Hormone replacement therapy after treatment for breast cancer: physicians' attitudes towards randomized trials

What do primary care nurses and radiation therapists in a Canadian cancer centre think about clinical trials?

RATIONALE, AIMS AND OBJECTIVES

Clinical trials are integral to progress in cancer management. While doctors' attitudes to clinical trials have been documented, there is little or no literature on the perception of trials from the perspective of other clinicians who treat trial patients. The purpose of this phenomenological study was to explore nurses' and radiation therapists' (RTs) perceptions of clinical trials in their cancer centre.

METHODS

This study was conducted in a Canadian cancer centre where over 50 clinical trials actively recruit patients at any one time. Nurses and RTs were interviewed to explore their perceptions of clinical trials.

RESULTS

The following themes emerged from the analysis: (1) nurses and RTs perceived a variety of ethical concerns associated with clinical trials; (2) treating patients enrolled in clinical trials was perceived to add to the workload of RTs; (3) nurses and RTs did not perceive meaningful involvement in clinical trials as an option; and (4) the additional workload and ethical concerns associated with trials were off-set by the view that patients' interests outweighed those of nurses and RTs.

DISCUSSION

Nurses and RTs should be invited to provide input regarding trial procedures and be acknowledged for their work associated with clinical trials.

Why don’t cancer patients enter clinical trials? A review

Despite widespread agreement about the value of clinical trials, the proportion of patients who are enrolled in such trials is often considered to be too low. A comprehensive literature search was carried out for the period 1980 to the present, in order to review current data on barriers and facilitators to the development of multicentre clinical trials. Of 364 articles initially identified, 35 articles and 1 book were selected in order to assess the reasons that doctors and/or patients participate in clinical trials. This review emphasises the fact that doctors play a key role in the development and non-development of clinical trials. More studies, in particular studies outside the United States of America (USA), are needed in order better to understand doctors' attitudes towards clinical trials. Such studies should combine multivariate analyses and comparative approaches in order to associate doctors' behaviours with their individual characteristics, with the organisational context of their working environment and with the healthcare system.

Are Older Cancer Patients Being Referred to Oncologists? A Mail Questionnaire of Ontario Primary Care Practitioners to Evaluate Their Referral Patterns

Purpose: Understanding why older patients are frequently underrepresented in cancer services use and clinical research may help to increase their participation in clinical trials and eventually result in better cancer care for this vulnerable population.

Methods: To identify potential barriers that may prevent older cancer patients from being referred from a primary care physician (PCP) to an oncology specialist, a self-administered questionnaire was mailed to 9,312 PCPs throughout Ontario.

Results: With a one-time mailing, 2,240 questionnaires were returned (response rate, 24%) of which 2,089 (93%) were assessable. Although 86% of respondents would refer most older patients with early-stage, potentially curable cancers to oncologists, only 65% would refer those with advanced-stage, potentially incurable cancers. The factors that most influence referral decisions of PCPs are patient’s desire to be referred (69%), type (54%) and stage (49%) of cancer, and severity of cancer symptoms (49%). Other factors including age do not seem to influence the referral decision. Approximately 9% of respondents found it difficult to refer older cancer patients to oncology specialists, with the most commonly cited barriers being the length of waiting lists, mandatory tissue diagnosis before referral, and the belief that oncologists seldom relate to PCPs.

Conclusion: Most PCPs stated that they would refer all elderly patients with cancer to oncologists and that referral decisions were based mainly on patients’ wishes. Continued efforts are needed to overcome barriers in the referral process and to understand the perspectives of elderly patients to enhance their cancer care.