Survey of oncologists' perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials

Abstract

BACKGROUNDPrior research has documented the under‐representation in clinical trials of older patients with cancer. In part of a larger study to test the magnitude of these barriers to entering eligible older patients with carcinoma of the breast into clinical trials (Cancer and Leukemia Group B [CALGB] trial 9670), barriers to accruing eligible older patients to clinical trials were obtained from the physician's perspective.METHODSOne hundred fifty‐six physicians (85% oncologists) who treated patients with breast carcinoma at 10 CALGB institutions completed a questionnaire concerning what they perceived as barriers to enrolling older patients with breast carcinoma on clinical trials and possible interventions that may improve accrual.RESULTSPhysicians' perceptions of the most important barriers to accrual of older patients were: 1) elderly patients have significant comorbid conditions that are not excluded by the protocol but that may affect how they would respond to treatment (16%); elderly patients have difficulty understanding what is required in a complicated treatment trial, resulting in poor compliance (16%); treatment toxicity (14%); and elderly patients often do not meet the eligibility criteria (15%). Oncologists most frequently suggested that the most effective interventions for improving the accrual of elderly patients to trials included making personnel available in the clinic to explain clinical trials to older patients and their families (25%) and providing physicians with educational materials concerning treatment toxicity in the elderly (18%).CONCLUSIONSPhysicians viewed barriers to accruing older patients with breast carcinoma to clinical trials as multidimensional, with the most important involving protocol requirements, treatment specific issues, and older patients' medical and cognitive characteristics. Thus, a variety of interventions would be needed to improve accrual of older patients to clinical trials, including increasing physicians' knowledge concerning treatment toxicity in the elderly, simplifying protocol requirements, and reducing treatment toxicity. Cancer 2002;95:989–96. © 2002 American Cancer Society.DOI 10.1002/cncr.10792

Provider roles in the recruitment of underrepresented populations to cancer clinical trials

“…3), whereas 3 studies found provider attitudes to be a promoter of patient accrual. 18,20,26 The studies also reported that provider attitudes toward patient age, 11,12,16,17 comorbidities, 12,16,17 and disease stage, 16 physician perception of patient mistrust of researchers, 14,25 and lack of physician awareness about trials 14,23,25 were factors that prevented providers from enrolling their patients into clinical trials.…”

“…Of the 18 studies eligible for review, 3 were published before 1993, 10-12 2 were published between 1993 and 1999, 13,14 and 13 were published in 2000 or later (Table 1). [15][16][17][18][19][20][21][22][23][24][25][26][27] The study designs included a randomized controlled trial (n ¼ 1), concurrent controlled trial (n ¼ 1), casecontrol (n ¼ 1), and descriptive (n ¼ 15), with 4 of the studies also using qualitative techniques to facilitate in-depth assessments of physician attitudes and perceptions. Fourteen studies reported recruitment into treatment trials only [10][11][12][13][15][16][17][18][19][20][21][22]24,26 ; 3 studies reported recruitment into both prevention and treatment trials 14,25,27 ; and 1 study reported recruitment to a prevention trial (Table 1).…”

“…17 Eight of the studies targeted recruitment of at least 1 of the underrepresented populations as a primary goal of the study. Five studies targeted either racial or ethnic minorities, 14,15,23,25,27 3 studies targeted the elderly, [16][17][18] and 1 study targeted rural populations 24 as the primary goal. Nine studies did not target an underrepresented population as a primary objective; however, data were presented on advanced age, [11][12][13]19,21,26 minority status, 20,22,26 and social class (non-US study) 13 to warrant their inclusion in this article.…”

“…Five studies 10,13,15,17,18 found that provider communication or method of presentation were barriers to patient enrollment, whereas 1 study found it to be a promoter of trial enrollment. 18 In focus groups of Latino/Hispanic patients, Ellington et al 15 reported that physician level barriers involved showing a lack of compassion and respect toward their patients as well as being rushed, defensive, or patronizing.…”

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

“…50 Some evidence suggests that attitudinal barriers on the part of physicians play a role. 13,54,55,56 In addition, older patients are likely to have higher comorbid burdens, inducing clinical exclusions. 57,58 To the extent that trials seek to reflect the population of patients for whom new trial-proven treatments will be administered, better representation of older patients on trials is critical.…”