Shared barriers and facilitators to enrollment of adolescents and young adults on cancer clinical trials

Abstract

Adolescent and young adult (AYA) enrollment in cancer clinical trials (CCT) is suboptimal. Few studies have explored site level barriers and facilitators to AYA enrollment on CCTs and the efficacy of interventions to enhance enrollment. A cross sectional survey was developed by the COG AYA Oncology Discipline Committee Responsible Investigator (RI) Network to identify perceived barriers and facilitators to enrollment, as well as opportunities to improve enrollment. Associations of barriers and facilitators to enrollment with program demographics were assessed. The survey was sent to all AYA RI Network members (n = 143) and quantitative and thematic analyses were conducted. The overall response rate was 42% (n = 60/143). Participants represented diverse institutions based on size, presence or absence of dedicated AYA programs, and proximity and relationship between pediatric and medical oncology practices within the institution. The most frequently cited barriers to enrolling AYAs in CCTs were administrative logistical issues (45%), disparate enrollment practices (42%) and communication issues (27%) between pediatric and medical oncology and perceived limited trial availability (27%). The most frequently reported facilitators to enrollment included having strong communication between pediatric and medical oncology (48%), having a supportive research infrastructure (35%) and the presence of AYA champions (33%). Many barriers and facilitators were similar across institutions and AYA program types. Shared barriers and facilitators to AYA CCT enrollment exist across the landscape of cancer care settings. Interventions aimed at increasing coordination between pediatric and medical oncology clinical trials offices and providers have high potential to improve site-level AYA enrollment.

Children's Oncology Group 2023 blueprint for research: Adolescent and young adult oncology

“…The AYA RI Network now includes local site AYA champions, including pediatric and medical oncology providers, from more than 120 institutions working together to boost local AYA clinical trial enrollment. The network has identified additional accrual barriers through regular webinars and workshops, has developed a Frequently Asked Questions document addressing common questions and misconceptions on how to cross‐enroll AYAs onto NCTN trials, and developed novel strategies leveraging communication technology to further improve enrollment 36,37 …”

“…The network has identified additional accrual barriers through regular webinars and workshops, has developed a Frequently Asked Questions document addressing common questions and misconceptions on how to cross-enroll AYAs onto NCTN trials, and developed novel strategies leveraging communication technology to further improve enrollment. 36,37 The COG AYA RI Network will continue to foster site-level participation in newly developed NCTN and NCORP AYA trials via regular webinars for presentations by study chairs. Newer approaches to improve accrual are under investigation, including a multisite quality improvement initiative known as ATAQI (AYA Trial Access Quality Initiative).…”

Adolescent and young adult cancers: unmet needs and closing the gaps

“…The development of cross-network AYA CCTs from concept inception was an important step taken by National Cancer Institute National Clinical Trial's Network (NCTN) to improve AYA accrual and there is currently a large, and growing, portfolio of available AYA therapeutic trials. There have been challenges to cross-enrolling AYAs on cross-network CCTs due to limited knowledge of the process and differences in treatment approaches between pediatric and medical oncologists, though many of these barriers are currently being addressed by The Children's Oncology Group AYA Responsible Investigator Network [41 ▪ ,42]. The network has developed cross-enrollment frequently asked questions (FAQs), empowered site champions to increase local AYA enrollment, and led a series of webinars on opportunities to overcome barriers to enrollment.…”

Using Teamwork to Bridge the Adolescent and Young Adult Gap

“…[19][20][21][22] For example, retrospective review of cooperative group clinical trial data revealed that AYAs of the same age with acute lymphoblastic leukemia (ALL) have superior survival when treated on pediatric rather than adult trials (event-free survival: 34%-41% v 63%-79%, P , .0001). [23][24][25] Theoretical frameworks of barriers to clinical trial enrollment 26 and use of a novel style of therapy (pediatric v adult) 27 cite the key role of physician and staff collaboration across medical and pediatric oncology.…”