1
|
Lochmann M, Girodet M, Despax J, Baudry V, Duranti J, Mastroianni B, Vanacker H, Vinceneux A, Brahmi M, Renard O, Verlingue L, Amini-Adle M, Swalduz A, Gautier J, Ducimetière F, Anota A, Cassier PA, Chvetzoff G, Christophe V. Qualitative evaluation of motives for acceptance or refusal of early palliative care in patients included in early-phase clinical trials in a French comprehensive cancer center: the PALPHA study. Support Care Cancer 2024; 32:353. [PMID: 38748187 DOI: 10.1007/s00520-024-08535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/29/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The integration of palliative care (PC) into oncological management is recommended well before the end of life. It improves quality of life and symptom control and reduces the aggressiveness of end-of-life care. However, its appropriate timing is still debated. Entry into an early-phase clinical trial (ECT) represents hopes for the patient when standard treatments have failed. It is an opportune moment to integrate PC to preserve the patient's general health status. The objective of this study was to evaluate the motives for acceptance or refusal of early PC management in patients included in an ECT. METHODS Patients eligible to enter an ECT were identified and concomitant PC was proposed. All patients received exploratory interviews conducted by a researcher. Their contents were analyzed in a double-blind thematic analysis with a self-determination model. RESULTS Motives for acceptance (PC acceptors: n = 27) were both intrinsic (e.g., pain relief, psychological support, anticipation of the future) and extrinsic (e.g., trust in the medical profession, for a relative, to support the advance of research). Motives for refusal (PC refusers: n = 3) were solely intrinsic (e.g., PC associated with death, negative representation of psychological support, no need for additional care, claim of independence). CONCLUSIONS The motives of acceptors and refusers are not internalized in the same way and call for different autonomy needs. Acceptors and refusers are influenced by opposite representations of PC and a different perception of mixed management.
Collapse
Affiliation(s)
- Mathilde Lochmann
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France.
| | - Magali Girodet
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Evaluation Médicale et Sarcomes (EMS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Johanna Despax
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Valentine Baudry
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Julie Duranti
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Bénédicte Mastroianni
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Hélène Vanacker
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Armelle Vinceneux
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Mehdi Brahmi
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Olivier Renard
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Loïc Verlingue
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Mona Amini-Adle
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Aurélie Swalduz
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Julien Gautier
- Direction de la Recherche Clinique et de l'Innovation (DRCI), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Françoise Ducimetière
- Evaluation Médicale et Sarcomes (EMS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Amélie Anota
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Direction de la Recherche Clinique et de l'Innovation (DRCI), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Philippe A Cassier
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Gisèle Chvetzoff
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Véronique Christophe
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Centre de Recherche sur le Cancer de Lyon (CRCL), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Université Claude Bernard Lyon 1 (UCBL), 43 Bd du 11 Novembre 1918, 69100, Villeurbanne, France
| |
Collapse
|
2
|
Chatters R, Dimairo M, Cooper C, Ditta S, Woodward J, Biggs K, Ogunleye D, Thistlethwaite F, Yap C, Rothman A. Exploring the barriers to, and importance of, participant diversity in early-phase clinical trials: an interview-based qualitative study of professionals and patient and public representatives. BMJ Open 2024; 14:e075547. [PMID: 38508621 PMCID: PMC10952868 DOI: 10.1136/bmjopen-2023-075547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES To explore the importance of, and barriers to achieving, diversity in early-phase clinical trials. DESIGN Qualitative interviews analysed using thematic analysis. SETTING AND PARTICIPANTS Five professionals (clinical researchers and methodologists) and three patient and public representatives (those with experience of early-phase clinical trials and/or those from ethnic minority backgrounds) were interviewed between June and August 2022. Participants were identified via their institutional web page, existing contacts or social media (eg, X, formerly known as Twitter). RESULTS Professionals viewed that diversity is not currently considered in all early-phase clinical trials but felt that it should always be taken into account. Such trials are primarily undertaken at a small number of centres, thus limiting the populations they can access. Referrals from clinicians based in the community may increase diversity; however, those referred are often not from underserved groups. Referrals may be hindered by the extra resources required to approach and recruit underserved groups and participants often having to undertake 'self-driven' referrals. Patient and public representatives stated that diversity is important in research staff and that potential participants should be informed of the need for diversity. Those from underserved groups may require clarification regarding the potential harms of a treatment, even if these are unknown. Education may improve awareness and perception of early-phase clinical trials. We provide 14 recommendations to improve diversity in early-phase clinical trials. CONCLUSIONS Diversity should be considered in all early-phase trials. Consideration is required regarding the extent of diversity and how it is addressed. The increased resources needed to recruit those from underserved groups may warrant funders to increase the funds to support the recruitment of such participants. The potential harms and societal benefits of the research should be presented to potential participants in a balanced but accurate way to increase transparency.
Collapse
Affiliation(s)
- Robin Chatters
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Munyaradzi Dimairo
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Shamila Ditta
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Jonathan Woodward
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Katie Biggs
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Fiona Thistlethwaite
- The Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, UK
| | - Alexander Rothman
- Department of Infection, Immunity, and Cardiovascular Disease, The University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
3
|
van Gurp JLP, van Lent LGG, Stoel N, van der Rijt CCD, de Jonge MJA, Pulleman SM, van Weert JCM, Hasselaar J. Core values of patients with advanced cancer considering participation in an early-phase clinical trial: a qualitative study. Support Care Cancer 2022; 30:7605-7613. [PMID: 35676342 PMCID: PMC9385761 DOI: 10.1007/s00520-022-07200-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This article identifies the core values that play a role in patients' decision-making process about participation in early-phase clinical cancer trials. METHODS Face-to-face, semi-structured serial interviews (n = 22) were performed with thirteen patients with advanced cancer recruited in two Dutch specialized cancer centers. In a cyclic qualitative analysis process, open and axial coding of the interviews finally led to an overview of the values that are woven into patients' common language about cancer and clinical trials. RESULTS Six core values were described, namely, acceptance creates room for reconsideration of values, reconciliation with one's fate, hope, autonomy, body preservation, and altruism. Previously found values in advanced cancer, such as acceptance, hope, autonomy, and altruism, were further qualified. Reconciliation with one's fate and body preservation were highlighted as new insights for early-phase clinical cancer trial literature. CONCLUSIONS This article furthers the understanding of core values that play a role in the lives and decision-making of patients with advanced cancer who explore participation in early-phase clinical cancer trials. These values do not necessarily have to be compatible with one another, making tragic choices necessary. Understanding the role of core values can contribute to professional sensitivity regarding what motivates patients' emotions, thoughts, and decisions and help patients reflect on and give words to their values and preferences. It supports mutual understanding and dialog from which patients can make decisions according to their perspectives on a good life for themselves and their fellows in the context of participation in an early-phase clinical cancer trial.
Collapse
Affiliation(s)
- Jelle L P van Gurp
- Department of IQ Healthcare, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Liza G G van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Nicole Stoel
- Department of Anaesthesiology, Pain & Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Maja J A de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Saskia M Pulleman
- Department of Medical Oncology and Clinical Pharmacology, Antoni Van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research (ASCoR) and University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain & Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| |
Collapse
|
4
|
Dooms M, Saesen R, Steemans I, Lansens J, Huys I. Characteristics of Early Phase Clinical Trials for Rare Cancers: Insights From Interviews With Stakeholders. Front Pharmacol 2022; 13:775217. [PMID: 35586057 PMCID: PMC9108391 DOI: 10.3389/fphar.2022.775217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Rare cancers occur with an incidence of no more than six cases per 100,000 people according to the definition used by the Surveillance of Rare Cancers in Europe project. For a variety of reasons (low prevalence, cytotoxicity), it is challenging to perform the necessary clinical studies to investigate the safety and efficacy of investigational medicines against such rare malignancies, reformulating even at the earliest stages of the drug development process. This article investigates the differences between phase I rare cancer trials performed in commercial (companies) and non-commercial settings (academic hospitals).Materials and Methods: The differences were explored through the conduct of semi-structured interviews with three different stakeholder groups: representatives from academia (n = 7), representatives from companies (n = 4) and representatives from patient organizations (n = 4). All the interviews were transcribed verbatim and analyzed in NVivo using the framework method.Results: According to the interviewees, the academic and commercial stakeholders collaborate in the majority of phase I rare cancer trials. In general, the commercial partner finances the trial, whereas academia is responsible for the execution of the study procedures. The average cost of undertaking these trials is difficult to estimate because it depends on what is specifically requested during the trial. The 3 + 3 study design remains the most widely used design and the use of expansion cohorts is controversial. With regard to the regulatory aspects of phase I rare cancer trials, it was expressed that a good regulatory framework facilitates the conduct of these studies, but that increased regulation and oversight also has drawbacks, e.g., differences in standards between different ethics committees, over interpretation of the rules, insufficient availability of qualified personnel and higher workloads. The patient organization representatives claimed that patients experience no differences in terms of accommodation, compensation and paperwork between the academic and commercial settings or the degree of follow-up. They also believed that the direct input of patients can bring added value to such studies not only with regard to the recruitment process and the feasibility of the study but also the legibility of the informed consent forms.Conclusion: The growing need for first-in-man trials in rare malignancies needs to be highlighted, as difficult as they are to undertake and to co-develop, not only because rare cancer patients deserve an appropriate treatment, but also because these medicines represent the future of cancer therapy in the precision medicine era. Cooperation of commercial and academic sites are needed. Patient organizations need to be educated to take part in this process.
Collapse
|
5
|
Gray TF, Allgood SJ, Nolan MT, Gallo JJ, Han HR, Clayman ML, Budhathoki C, Lansey DG, Wenzel J. "It All Depends": Patient and Decision Partner Experiences in Cancer Clinical Trial Decision-Making. QUALITATIVE HEALTH RESEARCH 2022; 32:887-901. [PMID: 35343318 DOI: 10.1177/10497323221083355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While the supporting role of families and friends has been widely recognized in cancer care, little data exist on how they influence patients' decisions regarding clinical trial participation, accounting for patients' decisional preferences. The goal of our study was to examine the process of clinical trial decision-making from the perspective of adults with cancer and their decision partners. Semi-structured interviews were conducted with 12 patients and 12 decision partners-family and friends engaged in the medical decision-making. Themes included: (1) having the ability and confidence to make decisions; (2) gaining insight about clinical trials; (3) trusting someone in the process; and (4) realizing readiness and context. Our findings will enhance understanding of how patients make clinical trial decisions based on decisional preferences from the perspectives of patients and decision partners. The findings may also help to increase clinician awareness and inclusion of decision partners in conversations regarding clinical trials.
Collapse
Affiliation(s)
- Tamryn F Gray
- 1855Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Marie T Nolan
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Joseph J Gallo
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hae-Ra Han
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marla L Clayman
- 560937Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Bedford, MA, USA
| | | | - Dina G Lansey
- Department of Oncology, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jennifer Wenzel
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Oncology, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Ramirez AG, Chalela P. Equitable Representation of Latinos in Clinical Research Is Needed to Achieve Health Equity in Cancer Care. JCO Oncol Pract 2022; 18:e797-e804. [PMID: 35544655 PMCID: PMC10476724 DOI: 10.1200/op.22.00127] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Identify key barriers that keep Latinos from participating in clinical trials (CTs) and interventions proven effective in increasing their representation in clinical research. METHODS Utilize our own extensive research experience and review the literature to: identify key barriers, summarize strategies that have been proven effective in increasing Latino representation in CTs, issue a call to action for programs/practices and practitioners to implement what is proven effective, and make recommendations for further research to address current gaps. RESULTS Participation barriers are complex, multifactorial, and exist at different levels, including study design (eg, protocol complexity, patient exclusion criteria, trial duration and frequency), healthcare system barriers (eg, lack of minority staff), patient-related factors (eg, lack of awareness, low health literacy, language, social determinants of health [SDoH]), and medical team issues (eg, lack of cultural competence, lack of referrals, implicit bias, provider/patient communication). Research has shown that the most effective strategies to increase participation of underrepresented minorities in CTs include culturally sensitive educational tools aimed at community members, patients, and physicians, and strategies to address the multiple SDoH and other barriers to participation facing cancer patients and the factors that influence patient decision-making. CONCLUSION Raising awareness or offering clinical trials to everyone will not alone increase Latino participation. Other key barriers at different levels must also be addressed, especially SDoH and patients' contextual factors. To achieve equitable participation of Latinos and other underrepresented groups in clinical research, comprehensive approaches that address interrelated multilevel and multifactorial barriers to participation can produce a substantial, sustained impact-ensuring everyone equitably benefits from scientific advances in cancer treatment, improved cancer outcomes and quality of life, and reduced health care costs.
Collapse
Affiliation(s)
- Amelie G. Ramirez
- UT Health San Antonio, Institute for Health Promotion Research, San Antonio, TX
| | - Patricia Chalela
- UT Health San Antonio, Institute for Health Promotion Research, San Antonio, TX
| |
Collapse
|
7
|
The psychosocial responses of patients in cancer clinical trials: are they a barrier to participation? JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction:
This paper aims to discuss the psychosocial concomitants with involvement in oncology clinical trials, focusing on barriers that can impact upon participation. It will conclude with some recommendations for strategies to address potential psychosocial barriers with the aim of increasing trial participation rates.
Materials and methods:
A literature search was carried out using CINAHL, PubMed and EMCare databases with the following keywords for filtering: psychological distress, clinical trials, participation and oncology. The final selection of papers that met the inclusion criteria for this review was manually subjected to Critical Appraisal Skills Programme tool for relevance.
Results:
Thirteen papers were included in the review. The dominant theme within the literature is psychosocial obstacles to oncology clinical trial participation. Five key barriers were identified: anxiety and fear; ethnicity and social background; tensions between scientific objectives and personal motivations to participation; tensions between personal benefits versus altruism; carer perspectives.
Conclusions:
The key barriers discussed led to the identification of a set of strategies to help mediate conflicting tensions and motivations of trial enrolment with a view to increasing participation rates. Further prospective research garnering primary data investigating both the psychological and psychosocial factors influencing cancer clinical trial participation for patients needs to be undertaken.
Collapse
|
8
|
Kogan N, Tolley M, Cohen R. Family caregivers support their patient's decision to participate in a phase 1 clinical trial: Weighing the pros and cons, bearing the costs. Psychooncology 2022; 31:1374-1380. [PMID: 35460308 DOI: 10.1002/pon.5942] [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: 11/03/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES When patients with advanced cancer pursue phase 1 clinical trials, family caregivers are impacted as they adopt new roles and responsibilities in time-pressured, uncertain circumstances. This study explored the nature of the caregivers' participation in patients' decision to pursue phase 1 clinical trials and the early impact of the decision on the caregiver. METHODS Semi-structured interviews were conducted with 19 family caregivers of advanced cancer patients who had agreed to participate in phase 1 clinical trials. They were coded for information about the caregiver's relationship with the patient, typical style of decision-making together, understanding of the patient's prognosis and trial, contributions to decision-making and the initial impacts of the trial on the caregiver. Codes illuminating the research questions were grouped into categories and themes, compared across transcripts and examined against the literature. RESULTS Caregivers unequivocally supported the patients' decision to pursue the phase 1 trial as they hoped that the patient would derive medical benefit from the trial. They withheld their opinions and fears about the trial from the patients to support patient autonomy during the decision-making process. The patient's decision to participate increased the caregivers' burdens and deprived them of time spent on pleasurable activities at end of life. CONCLUSIONS Respecting the patients' personal autonomy, caregivers supported the trial, despite the complex caregiving required. As the success of phase 1 trials relies on caregiver involvement, it is imperative that healthcare professionals be sensitized to the support needs of these caregivers.
Collapse
Affiliation(s)
- Naomi Kogan
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Robin Cohen
- Departments of Oncology and Medicine, McGill University, and Lady Davis Research Institute, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Chvetzoff G, Girodet M, Despax J, Baudry V, Duranti J, Mastroianni B, Vanacker H, Vinceneux A, Brahmi M, Renard O, Gautier J, Britel M, Ducimetière F, Anota A, Cassier P, Christophe V. Reasons for acceptance and refusal of early palliative care in patients included in early-phase clinical trials in a regional comprehensive cancer centre in France: protocol for a qualitative study. BMJ Open 2022; 12:e060317. [PMID: 35459679 PMCID: PMC9036432 DOI: 10.1136/bmjopen-2021-060317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A few studies have highlighted the potential synergy between early palliative care and inclusion in an early-phase clinical trial that may improve quality of life, reduce symptoms of exhaustion related to the side effects of treatment and allow patients to complete their treatment protocol. The primary objective of this qualitative study is to evaluate the reasons for acceptance or refusal of early palliative care in patients included in early-phase clinical trials. METHOD AND ANALYSIS All patients from the Centre Léon Bérard (Comprehensive Cancer Centre in Lyon, France) who consent to one of the early-phase clinical trials proposed at the centre will be invited to participate in this study. The cohort will consist of a subgroup (n=20) of patients who accept palliative care together with their clinical trial, and a second subgroup (n=20) of patients who decline it. Patients will be interviewed in exploratory interviews conducted by a psychology researcher before the start of their clinical trial. The interviews will be audio-recorded. Patients will also be asked to complete quality of life and anxiety/depression questionnaires both before the beginning of the treatment and at the end of their clinical trial. The content of the interviews will be analysed thematically. Descriptive and comparative statistical analysis of both cohorts will also be conducted. ETHICS AND DISSEMINATION Personal data will be collected and processed in accordance with the laws and regulations in force. All patients will give informed consent to participate. This study complies with reference methodology MR004 of the Commission Nationale de l'Informatique et des Libertés. The protocol has received the validation of an ethics committee (Groupe de Réflexion Ethique du CLB, number: 2020-006). The results will be disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04717440.
Collapse
Affiliation(s)
- Gisele Chvetzoff
- Department of Oncology Patient Support Care, Centre Léon Bérard, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
| | - Magali Girodet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
| | - Johanna Despax
- Sciences Humaines et Sociales, Centre Léon Bérard, Lyon, France
| | - Valentine Baudry
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
| | - Julie Duranti
- Department of Oncology Patient Support Care, Centre Léon Bérard, Lyon, France
| | | | - Hélène Vanacker
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Olivier Renard
- Department of Oncology Patient Support Care, Centre Léon Bérard, Lyon, France
| | - Julien Gautier
- Clinical Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - Manon Britel
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
| | | | - Amélie Anota
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
- Clinical Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - Philippe Cassier
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Véronique Christophe
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
- CNRS, UMR 9193, SCALab Cognitives and Affectives Sciences, University of Lille, Lille, France
| |
Collapse
|
10
|
Decisional Conflict after Deciding on Potential Participation in Early Phase Clinical Cancer Trials: Dependent on Global Health Status, Satisfaction with Communication, and Timing. Cancers (Basel) 2022; 14:cancers14061500. [PMID: 35326653 PMCID: PMC8946532 DOI: 10.3390/cancers14061500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023] Open
Abstract
When standard treatment options are not available anymore, patients with advanced cancer may participate in early phase clinical trials. Improving this complex decision-making process may improve their quality of life. Therefore, this prospective multicenter study with questionnaires untangles several contributing factors to decisional conflict (which reflects the quality of decision-making) in patients with advanced cancer who recently decided upon early phase clinical trial participation (phase I or I/II). We hypothesized that health-related quality of life, health literacy, sense of hope, satisfaction with the consultation, timing of the decision, and the decision explain decisional conflict. Mean decisional conflict in 116 patients was 30.0 (SD = 16.9). Multivariate regression analysis showed that less decisional conflict was reported by patients with better global health status (β = −0.185, p = 0.018), higher satisfaction (β = −0.246, p = 0.002), and who made the decision before (β = −0.543, p < 0.001) or within a week after the consultation (β = −0.427, p < 0.001). These variables explained 37% of the variance in decisional conflict. Healthcare professionals should realize that patients with lower global health status and who need more time to decide may require additional support. Although altering such patient intrinsic characteristics is difficult, oncologists can impact the satisfaction with the consultation. Future research should verify whether effective patient-centered communication could prevent decisional conflict.
Collapse
|
11
|
Gad KT, Lassen U, Duun-Henriksen AK, Dalton SO, Mau-Sørensen M, Bidstrup PE, Høeg BL, Rohrberg KS, Spanggard I, von Heymann A, Johansen C. Patients in phase 1 cancer trials: psychological distress and understanding of trial information. Acta Oncol 2022; 61:341-348. [PMID: 34709958 DOI: 10.1080/0284186x.2021.1993331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psychological distress may be present among patients who are considering enrollment in phase 1 cancer trials, as they have advanced cancer and no documented treatment options remain. However, the prevalence of psychological distress has not been previously investigated in larger cohorts. In complex phase 1 cancer trials, it is important to ensure adequate understanding of the study premises, such as the undocumented effects and the risk of adverse events. MATERIALS AND METHODS In a prospective study, patients completed questionnaires at two time points. We investigated psychological distress, measured as stress, anxiety, and depression, among patients at their first visit to the phase 1 unit (N = 229). Further, we investigated the understanding of trial information among patients who were enrolled in a phase 1 cancer trial (N = 57). RESULTS We enrolled 75% of 307 eligible patients. We found a lower mean score of stress in our population compared to population norms, while the mean scores of anxiety and depression were higher. A total of 9% showed moderate to severe symptoms of anxiety and 11% showed moderate to severe symptoms of depression, which indicates higher levels than cancer patients in general. A total of 46 (81% of enrolled patients) completed questionnaires on trial information and consent. The understanding of the information on phase 1 cancer trials in these patients was slightly lower than the level reported for cancer trials in general. Some aspects relating to purpose, benefit, and additional risks were understood by fewer than half of the patients. CONCLUSION Our results suggest that distress is not as prevalent in the population of patients referred to phase 1 cancer trials as in the general cancer population. Although patients' understanding of trial information was reasonable, some aspects of complex phase 1 cancer trials were not easily understood by enrolled patients.
Collapse
Affiliation(s)
- Katrine T. Gad
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulrik Lassen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne K. Duun-Henriksen
- Statistics and Data analysis, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne O. Dalton
- Survivorship & Inequality in Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Services, Zealand University Hospital, Naestved, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pernille E. Bidstrup
- Survivorship & Inequality in Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Beverley. L. Høeg
- Statistics and Data analysis, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kristoffer S. Rohrberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Iben Spanggard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Annika von Heymann
- Late Effect Research Unit (CASTLE), Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Johansen
- Late Effect Research Unit (CASTLE), Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
12
|
Dam MS, Green S, Bogicevic I, Hillersdal L, Spanggaard I, Rohrberg KS, Svendsen MN. Precision patients: Selection practices and moral pathfinding in experimental oncology. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:345-359. [PMID: 34993996 DOI: 10.1111/1467-9566.13424] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/03/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
This paper addresses selection practices in a Danish phase 1 unit specialised in precision medicine in the field of oncology. Where precision medicine holds the ambition of selecting genetically fit medicine for the patient, we find that precision medicine in the early trial setting is oriented towards selecting clinically and genetically fit patients for available treatment protocols. Investigating how phase 1 oncologists experience and respond to the moral challenges of selecting patients for early clinical trials, we show that inclusion criteria and patient categories are not always transparent to patients. Lack of transparency about inclusion criteria has been interpreted as morally problematic. Yet drawing on social science studies of 'unknowing', we argue that silence and non-transparency in interactions between oncologists and patients are crucial to respect the moral agency of patients at the edge of life and recognise them as belonging to the public of Danish health care. In the discussion, we consider the practice of placing 'unfit' patients on a waiting list for trial participation. Rather than representing an ethical and political problem, we argue, the waiting list can act as a valve enabling oncologists to navigate the scientific and as well as the moral uncertainties in phase 1 oncology.
Collapse
Affiliation(s)
- Mie S Dam
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sara Green
- Centre for Medical Science and Technology Studies, Department of Science Education, University of Copenhagen, Copenhagen, Denmark
| | - Ivana Bogicevic
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Line Hillersdal
- Centre for Medical Science and Technology Studies, Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Iben Spanggaard
- The Phase I Unit, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | - Mette N Svendsen
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
13
|
Ovaitt AK, McCammon S. Ethical Considerations in Caring for Patients with Advanced Malignancy. Surg Oncol Clin N Am 2021; 30:581-589. [PMID: 34053670 DOI: 10.1016/j.soc.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients with advanced malignancy have decisions to make about next steps that are multifactorial and highly ramified. At each step, they, their loved ones, and their health care providers will attempt to make right decisions and avoid wrong ones. Beyond bare ethical principles, these patients face tensions between what they hope for, what is possible, and what those around them expect and advise. This article uses a case-based approach to explore the balance between prognostication and directive counsel; affective forecasting and decisional regret; hope and the therapeutic misconception; and issues of patient ownership and abandonment at the end of life.
Collapse
Affiliation(s)
- Alyssa K Ovaitt
- Department of Otolaryngology-Head and Neck Surgery, The University of Alabama at Birmingham, Faculty Office Tower 1155, 1720 2nd Avenue South, Birmingham, AL 35294-3412, USA
| | - Susan McCammon
- Department of Otolaryngology-Head and Neck Surgery, The University of Alabama at Birmingham, Faculty Office Tower 1155, 1720 2nd Avenue South, Birmingham, AL 35294-3412, USA; Department of Internal Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Community-Based Palliative Care, UAB Center for Palliative and Supportive Care, The University of Alabama at Birmingham, Faculty Office Tower 1155, 1720 2nd Avenue South, Birmingham, AL 35294-3412, USA.
| |
Collapse
|
14
|
van Lent LGG, Jabbarian LJ, van Gurp J, Hasselaar J, Lolkema MP, van Weert JCM, van der Rijt CCD, de Jonge MJA. Identifying patient values impacting the decision whether to participate in early phase clinical cancer trials: A systematic review. Cancer Treat Rev 2021; 98:102217. [PMID: 33965892 DOI: 10.1016/j.ctrv.2021.102217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND For many patients with advanced cancer, the decision whether to participate in early phase clinical trials or not is complex. The decision-making process requires an in-depth discussion of patient values. We therefore aimed to synthesize and describe patient values that may affect early phase clinical trial participation. METHODS We conducted a systematic search in seven electronic databases on patient values in relation to patients' decisions to participate in early phase clinical cancer trials. RESULTS From 3072 retrieved articles, eleven quantitative and five qualitative studies fulfilled our inclusion criteria. We extracted ten patient values that can contribute to patients' decisions. Overall, patients who seek trial participation usually report hope, trust, quantity of life, altruism, perseverance, faith and/or risk tolerance as important values. Quality of life and humanity are main values of patients who refuse trial participation. Autonomy and social adherence can be reported by both trial seekers or refusers, dependent upon how they are manifested in a patient. CONCLUSIONS We identified patient values that frequently play a role in the decision-making process. In the setting of discussing early phase clinical trial participation with patients, healthcare professionals need to be aware of these values. This analysis supports the importance of individual exploration of values. Patients that become aware of their values, e.g. by means of interventions focused on clarifying their values, could feel more empowered to choose. Subsequently, healthcare professionals could improve their support in a patients' decision-making process and reduce the chance of decisional conflict.
Collapse
Affiliation(s)
- Liza G G van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Lea J Jabbarian
- Department of Psychiatry, Erasmus MC, Rotterdam, the Netherlands
| | - Jelle van Gurp
- Department of IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain & Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research (ASCoR) and University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maja J A de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| |
Collapse
|
15
|
Lech S, O'Sullivan JL, Wellmann L, Supplieth J, Döpfmer S, Gellert P, Kuhlmey A, Nordheim J. Recruiting general practitioners and patients with dementia into a cluster randomised controlled trial: strategies, barriers and facilitators. BMC Med Res Methodol 2021; 21:61. [PMID: 33784967 PMCID: PMC8008594 DOI: 10.1186/s12874-021-01253-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/16/2021] [Indexed: 11/27/2022] Open
Abstract
Background Recruitment of general practitioners (GPs) and their patients is reported as one of the most challenging steps when undertaking primary care research. The present paper describes the recruitment process of a cluster randomised controlled trial (cRCT) aiming to improve dementia care in the primary care setting. Methods Recruitment data was analysed descriptively using frequency tables to investigate comparisons of recruitment rates and results of different recruitment strategies as well as reasons for participation and non-participation of GPs, patients with dementia (PwD) and their caregivers. Results Over a period of 23 months, N = 28 GPs were successfully included in the cRCT. This represents an overall recruitment rate of 4.6%. The most efficient strategy in terms of high response and low labour-intensity involved the dissemination of calls for participation in a GP research network. Most frequently reported reasons for GP’s participation were Improvement of patient’s well-being (n = 22, 79%) followed by Interest in dementia research (n = 18, 64%). The most common reasons for non-participation were Lack of time (n = 71, 34%) followed by Not interested in participation (n = 63, 30%). On a patient level, N = 102 PwD were successfully recruited. On average, each GP referred about n = 7 PwD (range: 1–17; mdn = 6; IQR = 3.5) and successfully recruited about n = 4 PwD (range: 1–11; mdn = 3; IQR = 3.5). Conclusion First, our findings propose GP research networks as a promising strategy to promote recruitment and participation of GPs and their patients in research. Second, present findings highlight the importance of including GPs and their interests in specific research topics in early stages of research in order to ensure a successful recruitment. Finally, results do not support cold calls as a successful strategy in the recruitment of GPs. Trial registration The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019.
Collapse
Affiliation(s)
- Sonia Lech
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Julie L O'Sullivan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Leonard Wellmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Juliana Supplieth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Susanne Döpfmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
| | - Paul Gellert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Adelheid Kuhlmey
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Johanna Nordheim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
16
|
Viljoen B, Chambers SK, Dunn J, Ralph N, March S. Deciding to Enrol in a Cancer Trial: A Systematic Review of Qualitative Studies. J Multidiscip Healthc 2020; 13:1257-1281. [PMID: 33149597 PMCID: PMC7603415 DOI: 10.2147/jmdh.s266281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
Background Clinical trials are essential for the advancement of cancer treatments; however, participation by patients is suboptimal. Currently, there is a lack of synthesized qualitative review evidence on the patient experience of trial entry from which to further develop decision support. The aim of this review is to synthesise literature reporting experiences of participants when deciding to enrol in a cancer clinical trial in order to inform practice. Methods A systematic review and meta-synthesis of qualitative studies were conducted to describe the experiences of adult cancer patients who decided to enrol in a clinical trial of an anti-cancer treatment. Results Forty studies met eligibility criteria for inclusion. Three themes were identified representing the overarching domains of experience when deciding to enrol in a cancer trial: 1) need for trial information; (2) trepidation towards participation; and (3) justifying the decision. The process of deciding to enrol in a clinical trial is one marked by uncertainty, emotional distress and driven by the search for a cure. Conclusion Findings from this review show that decision support modelled by shared decision-making and the quality of a shared decision needs to be accompanied by tailored or personalised psychosocial and supportive care. Although the decision process bears similarities to theoretical processes outlined in decision-making frameworks, there are a lack of supportive interventions for cancer patients that are adapted to the clinical trial context. Theory-based interventions are urgently required to support the specific needs of patients deciding whether to participate in cancer trials.
Collapse
Affiliation(s)
- Bianca Viljoen
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Suzanne K Chambers
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Jeff Dunn
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Nicholas Ralph
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Sonja March
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield, Brisbane, Australia
| |
Collapse
|
17
|
Ferrell B, Chung V, Hughes MT, Koczywas M, Azad NS, Ruel NH, Knight L, Cooper RS, Smith TJ. A Palliative Care Intervention for Patients on Phase 1 Studies. J Palliat Med 2020; 24:846-856. [PMID: 33103938 DOI: 10.1089/jpm.2020.0597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Phase 1 clinical trials remain vital for oncology care. Patients on these trials require supportive care for quality-of-life (QOL) concerns. Objective: To test a Palliative Care Intervention (PCI) for patients with solid tumors enrolled in Phase I therapeutic trials with a priori hypothesis that psychological distress, QOL, satisfaction, symptoms, and resource utilization would be improved in the PCI group. Design: This unblinded randomized trial compared the PCI with usual care in patients accrued to Phase I Clinical Trials. Subjects (n = 479) were followed for 24 weeks, with 12 weeks as the primary outcome. Setting: Two Comprehensive Cancer Centers in the United States. Subjects: A consecutive sample, 21 years or older, English fluency, with solid tumors initiating a Phase 1 trial. Measurements: Psychological Distress (Distress Thermometer), QOL total and subscales (FACT-G), satisfaction (FAM-CARE), survival, and resource utilization (chart audit). Results: PCI subjects showed improved Psychological Distress (-0.47, p = 0.015) and Emotional Well-Being (0.81, p = 0.045), with differences on variables of QOL and distress between sites. High rates of symptom-management admissions (41.3%) and low rates of Advance Directive completion (39.0%), and hospice enrollment (30.7%), despite a median survival in both groups of 10.1 months from initiating a Phase 1 study. Conclusions: A nurse-delivered PCI can improve some QOL outcomes and distress for patients participating in Phase 1 trials. Greater integration of PC is needed to provide quality care to these patients and to support transitions from treatment to supportive care, especially at the end of life. ClinicalTrials.gov Identifier: NCT01612598.
Collapse
Affiliation(s)
- Betty Ferrell
- Division of Nursing Research and Education, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Vincent Chung
- Department of Medical Oncology and Therapeutics Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Mark T Hughes
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marianna Koczywas
- Department of Medical Oncology and Therapeutics Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Nilofer Saba Azad
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Nora H Ruel
- Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Louise Knight
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Rhonda S Cooper
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Thomas J Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| |
Collapse
|
18
|
Engelbak Nielsen Z, Eriksson S, Schram Harsløf LB, Petri S, Helgesson G, Mangset M, Godskesen TE. Are cancer patients better off if they participate in clinical trials? A mixed methods study. BMC Cancer 2020; 20:401. [PMID: 32384883 PMCID: PMC7206768 DOI: 10.1186/s12885-020-06916-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/30/2020] [Indexed: 01/10/2023] Open
Abstract
Background Research and cancer care are closely intertwined; however, it is not clear whether physicians and nurses believe that clinical trials offer the best treatment for patients and, if so, whether this belief is justified. The aim of this study was therefore: (i) to explore how physicians and nurses perceive the benefits of clinical trial participation compared with standard care and (ii) whether it is justified to claim that clinical trial participation improves outcomes for cancer patients. Methods A mixed methods approach was used employing semi-structured interviews with 57 physicians and nurses in oncology and haematology and a literature review of the evidence for trial superiority, i.e. the idea that receiving treatment in a clinical trial leads to a better outcome compared with standard care. Inductive thematic analysis was used to examine the interview data. A literature review comprising nine articles was conducted according to a conceptual framework developed by Peppercorn et al. and evaluated recent evidence on trial superiority. Results Our findings show that many physicians and nurses make claims supporting trial superiority, however very little evidence is available in the literature comparing outcomes for trial participants and non-participants that supports their assertions. Conclusions Despite the recent rapid development and use of targeted therapy and immunotherapy, we find no support for trial participation to provide better outcomes for cancer patients than standard care. Hence, our present results are in line with previous results from Peppercorn et al. A weaker version of the superiority claim is that even if a trial does not bring about a direct positive effect, it brings about indirect positive effects. However, as the value of such indirect effects is dependent on the individual’s specific circumstances and preferences, their existence cannot establish the general claim that treatment in trials is superior. Belief in trial superiority is therefore unfounded. Hence, if such beliefs are communicated to patients in a trial recruitment context, it would provide misleading information. Instead emphasis should be on patients volunteering to give an altruistic contribution to the furthering of knowledge and to the potential benefit of future patients.
Collapse
Affiliation(s)
- Zandra Engelbak Nielsen
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Section 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Stefan Eriksson
- Centre for Research Ethics & Bioethics, Uppsala University, Box 564, 751 22, Uppsala, Sweden
| | - Laurine Bente Schram Harsløf
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Section 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Suzanne Petri
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Section 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Gert Helgesson
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Kirkeveien 166, Bygg 20, 0450, Oslo, Norway
| | - Tove E Godskesen
- Centre for Research Ethics & Bioethics, Uppsala University, Box 564, 751 22, Uppsala, Sweden. .,Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden.
| |
Collapse
|
19
|
Rezash V, Reed J, Gedeon B, Parsons E, Siedlecki S, Daniels B, Shepard DR. Who Needs What? Perceptions of Patients and Caregivers in Oncology Phase 1 Trials. J Patient Exp 2020; 7:27-33. [PMID: 32128368 PMCID: PMC7036678 DOI: 10.1177/2374373519830743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: The study design and nature of oncology phase 1 clinical trials create a uniquely
vulnerable patient population yet little research has been conducted to identify the
added burden these trials create for both cancer patients and their caregiver(s). Objective: Examining the perceptions and needs of patients and their caregivers participating in
phase 1 oncology clinical trials, the investigators tested the hypothesis that the
caregiver will exhibit a higher level of burden and/or distress than the patient. Method: A mixed-methods exploratory process utilizing patient and caregiver interviews and
quality-of-life questionnaires was used to assess the psychosocial burdens associated
with oncology clinical trial participation. A qualitative and quantitative analysis of
the responses were 8 performed. Result: Both patients and caregivers reported similar themes identifying the burdens and
benefits related to phase 1 clinical trial participation. However, the caregivers’
expressed burden exceeded that of the patients’ validating the study’s hypothesis. Conclusion: The need for ongoing additional support services for not only the patient but also the
caregiver was identified.
Collapse
Affiliation(s)
- Victoria Rezash
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Janice Reed
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Barbara Gedeon
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric Parsons
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sandra Siedlecki
- Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley Daniels
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dale R Shepard
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
20
|
Lewin J, Bell JAH, Wang K, Forcina V, Tam S, Srikanthan A, Lin YC, Taback N, Mitchell L, Gupta AA. Evaluation of Adolescents’ and Young Adults’ Attitudes Toward Participation in Cancer Clinical Trials. JCO Oncol Pract 2020; 16:e280-e289. [DOI: 10.1200/jop.19.00450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE: Participation in cancer clinical trials (CCTs) for adolescents and young adults (AYAs) remains the lowest of any patient group with cancer. Little is known about the personal barriers to AYA accrual. The aim of this study was to explore AYA attitudes that influence CCT participation. METHODS: A mixed-methods approach was used. AYAs and non-AYAs (≥ 40 years) completed the Cancer Treatment subscale of the Attitudes Toward Cancer Trials Scales and 9 supplementary questions formed from interview analysis. Differences between AYA and non-AYA cohorts were analyzed using the Mann-Whitney U test, and logistic regression models were constructed to evaluate the effect of demographics on perceptions of CCTs. RESULTS: Surveys were distributed to 61 AYAs (median age, 29 years; range, 17-39 years) and 74 non-AYAs (median age, 55 years; range, 40-88 years). Compared with non-AYAs, AYAs perceived CCTs to be unsafe/more difficult (Personal Barrier/Safety domain; P = .01). There were no differences based on age in other domains. AYAs were also more concerned with CCT interference in their long-term goals ( P = .04). Multivariable ordered logistic regression identified increased personal barriers in the Personal Barrier/Safety domain for AYAs ( P = .01), in patients with English as a second language (ESL; P < .01), and in patients previously not offered a clinical trial ( P = .03). Long-term goals were identified as a barrier in particular tumor types ( P = .01) and in patients with ESL ( P < .01), with a trend identified in AYAs ( P = .12). CONCLUSION: Age-related differences in attitudes toward CCTs suggest that tailored approaches to CCT accrual are warranted. Patient-centered delivery of information regarding CCTs, particularly in patients with ESL and who are trial naïve, may improve accrual.
Collapse
Affiliation(s)
- Jeremy Lewin
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princes Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jennifer A. H. Bell
- Department of Bioethics, University Health Network; Department of Supportive Care, Princess Margaret Cancer Centre; and Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kate Wang
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Victoria Forcina
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Seline Tam
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Amirrtha Srikanthan
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Yu-Chung Lin
- Departments of Statistical Science and Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Taback
- Departments of Statistical Science and Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Abha A. Gupta
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princes Margaret Cancer Center, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Garrett SB, Matthews TM, Abramson CM, Koenig CJ, Hlubocky FJ, Daugherty CK, Munster PN, Dohan D. Before Consent: Qualitative Analysis of Deliberations of Patients With Advanced Cancer About Early-Phase Clinical Trials. JCO Oncol Pract 2020; 16:e56-e63. [PMID: 31603726 PMCID: PMC6993554 DOI: 10.1200/jop.19.00256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with advanced cancer and oncologists deliberate about early-phase (EP) trials as they consider whether to pursue EP trial enrollment. We have limited information about those deliberations and how they may facilitate or impede trial initiation. This study describes these deliberations and their relationship to trial initiation. PATIENTS AND METHODS We collected longitudinal, ethnographic data on deliberations of patients with advanced cancer at two academic medical centers. We used constant comparative and framework analyses to characterize the deliberative process and its relationship to trial initiation. RESULTS Of 96 patients with advanced cancer, 26% initiated EP enrollment and 19% joined a trial. Constant comparative analysis revealed two foci of deliberation. Setting the stage focused on patient and physician support for EP trial involvement, including patients' interest in research and oncologists' awareness of trials and assessment of patient fit. Securing a seat focused on eligibility for and entrance to a specific trial and involved trial availability, treatment history, disease progression, and enrollment timing. Patients enrolled in a trial only when both stages could be successfully navigated. CONCLUSION Ethnographic data revealed two foci of deliberation about EP trial enrollment among patients with advanced cancer. Physician support played a consequential role in both stages, but enrollment also reflected factors beyond the control of any specific individual. Insights from this study, combined with other recent studies of trial enrollment, advance our understanding of the complex process of EP trial accrual and may help identify strategies to improve rates of participation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Daniel Dohan
- University of California San Francisco, San Francisco, CA
| |
Collapse
|
22
|
Dubé K, Simoni J, Louella M, Sylla L, Mohamed ZH, Patel H, Luter S, Collier AC. Acceptability of Cell and Gene Therapy for Curing HIV Infection Among People Living with HIV in the Northwestern United States: A Qualitative Study. AIDS Res Hum Retroviruses 2019; 35:649-659. [PMID: 30990052 PMCID: PMC6602097 DOI: 10.1089/aid.2019.0021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Multiple strategies to cure HIV infection are under investigation, including cell and gene therapy (C>) approaches. Research, and ultimately treatment, with these novel strategies will require patients' willingness to participate. To elicit the perspectives of people living with HIV specific to these novel approaches, we conducted 4 focus group discussions with a diverse group of 19 English-speaking men and women living with HIV in care at a large academic HIV clinic in the northwestern United States. Thematic analysis indicated participants expressed initial fear about C> research. They articulated specific concerns about risks, including analytical treatment interruptions, and thought only a person in desperate straits would participate. They voiced significant mistrust of research in general and believed there was already a cure from HIV that was being withheld from the poor. Overall, they were satisfied with their health and quality of life on antiretroviral therapy. These findings suggest the importance of community engagement and educational efforts about C> for HIV cure to ensure optimal collaborative partnerships.
Collapse
Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jane Simoni
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Psychology, University of Washington, Seattle, Washington
| | - Michael Louella
- defeatHIV Community Advisory Board (CAB), Seattle, Washington
- University of Washington Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Laurie Sylla
- defeatHIV Community Advisory Board (CAB), Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Zahra H. Mohamed
- Department of Global Health, University of Washington, Seattle, Washington
| | - Hursch Patel
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stuart Luter
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ann C. Collier
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
23
|
Lee MK, Suh SR. Effects of Peer-Led Interventions for Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2019; 45:217-236. [PMID: 29466347 DOI: 10.1188/18.onf.217-236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION To evaluate the effects of peer-led supportive interventions for patients with cancer.
. LITERATURE SEARCH Six electronic databases (EMBASE, MEDLINE®, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL®) were searched for articles published from 1997 to May 2017.
. DATA EVALUATION A total of 159 studies were identified. Eighteen (16 randomized, controlled trials [RCTs] and 2 non-RCTs) were eligible for systematic review and 16 for meta-analysis. The Cochrane risk of bias tool and Comprehensive Meta-Analysis software were used for analysis.
. SYNTHESIS The authors synthesized the results of the effect size of each trial according to cancer symptoms, coping, emotional health, quality of life, self-efficacy, sexuality, social support, and health-related behaviors.
. IMPLICATIONS FOR RESEARCH The findings from this study suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of peer-led supportive interventions within cancer care models.
Collapse
|
24
|
Chalela P, Muñoz E, Gallion KJ, Kaklamani V, Ramirez AG. Empowering Latina breast cancer patients to make informed decisions about clinical trials: a pilot study. Transl Behav Med 2018; 8:439-449. [PMID: 29800408 DOI: 10.1093/tbm/ibx083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Minority representation in clinical trials is vital for researchers to assess differential effects in outcomes of therapies on biological and genetic characteristics among groups. This study assessed the effect of Choices, a bilingual multi-component intervention, on perceived understanding of clinical trials, agreement with stages of decision readiness and consideration of clinical trials as a treatment option, among Latina breast cancer patients. This randomized controlled pilot study compared Choices with a control condition providing general clinical trial information to eligible patients. Seventy-seven Latina breast cancer patients were randomly assigned to either Choices (n = 38) or the control (n = 39). Choices included three components: an educational interactive video, a low-literacy booklet, and care coordination by patient navigation (i.e., educational and psychosocial support, coordinating appointments, translating, interacting with the medical team). Choices was more effective than the control in improving perceived understanding of clinical trials (p = .033) and increasing consideration of clinical trials as a treatment option (p = .008). Additionally, intervention participants showed significant changes between baseline and post-intervention on agreement with stages of decision readiness statements (p < .002) than control participants (p > .05); the percentage of intervention women in agreement with preparation to action statements increased from 52.8% at baseline to 86.1% at post-intervention, and those in agreement with ready to action stages rose from 50.0% to 88.9%. Computer-based videos and care coordination provided by patient navigation-specifically tailored to Latinos-are effective strategies to successfully address awareness, and improved decision-making skills to make informed decisions about clinical trial participation.
Collapse
Affiliation(s)
- Patricia Chalela
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Edgar Muñoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Kipling J Gallion
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Virginia Kaklamani
- Cancer Therapy and Research Center, UT Health San Antonio, San Antonio, USA
| | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| |
Collapse
|
25
|
Song B, Wen TJ. Integrating Incidental and Integral Emotions in Non-Profit Communications: An Experiment of Blood Donation Message. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/1553118x.2018.1524381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Baobao Song
- College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Taylor Jing Wen
- College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
26
|
van der Biessen DA, Oldenmenger WH, van der Helm PG, Klein D, Oomen-de Hoop E, Mathijssen RH, Lolkema MP, de Jonge MJ. Self-reported quality of life and hope in phase-I trial participants: An observational prospective cohort study. Eur J Cancer Care (Engl) 2018; 27:e12908. [PMID: 30179287 DOI: 10.1111/ecc.12908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/26/2018] [Accepted: 07/21/2018] [Indexed: 12/20/2022]
Abstract
For advanced cancer patients deliberating early clinical trial participation, adequate information about expected effect on quality of life (HRQoL) and hope, may support decision making. The aim was to assess the potential relation of HRQoL to eligibility for phase-I trial participation, and to observe the variations in patient-reported outcomes. Patients completed questionnaires at preconsent (n = 124), baseline (n = 96), and after first evaluation of a phase-I trial (n = 76). The Mann-Whitney U test was used to test differences between eligible and ineligible patients. Univariate logistic regression was performed for eligibility. Factorial repeated-measures ANOVA compared the outcomes of patients continuing vs. stopping participation after first evaluation over time. Eligibility is associated with significant better global health OR = 0.946, 95% CI [0.918, 0.975], p = 0.001, physical functioning OR = 0.959, 95% CI [0.933, 0.985], p = 0.002, role functioning OR = 0.974, 95% CI [0.957, 0.991] and better appetite OR = 1.114 95% CI [1.035, 1.192]. HRQoL outcomes like global health, social functioning and appetite decline in all patients and differ between patients continuing or having to end participation. Over time, hope and tenacity decline in all patients and coping strategies alter in patients stopping participation. Trial participation influences patient-reported outcomes. Global health may predict for eligibility and trial continuation. Informing patients could affect patients' decision making.
Collapse
Affiliation(s)
| | - Wendy H Oldenmenger
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Peer G van der Helm
- Faculty of Social Work and Applied Psychology, Leiden University of Applied Sciences, Leiden, The Netherlands
| | - Dennis Klein
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ron H Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maja J de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| |
Collapse
|
27
|
Gad KT, Lassen U, Mau-Søerensen M, Høybye MT, Johansen C. Patient information in phase 1 trials: A systematic review. Psychooncology 2017; 27:768-780. [DOI: 10.1002/pon.4559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Katrine Toubro Gad
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Ulrik Lassen
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Morten Mau-Søerensen
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Mette Terp Høybye
- Interdisciplinary Research Unit; Elective Surgery Center; Silkeborg Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Unit of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| |
Collapse
|
28
|
Jansen LA, Mahadevan D, Appelbaum PS, Klein WMP, Weinstein ND, Mori M, Degnin C, Sulmasy DP. Variations in Unrealistic Optimism Between Acceptors and Decliners of Early Phase Cancer Trials. J Empir Res Hum Res Ethics 2017; 12:280-288. [PMID: 28728498 PMCID: PMC6020823 DOI: 10.1177/1556264617720433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research has found that patient-subjects in early phase cancer trials exhibit unrealistic optimism regarding the risks and possible benefits of trial participation. Unrealistic optimism is associated with therapeutic misconception and failures to appreciate research-related information. This is the first study to assess whether those who decline to participate in these trials also exhibit unrealistic optimism. It is also the first study to assess whether there are significant differences in appreciation of research-related risks/benefits and therapeutic misconception between these two groups. We approached 261 patients at two academic medical centers who were offered enrollment in a Phase I, II, or I/II cancer trial (between 2012 and 2016). Two hundred thirty-three patients agreed to enroll in an early phase cancer trial, 171 of whom agreed to be interviewed for the study. Twenty-eight patients declined the offer to enroll, 15 of whom agreed to be interviewed for the study. Subjects participated in a structured face-to-face interview with a research associate trained to administer the study questionnaires. Acceptors demonstrated a significantly higher level of unrealistic optimism than decliners ( p < .05). Decliners had significantly less therapeutic misconception than acceptors (3.37 [ SD = 0.85] vs. 3.79 [ SD = 0.77], p = .042). There was a significant difference on one of the appreciation questions between acceptors and decliners ( p = .009). Comparative assessment of acceptors and decliners to early phase cancer trials casts light on whether unrealistic optimism is consequential for the decision to participate in these trials. The different levels of unrealistic optimism exhibited by these groups suggest that it may be a factor that affects the decision to participate.
Collapse
Affiliation(s)
- Lynn A Jansen
- 1 Oregon Health & Science University, Portland, OR, USA
| | | | - Paul S Appelbaum
- 3 Columbia University College of Physicians & Surgeons, New York, NY, USA
| | | | | | - Motomi Mori
- 1 Oregon Health & Science University, Portland, OR, USA
| | | | | |
Collapse
|
29
|
Dunn LB, Wiley J, Garrett S, Hlubocky F, Daugherty C, Trupin L, Munster P, Dohan D. Interest in initiating an early phase clinical trial: results of a longitudinal study of advanced cancer patients. Psychooncology 2017; 26:1604-1610. [PMID: 27233054 DOI: 10.1002/pon.4179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 04/14/2016] [Accepted: 05/22/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Enhanced recruitment of patients with advanced cancer (ACP) to early phase (EP) trials is needed. However, selective recruitment may affect the kinds of patients who are recruited. To address whether ACP who initiate EP trial enrollment differ from those who do not, we prospectively surveyed ACP well in advance of potential trial recruitment and followed them over time to identify those who initiated the recruitment process. METHODS EP trial initiation was defined as a patient being referred for screening to an active EP trial. Depression and anxiety were assessed with the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7), respectively. Demographic and disease characteristics, functional status, and patient preferences regarding decision making were examined as possible predictors of EP trial initiation. RESULTS Of the 78 advanced cancer patients in the cohort studied, 21 (27%) initiated EP trial participation, while 57 (73%) did not. Of those who initiated this process, 14 (67%) went on to enroll in an EP study. Level of depression severity was associated with EP trial initiation, with rates of initiation nearly three times higher (35% vs. 12%, p = 0.054) among patients with minimal to mild levels of depression compared to those with moderate or higher levels of depression. EP trial initiation was not associated with demographic or socioeconomic variables, cancer type, functional status, quality of life, or decision-making variables. CONCLUSIONS The presence of elevated depressive symptoms may be associated with the EP trial recruitment and enrollment processes. This possible relationship warrants further study. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jim Wiley
- Department of Family and Community Medicine and Institute for Health Policy Studies, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Sarah Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Fay Hlubocky
- Department of Medicine, Section of Hematology/Oncology, Maclean Center for Clinical Medical Ethics, The University of Chicago Medicine, Chicago, IL, USA
| | - Christopher Daugherty
- Department of Medicine, Section of Hematology/Oncology, Maclean Center for Clinical Medical Ethics, The University of Chicago Medicine, Chicago, IL, USA
| | - Laura Trupin
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Pamela Munster
- Department of Medicine (Hematology/Oncology), and UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies and the Department of Anthropology, History, and Social Medicine, University of California, San Francisco (UCSF), CA, USA
| |
Collapse
|
30
|
Ingersgaard MV, Tulstrup M, Schmiegelow K, Larsen HB. A qualitative study of decision-making on Phase III randomized clinical trial participation in paediatric oncology: Adolescents' and parents' perspectives and preferences. J Adv Nurs 2017; 74:110-118. [PMID: 28771784 DOI: 10.1111/jan.13407] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 01/07/2023]
Abstract
AIM To explore parents' and adolescents' motives for accepting/declining participation in the ALL2008 trials and adolescents' involvement in the decision-making process. BACKGROUND Children and adolescents with acute lymphoblastic leukaemia treated on the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol were eligible for two randomizations testing 6-mercaptopurine treatment intensifications to improve efficacy and Asparaginase de-escalation to reduce toxicity. We recently reported that while adolescents favoured treatment reduction, parents of young children favoured treatment intensification. DESIGN A qualitative, exploratory study. METHODS A maximum variation sampling strategy was used. Five adolescents aged 12-17 years, six parents of adolescents and five parents of children aged 1-12 years were interviewed in the period March-May 2015. Data were analysed using content analysis. FINDINGS Adolescents and parents emphasized the importance of adolescents' active participation in decisions regarding enrolment into clinical trials. A majority of adolescents were either final or collaborative decision-makers. Parents stated that in case of disagreement, they would overrule the adolescents' decision. There were no differences between motivations of preferences held by parents of children or adolescents, respectively. Decisions were based on subjective values attributed to cure contra toxicity and individual preferences for either standard or experimental treatment. The possibility of a negative outcome induced fear of decisional regret and distress by the parents, yet they invested considerable trust in the physician's expertise. CONCLUSION Our findings highlight the importance of adolescents' active involvement in consent conferences. Research on management of disagreements between adolescents and parents in trial decisions is needed.
Collapse
Affiliation(s)
- Marianne Vie Ingersgaard
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Morten Tulstrup
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen and the Pediatric Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
31
|
van der Biessen DA, van der Helm PG, Klein D, van der Burg S, Mathijssen RH, Lolkema MP, de Jonge MJ. Understanding how coping strategies and quality of life maintain hope in patients deliberating phase I trial participation. Psychooncology 2017; 27:163-170. [PMID: 28665008 DOI: 10.1002/pon.4487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/31/2017] [Accepted: 06/22/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to understand how hope and motivation of patients considering phase I trial participation are affected by psychological factors such as coping strategies and locus of control (LoC) and general well-being as measured by the quality of life (QoL). METHODS An exploratory cross-sectional study was performed in patients with incurable cancer (N = 135) referred to our phase I unit for the first time. Patients were potentially eligible for phase I trial participation and participated in our study while deliberating phase I trial participation. We used questionnaires on hope, motivation to participate, coping, LoC, and QoL. To investigate the nature and magnitude of the relationships between the scales, a structural equation modeling (SEM) was fitted to the data. RESULTS Hope significantly predicted the motivation to participate in phase I trials. Predictors of hope were a combination of flexible and tenacious goal pursuit (both P < .01), internal LoC (P < .01), and QoL (P < .01). The SEM showed an exact fit to the data, using a null hypothesis significance test: chi-square (8) = 9.30, P = .32. CONCLUSIONS Patients considering phase I trial participation seem to use a pact of tenacious and flexible coping and control to stay hopeful. Furthermore, hope and QoL positively affected each other. The psychological pact may promote an adaptation enabling them to adjust to difficult circumstances by unconsciously ignoring information, called dissonance reduction. This mechanism may impair their ability to provide a valid informed consent. We suggest including a systematic exploration of patients' social context and values before proposing a phase I trial.
Collapse
Affiliation(s)
| | | | - Dennis Klein
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Simone van der Burg
- Scientific Institute for Quality of Healthcare, Radboud UMC, Nijmegen, the Netherlands
| | - Ron H Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Maja J de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| |
Collapse
|
32
|
Thomas KS, Batchelor JM, Bath-Hextall F, Chalmers JR, Clarke T, Crowe S, Delamere FM, Eleftheriadou V, Evans N, Firkins L, Greenlaw N, Lansbury L, Lawton S, Layfield C, Leonardi-Bee J, Mason J, Mitchell E, Nankervis H, Norrie J, Nunn A, Ormerod AD, Patel R, Perkins W, Ravenscroft JC, Schmitt J, Simpson E, Whitton ME, Williams HC. A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundSkin diseases are very common and can have a large impact on the quality of life of patients and caregivers. This programme addressed four diseases: (1) eczema, (2) vitiligo, (3) squamous cell skin cancer (SCC) and (4) pyoderma gangrenosum (PG).ObjectiveTo set priorities and reduce uncertainties for the treatment and prevention of skin disease in our four chosen diseases.DesignMixed methods including eight systematic reviews, three prioritisation exercises, two pilot randomised controlled trials (RCTs), three feasibility studies, two core outcome initiatives, four funding proposals for national RCTs and one completed national RCT.SettingSecondary care, primary care and the general population.ParticipantsPatients (and their caregivers) with eczema, vitiligo, SCC and PG, plus health-care professionals with an interest in skin disease.InterventionsOur three intervention studies included (1) barrier enhancement using emollients from birth to prevent eczema (pilot RCT); (2) handheld narrowband ultraviolet light B therapy for treating vitiligo (pilot RCT); and (3) oral ciclosporin (Neoral®, Novartis Pharmaceuticals) compared with oral prednisolone for managing PG (pragmatic national RCT).ResultsSystematic reviews included two overarching systematic reviews of RCTs of treatments for eczema and vitiligo, an umbrella review of systematic reviews of interventions for the prevention of eczema, two reviews of treatments for SCC (one included RCTs and the second included observational studies), and three reviews of outcome measures and outcome reporting. Three prioritisation partnership exercises identified 26 priority areas for future research in eczema, vitiligo and SCC. Two international consensus initiatives identified four core domains for future eczema trials and seven core domains for vitiligo trials. Two pilot RCTs and three feasibility studies critically informed development of four trial proposals for external funding, three of which are now funded and one is pending consideration by funders. Our pragmatic RCT tested the two commonly used systemic treatments for PG (prednisolone vs. ciclosporin) and found no difference in their clinical effectiveness or cost-effectiveness. Both drugs showed limited benefit. Only half of the participants’ ulcers had healed by 6 months. For those with healed ulcers, recurrence was common (30%). Different side effect profiles were noted for each drug, which can inform clinical decisions on an individual patient basis. Three researchers were trained to PhD level and a dermatology patient panel was established to ensure patient involvement in all aspects of the programme.ConclusionsFindings from this programme of work have already informed clinical guidelines and patient information resources. Feasibility studies have ensured that large national pragmatic trials will now be conducted on important areas of treatment uncertainty that address the needs of patients and the NHS. There is scope for considerable improvement in terms of trial design, conduct and reporting for RCTs of skin disease, which can be improved through wider collaboration, registration of trial protocols and complete reporting and international consensus over core outcome sets. Three national trials have now been funded as a result of this work. Two international initiatives to establish how best to measure the core outcome domains for eczema and vitiligo are ongoing.Trial registrationCurrent Controlled Trials Barrier Enhancement for Eczema Prevention (BEEP) (ISRCTN84854178 and NCT01142999), Study of Treatments fOr Pyoderma GAngrenosum Patients (STOP GAP) (ISRCTN35898459) and Hand Held NB-UVB for Early or Focal Vitiligo at Home (HI-Light Pilot Trial) (NCT01478945).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 18. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | | | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Tessa Clarke
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Finola M Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Nicholas Evans
- Trust Headquarters, West Hertfordshire Hospital NHS Trust, Hemel Hempstead, UK
| | - Lester Firkins
- Strategy and Development Group, James Lind Alliance, Oxford, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Louise Lansbury
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - James Mason
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Nunn
- Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK
| | | | - Ramesh Patel
- Radcliffe-on-Trent Health Centre, Nottingham, UK
| | - William Perkins
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane C Ravenscroft
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jochen Schmitt
- Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Eric Simpson
- Oregon Health and Science University, Portland, OR, USA
| | - Maxine E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| |
Collapse
|
33
|
Dainesi SM, Goldbaum M. Reasons behind the participation in biomedical research: a brief review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 17:842-51. [PMID: 25388485 DOI: 10.1590/1809-4503201400040004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/18/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Clinical research is essential for the advancement of Medicine, especially regarding the development of new drugs. Understanding the reasons behind patients' decision of participating in these studies is critical for the recruitment and retention in the research. OBJECTIVES To examine the decision-making of participants in biomedical research, taking into account different settings and environments where clinical research is performed. METHODS A critical review of the literature was performed through several databases using the keywords: "motivation", "decision", "reason", "biomedical research", "clinical research", "recruitment", "enrollment", "participation", "benefits", "altruism", "decline", "vulnerability" and "ethics", between August and November 2013, in English and in Portuguese. RESULTS The review pointed out that the reasons can be different according to some characteristics such as the disease being treated, study phase, prognoses and socioeconomic and cultural environment. Access to better health care, personal benefits, financial rewards and altruism are mentioned depending on the circumstances. CONCLUSION Finding out more about individuals' reasons for taking part in the research will allow clinical investigators to design studies of greater benefit for the community and will probably help to remove undesirable barriers imposed to participation. Improving the information to health care professionals and patients on the benefits and risks of clinical trials is certainly a good start.
Collapse
Affiliation(s)
| | - Moisés Goldbaum
- School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
34
|
How did partners experience cancer patients' participation in a phase I study? An observational study after a patient's death. Palliat Support Care 2015; 14:241-9. [PMID: 26675215 DOI: 10.1017/s1478951515000887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It can be assumed that patients' participation in a phase I study will have an important impact on their partners' life. However, evaluation of partners' experiences while patients are undergoing experimental treatment and of their well-being after the patient's death is lacking. We aimed to explore partners' experience of patients' participation in phase I studies and to investigate their well-being after a patient's death. METHOD This was an observational study conducted after the patient's death. Partners of deceased patients who had participated in a phase I study completed a questionnaire designed by us for experience evaluation and the Beck Depression Inventory for Primary Care, the Hospital Anxiety and Depression Scale, the Inventory of Traumatic Grief, and the RAND-36 Health Survey. RESULTS The median age of the 58 participating partners was 58 years (range: 51-65), and 67% was female. Partners reported negative effects on patients' quality of life, but only 5% of partners regretted patients' participation. Approximately two years after the patients' death, 19% of partners scored for depression, 36% for psychological distress, and 46% for complicated grief, and partners generally scored significantly lower on social and mental functioning compared to normative comparators. SIGNIFICANCE OF RESULTS Although partners reported negative consequences on patients' quality of life, most did not regret patients' participation in the phase I studies. Prevalence of depression, psychological distress, and complicated grief seemed important problems after a patient's death, and these must be considered when shaping further support for partners of patients participating in phase I trials.
Collapse
|
35
|
Abstract
OBJECTIVES The aims of this study were to determine a sound recruitment strategy for multisite wound studies to address the rising prevalence and incidence of chronic wounds and to identify appropriate adult patient populations with wounds of interest and establish partnerships with their clinicians and clinical services as a model for a multisite wound care feasibility study. DESIGN A pilot multisite recruitment feasibility study. SETTING Three wound clinics located in a large, Midwestern metropolitan area. PARTICIPANTS AND INTERVENTION A convenience sample of 3 staff and 3 patients with lower-extremity wounds from each clinic was interviewed. Medical records of all patients with lower-extremity wounds seen during 1 week at each clinic were reviewed. Outcome measures included characteristics of patients being treated at the 3 wound care clinics (patient demographics and wound characteristics) and wound treatments used. Barriers and opportunities that could be addressed in recruitment and other research strategies were identified. MAIN RESULTS Barriers and facilitators for future research were identified and varied within and between clinics. Patients reported they were willing to participate in future research, although fewer were willing if the study was blinded. Patients received a variety of treatments within and across clinics. Medical record reviews provided further information about wound clinic patients, wound characteristics, and barriers and facilitators for future study. CONCLUSIONS Characteristics of wound clinic patients and their wounds were found to vary by site, suggesting tailored recruitment methods by site within multisite wound care studies may be most productive. This study suggests successful recruitment strategies for future wound care intervention research.
Collapse
|
36
|
Gorini A, Mazzocco K, Pravettoni G. Decision-Making Process Related to Participation in Phase I Clinical Trials: A Nonsystematic Review of the Existing Evidence. Public Health Genomics 2015; 18:359-65. [PMID: 26529420 DOI: 10.1159/000441559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Due to the lack of other treatment options, patient candidates for participation in phase I clinical trials are considered the most vulnerable, and many ethical concerns have emerged regarding the informed consent process used in the experimental design of such trials. Starting with these considerations, this nonsystematic review is aimed at analyzing the decision-making processes underlying patients' decision about whether to participate (or not) in phase I trials in order to clarify the cognitive and emotional aspects most strongly implicated in this decision. Considering that there is no uniform decision calculus and that many different variables other than the patient-physician relationship (including demographic, clinical, and personal characteristics) may influence patients' preferences for and processing of information, we conclude that patients' informed decision-making can be facilitated by creating a rigorously developed, calibrated, and validated computer tool modeled on each single patient's knowledge, values, and emotional and cognitive decisional skills. Such a tool will also help oncologists to provide tailored medical information that is useful to improve the shared decision-making process, thereby possibly increasing patient participation in clinical trials.
Collapse
Affiliation(s)
- Alessandra Gorini
- Department of Health Science, University of Milan, and European Institute of Oncology, Milan, Italy
| | | | | |
Collapse
|
37
|
Otado J, Kwagyan J, Edwards D, Ukaegbu A, Rockcliffe F, Osafo N. Culturally Competent Strategies for Recruitment and Retention of African American Populations into Clinical Trials. Clin Transl Sci 2015; 8:460-6. [PMID: 25974328 PMCID: PMC4626379 DOI: 10.1111/cts.12285] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To identify successful recruitment strategies, challenges and best practices for researchers to engage African American communities in clinical studies taken into consideration target participants' culture and context. METHODS We reviewed 50 studies conducted from 2001 to 2012 at an inner-city research center to determine the type, duration, anticipated enrollments and actual enrollments. Survey was sent to study coordinators to obtain data on recruitment and retention strategies, challenges and dropout rates. We also interviewed 25 study coordinators on challenges and strategies. RESULTS Of the 50 studies, 24 had completed recruitment at the time of this report. The completed studies achieved a median recruitment rate of 88% (range: 50-110). Successful recruitment and retention strategies included: field-based strategy and snowballing. Major barriers were: distrust, compensation, education disadvantage, lack of interest, and inability to have study partner. Strategies to reduce barriers included providing informational sessions, disseminating newsletters about study outcomes. Best practices include being culturally sensitive including demonstrating a caring attitude and being responsive to participants needs. CONCLUSIONS Cultural competence is critical in order to design and implement successful recruitment strategies in this population. Research teams should consist of multiethnic staff, involve the community, demonstrate trust and deliver concise education of the research endeavor.
Collapse
Affiliation(s)
- Jane Otado
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - John Kwagyan
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - Diana Edwards
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - Alice Ukaegbu
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - Faun Rockcliffe
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - Nana Osafo
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| |
Collapse
|
38
|
Feasibility of Targeting PIK3CA Mutations in Head and Neck Squamous Cell Carcinoma. Pathol Oncol Res 2015; 22:35-40. [DOI: 10.1007/s12253-015-9970-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/04/2015] [Indexed: 11/25/2022]
|
39
|
McGrath-Lone L, Ward H, Schoenborn C, Day S. The effects of cancer research participation on patient experience: a mixed-methods analysis. Eur J Cancer Care (Engl) 2015; 25:1056-1064. [PMID: 26094639 PMCID: PMC5095768 DOI: 10.1111/ecc.12336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/28/2022]
Abstract
Patient-reported benefits of research participation have been described by study participants; however, many studies have small sample sizes or are limited to patient groups with poor prognoses. The purpose of this study was to explore the effects of research participation on patient experience using survey responses from a large, national sample of cancer patients (N = 66 462) and interviews with breast cancer patients attending a London trust. Multivariate logistic regression was used to investigate associations between taking part in research and positive patient experience. Based on our analysis, patients who participated in research were more likely to rate their overall care and treatment as 'very good/excellent' (ORadj :1.64, 95%CI: 1.53-1.76, P < 0.001) and to describe positive patient experiences, such as better access to non-standard care, better interactions with staff and being treated as an individual. However, findings from our interviews indicated that there was no common understanding of what constitutes cancer research and no clear delineation between research participation and standard care, from the patient perspective. Further work to explore how participation positively influences patient experience would be useful to develop strategies to improve care and treatment for all patients regardless of whether or not they choose, or have the opportunity, to take part in research.
Collapse
Affiliation(s)
- L McGrath-Lone
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, W2 1PG, UK.
| | - H Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - C Schoenborn
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - S Day
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, W2 1PG, UK
| |
Collapse
|
40
|
Gollhofer SM, Wiskemann J, Schmidt ME, Klassen O, Ulrich CM, Oelmann J, Hof H, Potthoff K, Steindorf K. Factors influencing participation in a randomized controlled resistance exercise intervention study in breast cancer patients during radiotherapy. BMC Cancer 2015; 15:186. [PMID: 25885634 PMCID: PMC4466838 DOI: 10.1186/s12885-015-1213-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 03/18/2015] [Indexed: 11/25/2022] Open
Abstract
Background Over the past years knowledge about benefits of physical activity after cancer is evolving from randomized exercise intervention trials. However, it has been argued that results may be biased by selective participation. Therefore, we investigated factors influencing participation in a randomized exercise intervention trial for breast cancer patients. Methods Non-metastatic breast cancer patients were systematically screened for a randomized exercise intervention trial on cancer-related fatigue. Participants and nonparticipants were compared concerning sociodemographic characteristics (age, marital status, living status, travel time to the training facility), clinical data (body-mass-index, tumor stage, tumor size and lymph node status, comorbidities, chemotherapy), fatigue, and physical activity. Reasons for participation or declination were recorded. Results 117 patients (52 participants, 65 nonparticipants) were evaluable for analysis. Multiple regression analyses revealed significantly higher odds to decline participation among patients with longer travel time (p = 0.0012), living alone (p = 0.039), with more comorbidities (0.031), previous chemotherapy (p = 0.0066), of age ≥ 70 years (p = 0.025), or being free of fatigue (p = 0.0007). No associations were found with BMI or physical activity. By far the most frequently reported reason for declination of participation was too long commuting time to the training facility. Conclusions Willingness of breast cancer patients to participate in a randomized exercise intervention study differed by sociodemographic factors and health status. Neither current physical activity level nor BMI appeared to be selective for participation. Reduction of personal inconveniences and time effort, e.g. by decentralized training facilities or flexible training schedules, seem most promising for enhancing participation in exercise intervention trials. Trial registration Registered at ClinicalTrials.gov: NCT01468766 (October 2011).
Collapse
Affiliation(s)
- Sandra M Gollhofer
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Joachim Wiskemann
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,Department of Medical Oncology, National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), Divisions of Medical Oncology and Preventive Oncology, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Martina E Schmidt
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,Unit of Environmental Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Oliver Klassen
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Cornelia M Ulrich
- Department of Preventive Oncology, National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Jan Oelmann
- Department of Radiation Oncology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Holger Hof
- Department of Radiation Oncology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Karin Potthoff
- Department of Medical Oncology, National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,Department of Radiation Oncology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Karen Steindorf
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,Unit of Environmental Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| |
Collapse
|
41
|
Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients' relational autonomy. Support Care Cancer 2015; 23:1169-96. [PMID: 25591627 DOI: 10.1007/s00520-014-2581-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Oncology clinical trials are necessary for the improvement of patient care as they have the ability to confirm the efficacy and safety of novel cancer treatments and in so doing, contribute to a solid evidence base on which practitioners and patients can make informed treatment decisions. However, only 3-5 % of adult cancer patients enroll in clinical trials. Lack of participation compromises the success of clinical trials and squanders an opportunity for improving patient outcomes. This literature review summarizes the factors and contexts that influence cancer patient decision making related to clinical trial participation. METHODS An integrative review was undertaken within PubMed, CINAHL, and EMBASE databases for articles written between 1995 and 2012 and archived under relevant keywords. Articles selected were data-based, written in English, and limited to adult cancer patients. RESULTS In the 51 articles reviewed, three main types of factors were identified that influence cancer patients' decision making about participation in clinical trials: personal, social, and system factors. Subthemes included patients' trust in their physician and the research process, undue influence within the patient-physician relationship, and systemic social inequalities. How these factors interact and influence patients' decision-making process and relational autonomy, however, is insufficiently understood. CONCLUSIONS Future research is needed to further elucidate the sociopolitical barriers and facilitators of clinical trial participation and to enhance ethical practice within clinical trial enrolment. This research will inform targeted education and support interventions to foster patients' relational autonomy in the decision-making process and potentially improve clinical trial participation rates.
Collapse
|
42
|
Staunton C. Informed consent for HIV cure research in South Africa: issues to consider. BMC Med Ethics 2015; 16:3. [PMID: 25591806 PMCID: PMC4324028 DOI: 10.1186/1472-6939-16-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/02/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND South Africa has made great progress in the development of HIV/AIDS testing, treatment and prevention campaigns. Yet, it is clear that prevention and treatment campaigns alone are not enough to bring this epidemic under control. DISCUSSION News that the "Berlin patient" and the "Mississippi baby" have both been "cured" of HIV brought hope to people living with HIV/AIDS in South Africa that a cure for HIV/AIDS is within reach. Despite the recent setbacks announced in the "Mississippi Baby" case, protocols aimed at curing HIV/AIDS are being developed in South Africa. However with evidence to suggest that participants in clinical trials do not understand the basic concepts in the informed consent process, there is concern that future participants in HIV/AIDS cure research will lack comprehension of the basic elements of future clinical trials that aims to cure HIV/AIDS and confuse research with clinical care. SUMMARY Research ethics committees have an important role to play in ensuring that participants understand the basic concepts discussed in the informed consent process, that they understand that research is not clinical care and they are unlikely to benefit from any early phase trials seeking to cure HIV/AIDS.
Collapse
Affiliation(s)
- Ciara Staunton
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Francie van Zijl Drive, 7505 Tygerberg, South Africa.
| |
Collapse
|
43
|
Islam KM, Opoku ST, Apenteng BA, Fetrick A, Ryan J, Copur M, Tolentino A, Vaziri I, Ganti AK. Engaging patients and caregivers in patient-centered outcomes research on advanced stage lung cancer: insights from patients, caregivers, and providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:796-801. [PMID: 24744120 DOI: 10.1007/s13187-014-0657-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Participatory and patient-centered approaches to cancer research have been highlighted as the most appropriate means of engaging patients in the conduct of clinical research. However, there is a paucity of patient-centered outcomes research (PCOR) on lung cancer. Previous studies seeking to define lung cancer treatment success have generally not included patients' and caregivers' perceptions and views in treatment decision-making. Additionally, little is known about effective strategies for the engagement of lung cancer patients in PCOR. We sought to gain insights into the perceptions of patients, caregivers, and providers on lung cancer treatment success, as well as on strategies for patient engagement in lung cancer PCOR. Four focus groups were conducted with provider, patient, and caregiver participants from four cancer centers in Nebraska and South Dakota. A total of 36 providers, patients, and caregivers participated in this study. Patients and caregivers confirmed that survival alone should not be the measure of lung cancer treatment success and that definitions of treatment success should emphasize factors such as effective clinical guidance throughout treatment, symptom management, functionality, and quality of life. Clinician participants noted that the definition of treatment success evolved over time and appeared to be linked to patients' experiences with chemotherapy. Participants identified barriers to and facilitators of research participation and suggested strategies for the recruitment and retention of research participants. Our study indicates that patients can successfully play active and engaged roles in clinical research, ranging from participant to partner. Judging from the enthusiasm of our focus group attendees, patients and caregivers want to participate and be engaged in clinical research.
Collapse
Affiliation(s)
- K M Islam
- College of Public Health (COPH), Department of Epidemiology, University of Nebraska Medical Center (UNMC), Omaha, NE, USA,
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Tuxen IV, Jønson L, Santoni-Rugiu E, Hasselby JP, Nielsen FC, Lassen U. Personalized oncology: genomic screening in phase 1. APMIS 2014; 122:723-33. [PMID: 25046202 DOI: 10.1111/apm.12293] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/03/2014] [Indexed: 12/23/2022]
Abstract
Improvements in cancer genomics and tumor biology have reinforced the evidence of cancer development driven by numerous genomic alterations. Advanced genomics technology can be used to characterize genomic alterations that potentially drive tumor growth. With the possibility of screening thousands of genes simultaneously, personalized molecular medicine has become an option. New treatments are being investigated in phase 1 trials around the world. Traditionally, the goal of phase 1 studies was to determine the optimal dose and assess dose-limiting toxicity of a potential new experimental drug. Only a limited number of patients will benefit from the treatment. However, introducing genomic mapping to select patients for early clinical trials with targeted molecular therapy according to the genomic findings, may lead to a better outcome for the patient, an enrichment of phase 1 trials, and thereby accelerated drug development. The overall advantage is to determine which mutation profiles correlate with sensitivity or lack of resistance to specific targeted therapies. The utility and current limitations of genomic screening to guide selection to Phase 1 clinical trial will be discussed.
Collapse
Affiliation(s)
- Ida Viller Tuxen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|
45
|
Chalela P, Suarez L, Muñoz E, Gallion KJ, Pollock BH, Weitman SD, Karnad A, Ramirez AG. Promoting Factors and Barriers to Participation in Early Phase Clinical Trials: Patients Perspectives. JOURNAL OF COMMUNITY MEDICINE & HEALTH EDUCATION 2014; 4:1000281. [PMID: 25077043 PMCID: PMC4112537 DOI: 10.4172/2161-0711.1000281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inclusion of minorities in clinical research is an essential step to develop novel cancer treatments, improve health care overall, understand potential differences in pharmacogenomics and address minorities' disproportionate cancer burden. However, Latinos and other minority groups continue to be critically underrepresented, particularly in early-phase clinical trials (EPCTs). The objective of the present study was to explore barriers and promoting factors influencing patients' decisions to enroll or not in early phase clinical trials (EPCTs) and identify areas for intervention to increase minority enrollment into clinical research. METHODS An interviewer-administered survey was conducted with 100 cancer patients in the predominantly Latino region of South Texas. Exploratory factor analysis was conducted to identify underlying dimensions, and multiple logistic regression assessed significant factors that promote or deter patients enrollment to EPCTs. In addition, a separate subgroup mean analysis assessed differences by enrollment status and race/ethnicity. RESULTS For one standard deviation increase in the importance given to the possibility of symptoms improvement, the predicted odds of refusing enrollment were 3.20 times greater (OR=3.20, 95% CI=1.06-9.71, p 0.040). Regarding barriers, among patients who considered fear/uncertainty of the new treatment a deterrent to enrollment, one standard deviation increase in agreement with these barriers was associated with a 3.60 increase (OR=3.60, 95% CI=1.30-9.97h, p 0.014) in the odds of not being enrolled in an EPCT. In contrast, non-enrolled patients were less likely (OR=0.14, 95% CI=0.05-0.44, p 0.001) to consider fatalistic beliefs as an important barrier. CONCLUSION This study, one of the first to identify South Texas patients' barriers to enroll in EPCTs, highlights potential focal areas to increase participation of both minority and non-minority patients in clinical research. Culturally tailored interventions promoting patient-centered care and bilingual, culturally competent study teams could solve common barriers and enhance Latinos' likelihood of joining clinical trials. These interventions may simultaneously increase opportunities to involve patients and physicians in clinical trials, while ensuring the benefits of participation are equitably distributed to all patients.
Collapse
Affiliation(s)
- Patricia Chalela
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | | | - Edgar Muñoz
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | - Kipling J Gallion
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | - Brad H Pollock
- Department of Epidemiology and Biostatistics The University of Texas Health Science Center at San Antonio 7703 Floyd Curl Ave., Mail Code 7933 San Antonio, TX 78229-3901
| | - Steven D Weitman
- The University of Texas Health Science Center at San Antonio Cancer Therapy & Research Center Institute for Drug Development 7979 Wurzbach Road, Room Z459 San Antonio, Texas 78229
| | - Anand Karnad
- The University of Texas Health Science Center at San Antonio Cancer Therapy & Research Center Institute for Drug Development 7979 Wurzbach Road, Room Z459 San Antonio, Texas 78229
| | - Amelie G Ramirez
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| |
Collapse
|
46
|
Everett JN, Gustafson SL, Raymond VM. Traditional roles in a non-traditional setting: genetic counseling in precision oncology. J Genet Couns 2014; 23:655-60. [PMID: 24578120 DOI: 10.1007/s10897-014-9698-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 01/31/2014] [Indexed: 02/06/2023]
Abstract
Next generation sequencing technology is increasingly utilized in oncology with the goal of targeting therapeutics to improve response and reduce side effects. Interpretation of tumor mutations requires sequencing of paired germline DNA, raising questions about incidental germline findings. We describe our experiences as part of a research team implementing a protocol for whole genome sequencing (WGS) of tumors and paired germline DNA known as the Michigan Oncology Sequencing project (MI-ONCOSEQ) that includes options for receiving incidental germline findings. Genetic counselors (GCs) discuss options for return of results with patients during the informed consent process and document family histories. GCs also review germline findings and actively participate in the multi-disciplinary Precision Medicine Tumor Board (PMTB), providing clinical context for interpretation of germline results and making recommendations about disclosure of germline findings. GCs have encountered ethical and counseling challenges with participants, described here. Although GCs have not been traditionally involved in molecular testing of tumors, our experiences with MI-ONCOSEQ demonstrate that GCs have important applicable skills to contribute to multi-disciplinary care teams implementing precision oncology. Broader use of WGS in oncology treatment decision making and American College of Medical Genetics and Genomics (ACMG) recommendations for active interrogation of germline tissue in tumor-normal dyads suggests that GCs will have future opportunities in this area outside of research settings.
Collapse
Affiliation(s)
- Jessica N Everett
- Department of Internal Medicine, University of Michigan, 300 North Ingalls, NI3A16, Ann Arbor, MI, 48109, USA,
| | | | | |
Collapse
|
47
|
Fu S, McQuinn L, Naing A, Wheler JJ, Janku F, Falchook GS, Piha-Paul SA, Tu D, Howard A, Tsimberidou A, Zinner R, Hong DS, Kurzrock R. Barriers to study enrollment in patients with advanced cancer referred to a phase I clinical trials unit. Oncologist 2013; 18:1315-20. [PMID: 24153239 DOI: 10.1634/theoncologist.2013-0202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED We conducted this retrospective study to identify reasons that patients referred to a phase I clinical trial failed to enroll or delayed enrollment onto the trial. MATERIALS AND METHODS Outcome analyses were conducted independently on data collected from electronic medical records of two sets of consecutive patients referred to a phase I clinical trial facility at MD Anderson Cancer Center. Data from the first set of 300 patients were used to determine relevant variables affecting enrollment; data from the second set of 957 patients were then analyzed for these variables. RESULTS Results from the two sets of patients were similar. Approximately 55% of patients were enrolled in a phase I trial. Patients referred from within MD Anderson were more likely to be enrolled than patients seen originally outside the institution (p = .006); black patients were more likely than white patients to enroll (69% vs. 43%; p = .04). The median interval from the initial visit to initiation of treatments was 19 days. Major reasons for failure to enroll included failure to return to the clinic (36%), opting for treatment in another clinic (17%), hospice referral (11%), early death (10%), and lack of financial clearance (5%). Treatment was delayed for three weeks or more in 250 patients; in 85 patients (34%), the delay was caused by financial and insurance issues. CONCLUSION Failure to return to the clinic, pursuit of other therapy, and rapid deterioration were the major reasons for failure to enroll; lengthy financial clearance was the most common reason for delayed enrollment onto a phase I trial.
Collapse
Affiliation(s)
- Siqing Fu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Catania C, Radice D, Spitaleri G, Adamoli L, Noberasco C, Delmonte A, Vecchio F, de Braud F, Toffalorio F, Goldhirsch A, De Pas T. The choice of whether to participate in a phase I clinical trial: increasing the awareness of patients with cancer. An exploratory study. Psychooncology 2013; 23:322-9. [DOI: 10.1002/pon.3424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 09/06/2013] [Accepted: 09/11/2013] [Indexed: 01/29/2023]
Affiliation(s)
- C. Catania
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - D. Radice
- Epidemiology and Biostatistics Division; European Institute of Oncology; Milan Italy
| | - G. Spitaleri
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - L. Adamoli
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - C. Noberasco
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - A. Delmonte
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - F. Vecchio
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - F. de Braud
- Medical Oncology Unit 1; Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - F. Toffalorio
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - A. Goldhirsch
- Department of Medicine; European Institute of Oncology; Milan Italy
| | - T. De Pas
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| |
Collapse
|
49
|
Saggese M, Dua D, Simmons E, Lemech C, Arkenau HT. Research biopsies in the context of early phase oncology studies: clinical and ethical considerations. Oncol Rev 2013; 7:e5. [PMID: 25992226 PMCID: PMC4419615 DOI: 10.4081/oncol.2013.e5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/26/2013] [Indexed: 11/30/2022] Open
Abstract
The Personalized Medicine approach in oncology is a direct result of an improved understanding of complex tumor biology and advances in diagnostic technologies. In recent years, there has been an increased demand for archival and fresh tumor analysis in early clinical trials to foster proof-of-concept biomarker development, to understand resistance mechanisms, and ultimately to assess biological response. Although phase I studies are aimed at defining drug safety, pharmacokinetics, and to recommend a phase II dose for further testing, there is now increasing evidence of mandatory tumor biopsies even at the earliest dose-finding stages of drug development. The increasing demand for fresh tumor biopsies adds to the complexity of novel phase I studies and results in different challenges, ranging from logistical support to ethical concerns. This paper investigates key issues, including patients’ perceptions of research biopsies, the need for accurate informed consent, and alternative strategies that may guide the drug development process.
Collapse
Affiliation(s)
- Matilde Saggese
- Sarah Cannon Research UK , UK ; University College London , UK
| | - Divyanshu Dua
- Sarah Cannon Research UK , UK ; Guy's and St Thomas' Hospital , London, UK
| | | | | | | |
Collapse
|
50
|
Miller VA, Baker JN, Leek AC, Hizlan S, Rheingold SR, Yamokoski AD, Drotar D, Kodish E. Adolescent perspectives on phase I cancer research. Pediatr Blood Cancer 2013; 60:873-8. [PMID: 23034985 PMCID: PMC3538102 DOI: 10.1002/pbc.24326] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/21/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to examine adolescent patients' perspectives on their understanding and decision making about a pediatric phase I cancer study. PROCEDURE Participants included adolescents ages 14-21 years with cancer (N = 20), all of whom attended a phase I study consent conference. Participants responded to closed- and open-ended questions on a verbally administered structured interview, which assessed aspects of understanding and decision making about the phase I study. RESULTS All participants decided to enroll in the phase I study. The majority of participants understood that participation was voluntary, entailed risks, and that they could withdraw. Most also believed that participation in the phase I study would increase the length of their lives. The most frequent reasons for enrolling were positive clinical benefit, needing an option, impact on quality of life, and few side effects or fewer than those of current or past treatments. Eighty-five percent of participants reported that they themselves made the final decision about enrollment in the phase I study. CONCLUSIONS Most participants hoped or expected that the phase I study would provide a direct benefit (increased survival time or cure) and reported that they themselves were the final decision-maker about enrollment. Clinicians may underestimate the role of adolescents, especially if they believe that parents typically make such decisions. Future research should assess the actual participation of children and adolescents during the informed consent process and explore the role of hope in their decision making about phase I studies.
Collapse
Affiliation(s)
- Victoria A. Miller
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN
| | - Angela C. Leek
- Department of Bioethics, Cleveland Clinic, Cleveland, OH
| | - Sabahat Hizlan
- Department of Bioethics, Cleveland Clinic, Cleveland, OH
| | - Susan R. Rheingold
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Dennis Drotar
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Eric Kodish
- Center for Ethics, Humanities and Spiritual Care, Cleveland Clinic, Cleveland, OH
| |
Collapse
|