Factors associated with participation in breast cancer treatment clinical trials

[Health services research and geriatrics: deficits and research approaches using the example of colorectal carcinoma and anaemia]

The number of elderly people with cancer will increase within the next decades. Cancer will surpass cardiovascular diseases as the leading cause of death. In comparison to younger patients elderly patients with cancer are less often treated within the scope of clinical trials. Data from health care research demonstrate that the treatment of elderly patients is less often guideline-directed than that of younger patients. This will be demonstrated in more detail for patients with colorectal carcinoma and for patients with anaemia. Older people are reluctant to participate in programs for the early detection of colorectal carcinoma and its precursors. They less often receive adjuvant chemotherapy in stage III disease, despite the fact that adjuvant chemotherapy is no more toxic than in younger patients and equally effective and therefore recommended in the guidelines. Compared to younger patients, elderly patients less often receive palliative chemotherapy in stage IV disease. Anaemia has a prevalence of about 10% in people aged 65 and more; the reported values are highly variable. There is a lack of data on the grade of evaluation. Also, there are no diagnostic and therapeutic guidelines in Germany. Health services research will play an important role in assessing deficits in the diagnosis and therapy of cancer diseases in the elderly and in determining the goals for future efforts in health care and research.

Patterns of participation of patients in cancer clinical trials in Ireland

BACKGROUND

In the United States the overall participation in cancer clinical trials (CCT) is less than 3% [Avis et al. in J Clin Oncol 24:1860-1867 (2006); Lara et al. in J Clin Oncol 19:1728-1733 (2001)]. In Europe there is little data on participation in such trials.

AIM

We aim to gather information on factors influencing CCT enrolment in Ireland.

METHODS

From November 2005 to 28 February 2006 all consecutive patients considered for systemic therapy were assessed for eligibility re participation in available CCTs.

RESULTS

A total of 290 patients were included. Overall 2.4% of patients were recruited to one of the available CCTs. The main reasons for failure of trial recruit were: no trial for cancer type (60%), no trial for stage (21%), ineligible by trial criteria (16.1%), patient declined (0.3%), and physician discretion (2.6%). Only one patient, who was otherwise eligible, declined entry into a clinical trial.

CONCLUSIONS

Irish patients with cancer are very willing to participate in CCTs. Current levels of recruitment compare favourably with international levels.

An examination of the influence of patient race and ethnicity on expressed interest in learning about cancer clinical trials

PURPOSE

A number of factors have been identified as being associated with the documented low accrual rate of minorities into cancer-related clinical trials in the USA. An important issue is the fundamental interest, or lack thereof, of these specific patient populations in actually considering study participation.

METHODS

To examine this issue, aggregate data were analyzed from a proprietary Internet-based decision support program (NexProfiler Treatment Option Tools for Cancer, NexCura, Seattle, WA, USA) embedded into approximately 100 cancer-associated Web sites where responding patients (or their families) were asked, but not required, to identify their race/ethnicity (African-American, Asian-American, Caucasian and Hispanic) and to also respond to the question, "Are you interested in learning about clinical trials?".

RESULTS

Of the > 60,000 patients who both self-identified their race/ethnicity and responded to the question regarding their desire to learn about clinical trials, approximately 10% were from the minority (non-Caucasian) groups. Of note, in all four malignancies analyzed (breast, colorectal, lung, and prostate) and in both patients < or = 60 and > 60 years of age, each of the three non-Caucasian populations expressed an interest in learning about such studies that was equal to, if not greater than, that observed in the Caucasian respondents.

CONCLUSION

Assuming these provocative results regarding self-declared desire to learn about clinical trials can be confirmed by others with similar Internet-associated databases, this analysis suggests Web-based recruitment strategies may be an effective method to communicate with minority populations in the US (and, perhaps, elsewhere) with a specific interest in considering participation in cancer clinical trials.