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Presti D, Havas J, Soldato D, Lapidari P, Martin E, Pistilli B, Jouannaud C, Emile G, Rigal O, Fournier M, Soulie P, Mouret-Reynier MA, Tarpin C, Campone M, Guillermet S, Martin AL, Everhard S, Di Meglio A. Factors associated with enrolment in clinical trials among women with early-stage breast cancer. ESMO Open 2022; 7:100513. [PMID: 35724624 PMCID: PMC9271499 DOI: 10.1016/j.esmoop.2022.100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Clinical trials allow development of innovative treatments and ameliorate the quality of clinical care in oncology. Data show that only a minority of patients are enrolled in clinical trials. We assessed enrolment in clinical trials and its correlates among women with early breast cancer. Methods We included 9516 patients with stage I-III breast cancer from the multicenter, prospective CANTO study (NCT01993498), followed-up until year 4 (Y4) post-diagnosis. We assessed factors associated with enrolment using multivariable logistic regression. In exploratory, propensity score matched analyses, we used multiple linear regression to evaluate the relationship of enrolment in clinical trials with the European Organisation for Research and Treatment of Cancer Quality Of Life (QoL) questionnaire (EORTC QLQ-C30) Summary Score and described clinical outcomes (distant disease event, invasive disease event, and death by any cause) according to enrolment. Results Overall, 1716 patients (18%) were enrolled in a clinical trial until Y4 post-diagnosis of breast cancer. Socioeconomic factors were not associated with enrolment. Centres of intermediate volume were most likely to enrol patients in clinical trials [versus low volume, odds ratio 1.45 (95% confidence interval (CI) 1.08-1.95), P = 0.0124]. Among 2118 propensity score matched patients, enrolment was associated with better QoL at Y4 (adjusted mean difference versus not enrolled 1.37, 95% CI 0.03-2.71, P = 0.0458), and clinical outcomes (enrolled versus not enrolled, distant disease event 7.3% versus 10.1%, P = 0.0206; invasive disease event 8.2% versus 10.5%, P = 0.0732; death by any cause 2.8% versus 3.7%, P = 0.2707). Conclusions In this large study, one in five patients enrolled on a clinical trial until Y4 after diagnosis of early breast cancer. Geographical and centre-related factors were significantly associated with enrolment in clinical trials. Inclusion in clinical trials seemed associated with improved QoL and clinical outcomes. Access to innovation for early-stage breast cancer patients should be encouraged and facilitated by overcoming organizational and geographical barriers to recruitment. The proportion of patients who access innovation through participation in clinical trials is generally limited. Rate of enrolment in clinical trials among women with early breast cancer exceeded what previously found in other settings. Clinical and geographical factors were associated to access to innovation in clinical trials. Enrolment in clinical trials is associated with better quality of life and clinical outcomes.
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Affiliation(s)
- D Presti
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - J Havas
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - D Soldato
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - P Lapidari
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - E Martin
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - G Emile
- Centre François Baclesse, Caen, France
| | - O Rigal
- Centre Henri Becquerel, Rouen, France
| | | | - P Soulie
- Institut de Cancérologie de L'ouest -Paul Papin, Angers, France
| | | | - C Tarpin
- Institut Paoli Calmettes, Marseille, France
| | - M Campone
- Institut de Cancérologie de l'Ouest - Site de Nantes - Centre René Gauducheau, Nantes, France
| | | | | | | | - A Di Meglio
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France.
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Ohsumi S, Mukai H, Takahashi M, Hozumi Y, Akabane H, Park Y, Tokunaga E, Takashima T, Watanabe T, Sagara Y, Kaneko T, Ohashi Y. Factors affecting enrollment in randomized controlled trials conducted for patients with metastatic breast cancer. Jpn J Clin Oncol 2020; 50:873-881. [PMID: 32463090 DOI: 10.1093/jjco/hyaa065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/20/2020] [Accepted: 04/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is critical to obtain informed consent from eligible patients to complete clinical trials. We investigated the factors that affect the participation rates of eligible patients. PATIENTS AND METHODS Patients with metastatic breast cancer who were eligible for SELECT BC or SELECT BC-CONFIRM trials, randomized controlled trials conducted for patients with chemotherapy-naive metastatic breast cancer were recruited to prospective studies, SELECT BC-FEEL and SELECT BC-FEEL II, respectively. SELECT BC FEEL and SELECT BC-FEEL II were conducted to identify the factors affecting the rates at which informed consent was obtained, using a self-administered questionnaire we developed. RESULTS In total, 232 patients participated in the studies. The patients who agreed to take part in the randomized trials were more likely than the refusers to answer that they decided to participate because: 'My doctor wanted me to participate in this trial' (P = 0.00000), ' My family or friends wanted me to participate in this trial' (P = 0.00000), 'Both treatment regimens used in the trial are suitable to me' (P = 0.00383), 'I know that the trial is conducted to determine which is a better treatment' (P = 0.01196), and ' I think that my participation in the trial will contribute to the benefit to future patients with the same disease' (P = 0.00756). CONCLUSIONS To enhance the consent rate in randomized trials of metastatic breast cancer patients, concepts of the trials must be considered important and acceptable not only by patients but also by doctors and their families.
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Affiliation(s)
- Shozo Ohsumi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama 791-0280, Japan
| | - Hirofumi Mukai
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa
| | - Masato Takahashi
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo
| | - Yasuo Hozumi
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital, Kasama
| | | | - Youngjin Park
- Department of Breast and Endocrine Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai
| | - Eriko Tokunaga
- Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka
| | - Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai
| | - Yoshiaki Sagara
- Department of Breast Oncology, Hakuaikai Medical Corp Sagara Hospital, Kagoshima
| | - Tetsuji Kaneko
- Department of Clinical Research, Tokyo Metropolitan Children's Medical Center, Fuchu
| | - Yasuo Ohashi
- Faculty of Science and Engineering, Chuo University, Tokyo
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Bhardwaj P, Kumar J, Yadav RK. Patients Driving the Clinical Trial Designs - Democracy in Clinical Research. Rev Recent Clin Trials 2019; 14:237-246. [PMID: 31393256 DOI: 10.2174/1574887114666190808142339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/11/2019] [Accepted: 08/19/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Many of the clinical trials remain inefficient owing to the low retention rate, and an impact on the power of the study. In addition, regulatory bodies recommend including the patients' experience, especially, patient-reported outcomes, while making clinical decisions, and approvals. INTRODUCTION Patient centricity has reached the stage where patients are both willing and required to participate in clinical trial designs, regulatory review and experts on other panels. Efforts are being made in the right direction and there are multiple aspects that have been or are being addressed. OBJECTIVE The current article focuses on how to include patients in clinical trial designs, the benefits, challenges, and solutions. This means patients who were merely the participants until now, they will be the drivers of trials now, and hence the clinical trials will be more efficient and productive. KEY FINDINGS There is a drive to enhance patients' participation in clinical trial designs, especially, visits, efficacy outcomes and their expectations with the treatment. Patients want to remain informed, right from before participation to the completion of the trial. Patients are now an important part of regulatory review, as apparent from recent initiatives by the FDA and EMA. This will enhance patients' awareness, and bring ownership and transparency. Various patient organizations, advocacy groups have made some great suggestions and taken initiatives in this direction. Clinical Trials Transformation Initiative, European Patient's Academy on Therapeutic Innovation, and Patient- Centered Outcomes Research Institute are a few key initiatives. However, there is a set of challenges emanating from the complexity of trials, associated with unique mechanism of action of drugs, their efficacy and safety profiles, which has to be dealt with properly. CONCLUSION Overall, the pharma domain is at the verge of putting the patient in the spotlight, to achieve a near-real democracy, where the clinical research is the by the patient, for the patient, and, of the patient.
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Affiliation(s)
| | | | - Raj Kumar Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Shao J, Rodrigues M, Corter AL, Baxter NN. Multidisciplinary care of breast cancer patients: a scoping review of multidisciplinary styles, processes, and outcomes. Curr Oncol 2019; 26:e385-e397. [PMID: 31285683 PMCID: PMC6588064 DOI: 10.3747/co.26.4713] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Clinical practice guidelines recommend a multidisciplinary approach to cancer care that brings together all relevant disciplines to discuss optimal disease management. However, the literature is characterized by heterogeneous definitions and few reviews about the processes and outcomes of multidisciplinary care. The objective of this scoping review was to identify and classify the definitions and characteristics of multidisciplinary care, as well as outcomes and interventions for patients with breast cancer. Methods A systematic search for quantitative and qualitative studies about multidisciplinary care for patients with breast cancer was conducted for January 2001 to December 2017 in the following electronic databases: medline, embase, PsycInfo, and cinahl. Two reviewers independently applied our eligibility criteria at level 1 (title/abstract) and level 2 (full-text) screening. Data were extracted and synthesized descriptively. Results The search yielded 9537 unique results, of which 191 were included in the final analysis. Two main types of multidisciplinary care were identified: conferences and clinics. Most studies focused on outcomes of multidisciplinary care that could be variously grouped at the patient, provider, and system levels. Research into processes tended to focus on processes that facilitate implementation: team-working, meeting logistics, infrastructure, quality audit, and barriers and facilitators. Summary Approaches to multidisciplinary care using conferences and clinics are well described. However, studies vary by design, clinical context, patient population, and study outcome. The heterogeneity of the literature, including the patient populations studied, warrants further specification of multidisciplinary care practice and systematic reviews of the processes or contexts that make the implementation and operation of multidisciplinary care effective.
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Affiliation(s)
- J Shao
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - M Rodrigues
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - A L Corter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - N N Baxter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
- Department of Surgery, St. Michael's Hospital, Toronto, ON
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
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Les essais cliniques : leur apport dans le parcours de soins des patientes traitées pour un cancer du sein. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jefferson L, Cook L, Keding A, Brealey S, Handoll H, Rangan A. "Away Days" in multicenter randomized controlled trials: a questionnaire survey of their use and a case study on the effect of one Away Day on patient recruitment. J Evid Based Med 2016; 9:24-31. [PMID: 26549433 DOI: 10.1111/jebm.12180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 10/27/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE "Away Days" (trial promotion and training events for trial site personnel) are a well-established method used by trialists to encourage engagement of research sites in the recruitment of patients to multicenter randomized controlled trials (RCTs). We explored the use of Away Days in multicenter RCTs and analyzed the effect on patient recruitment in a case study. METHODS Members of the United Kingdom Trial Managers' Network were surveyed in June 2013 to investigate their experiences in the design and conduct of Away Days in RCTs. We used data from a multicenter pragmatic surgical trial to explore the effects of an Away Day on the screening and recruitment of patients. RESULTS A total of 94 people responded to the survey. The majority (78%), who confirmed had organized an Away Day previously, found them to be useful. This is despite their costs. There was no evidence, however, from the analysis of data from a surgical trial that attendance at an Away Day increased the number of patients screened or recruited at participating sites. CONCLUSIONS Although those responsible for managing RCTs in the UK tend to believe that trial Away Days are beneficial, evidence from a multicenter surgical trial shows no improvement on a key indicator of trial success. This points to the need to carefully consider the aims, design, and conduct of Away Days. Further more rigorous research nested within RCTs would be valuable to evaluate the design and conduct of Away Days.
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Affiliation(s)
- Laura Jefferson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Liz Cook
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Stephen Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Helen Handoll
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Amar Rangan
- The James Cook University Hospital, Middlesbrough, UK
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Brandberg Y, Johansson H, Bergenmar M. Patients' knowledge and perceived understanding - Associations with consenting to participate in cancer clinical trials. Contemp Clin Trials Commun 2015; 2:6-11. [PMID: 29736441 PMCID: PMC5935834 DOI: 10.1016/j.conctc.2015.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/05/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022] Open
Abstract
Recruitment to clinical trials is essential. The aims of the study were to investigate associations between patients' informed consent to participate in a cancer clinical trial and knowledge and perceived understanding of the trial. Furthermore, associations between demographic factors and consent to participate and knowledge and perceived understanding of information about the trial were studied. Methods The patients were recruited in connection to a visit at the oncology clinic for information about a drug trial. The Quality of Informed Consent questionnaire was mailed to the patients after they had decided about participation in the trial. The associations of demographic factors and "knowledge" and "perceived understanding" were analysed using linear regression models. Results A total of 125 patients were included. Higher levels of "knowledge" and "understanding" were found to be associated with consent to participate in a clinical trial, both in the univariate and multivariate analyses (p = 0.001). None of the tested demographic factors were related to consent to participate. No statistically significant associations between any of the demographic factors and knowledge or perceived understanding scores were found. Conclusion The results indicate that interventions that increase patients' knowledge and perceived understanding might improve participation rates in clinical trials.
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Affiliation(s)
- Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet Z1:00, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet Z1:00, Karolinska University Hospital, SE-17176 Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Mia Bergenmar
- Department of Oncology-Pathology, Karolinska Institutet Z1:00, Karolinska University Hospital, SE-17176 Stockholm, Sweden
- Center for Digestive Diseases, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
- Corresponding author. Department of Digestive Diseases, Karolinska University Hospital, Huddinge K53, SE-141 86 Stockholm, Sweden.
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