Act (Public Law 103-43), 3 mandated the inclusion of women and minorities in clinical research and government sponsored human subject research including clinical trials.…”

“…Some evidence suggests that slightly less than one-third (32%) of Americans would be willing to participate in clinical trials if asked, and, an additional 38% would be inclined to participate if asked but had some questions or reservations. 1 Therefore, factors other than patient intent or willingness seem to impede participation in clinical trials. Some of the salient factors impeding participation in clinical trials include: being a racial minority; 2, 5-7 older age; 2, 5, 7-9 lower socioeconomic status; 2, 6, 7, 10, 11 lack of appropriate clinical trials and the disqualification of patients; 1 the reluctance of physicians to engage in accrual; 1,12 doctor-patient communications regarding clinical trials; 7, 10, 13 mistrust of academic institutions, research and the medical system; 6, 10, 12, 14-17 fear of negative effects; 11 lack of community and physician awareness and knowledge of clinical trials benefits; 10,11,18 lack of sufficient infrastructure (including oncologists and approved cancer programs) to support trials in community settings; 2 lack of researcher training in culturally appropriate patient concerns and communication methods; 13,17,19 certain historical factors; 14 lack of adequate support for community outreach; poor access to care; 12 and lack of information on available trials.…”

Low evidence of radiation therapy in prostate cancer A plea for intensified scientific activity

“…Many share the responsibility to advance knowledge. The patients themselves are the least to blame; 'after appropriate information about a trial they generally accept participation, including randomization' (41). Actually, there has been a trend among patients to ask for a trial, recognizing that trial participation may mean that you get a better treatment than in routine care (42).…”