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Gallegos JM, Taylor A, Vardell V, Silberstein PT. Socioeconomic Factors Associated With a Late-Stage Pancreatic Cancer Diagnosis: An Analysis of the National Cancer Database. Cureus 2023; 15:e35857. [PMID: 37033563 PMCID: PMC10077919 DOI: 10.7759/cureus.35857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
Background Pancreatic adenocarcinoma is an aggressive, lethal cancer. It is the fourth leading cause of cancer death in the United States and is often asymptomatic until later stages. Thus, it is critical to identify patients earlier in their disease course. Socioeconomic factors can assist in determining who is at higher risk of presenting at later stages of the disease. Using the National Cancer Database (NCDB), we aim to identify the associations between socioeconomic factors and the stage of pancreatic cancer at diagnosis. Methodology In this study, 256,822 patients from the NCDB who were diagnosed with pancreatic cancer from 2004 to 2018 at stage 0-I and stage IV were compared based on age, race, sex, ethnicity, insurance type, income, geographic location, education, and Charlson-Deyo score. Demographic factors of patients who presented with early and late-stage disease were compared using the chi-squared test and multivariate logistic regression. Results We identified significant associations between race, sex, insurance status, education, income, and geographic location with the stage of disease at diagnosis. Males were more likely to be diagnosed with late-stage cancer than early-stage (52.8% vs. 47.9%, p < 0.001). Females were more likely to have an earlier-stage diagnosis when compared to males (odds ratio (OR) = 0.857, 95% confidence interval (CI) = 0.839-0.875, p < 0.001). Black patients presented at a later stage when compared to White patients (OR = 1.106, 95% CI = 1.069-1.144, p < 0.001). Private and Medicaid insurance had higher rates of late-stage diagnosis than early stages, and all other types of insurance had lower rates of late-stage diagnosis than patients without insurance (p < 0.001). Patients from a zip code with less than $38,000 median household income and zip codes with lower levels of high school graduation had higher rates of late-stage diagnosis (p < 0.025). Conclusions Factors associated with the increased likelihood of pancreatic cancer presentation at the advanced stage compared to the early stage include multiple minority and traditionally underserved populations. Black race, underinsurance, or residing in low-income or low-education zip codes was significantly associated with presenting at a late stage, which is strongly associated with worse survival outcomes.
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Ginossar T, Diaz Fuentes C, Oetzel J. Understanding Willingness to Participate in Cancer Clinical Trials Among Patients and Caregivers Attending a Minority-Serving Academic Cancer Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:179-187. [PMID: 32666504 PMCID: PMC10685662 DOI: 10.1007/s13187-020-01802-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Advances in cancer treatment are impeded by low accrual rates of patients to cancer clinical trials (CCTs). The national rates of recruitment of underserved groups, including racial/ethnic minorities, are limiting the generalizability of research findings and are likely to enhance inequities in cancer outcomes. The goal of this study was to examine willingness to participate (WTP) in CCTs and factors associated with this willingness among patients and caregivers attending a minority-serving university cancer center in the Southwest. A cross-sectional survey design was utilized (n = 236, 135 patients and 101 caregivers). Fear was the strongest predictor of WTP in CCTs. The only ethnic differences observed related to Spanish-speaking patients exhibiting increased WTP in CCTs, and Spanish-speaking caregivers' decreased WTP, compared to others. These results underscore the importance of future interventions to reduce CCT-related fear among patients and caregivers, with particular need for family-focused tailored interventions designed to meet the needs of Spanish-speaking patients and caregivers.
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Affiliation(s)
- Tamar Ginossar
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, 87103, USA.
| | | | - John Oetzel
- Waikato Management School, University of Waikato, Hamilton, 3240, New Zealand
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Lin TA, Fuller CD, Verma V, Mainwaring W, Espinoza AF, Miller AB, Jethanandani A, Pasalic D, Das P, Minsky BD, Thomas CR, Fogelman DR, Subbiah V, Subbiah IM, Ludmir EB. Trial Sponsorship and Time to Reporting for Phase 3 Randomized Cancer Clinical Trials. Cancers (Basel) 2020; 12:E2636. [PMID: 32947844 PMCID: PMC7563891 DOI: 10.3390/cancers12092636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
The pace of clinical trial data generation and publication is an area of interest within clinical oncology; however, little is known about the dynamics and covariates of time to reporting (TTR) of trial results. To assess these, ClinicalTrials.gov was queried for phase three clinical trials for patients with metastatic solid tumors, and the factors associated with TTR from enrollment completion to publication were analyzed. Based on the 319 included trials, cooperative-group-sponsored trials were reported at a slower rate than non-cooperative-group trials (median 37.5 vs. 31.0 months; p < 0.001), while industry-funded studies were reported at a faster rate than non-industry-supported trials (31.0 vs. 40.0 months; p = 0.005). Furthermore, successful trials (those meeting their primary endpoint) were reported at a faster rate than unsuccessful studies (27.5 vs. 36.0 months; p < 0.001). Multivariable analysis confirmed that industry funding was independently associated with a shorter TTR (p = 0.006), while cooperative group sponsorship was not associated with a statistically significant difference in TTR (p = 0.18). These data underscore an opportunity to improve cooperative group trial efficiency by reducing TTR.
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Affiliation(s)
- Timothy A. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
- Department of Radiation Oncology and Molecular Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway Baltimore, MD 21287, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Vivek Verma
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Walker Mainwaring
- Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA;
| | | | - Austin B. Miller
- McGovern Medical School, The University of Texas Health Science Center, 7000 Fannin, Suite 1880, Houston, TX 77030, USA;
| | - Amit Jethanandani
- Department of Radiation Oncology, The University of Miami Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA;
| | - Dario Pasalic
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Bruce D. Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Charles R. Thomas
- Department of Radiation Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA;
| | - David R. Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Ishwaria M. Subbiah
- Department of Palliative, Rehabilitational, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Ethan B. Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
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Frankel PH, Chung V, Tuscano J, Siddiqi T, Sampath S, Longmate J, Groshen S, Newman EM. Model of a Queuing Approach for Patient Accrual in Phase 1 Oncology Studies. JAMA Netw Open 2020; 3:e204787. [PMID: 32401317 PMCID: PMC7221509 DOI: 10.1001/jamanetworkopen.2020.4787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Phase 1 cancer studies, which guide dose selection for subsequent studies, are almost 3 times more prevalent than phase 3 studies and have a median study duration considerably longer than 2 years, which constitutes a major component of drug development time. OBJECTIVE To discern a method to reduce the duration of phase 1 studies in adult and pediatric cancer studies without violating risk limits by better accommodating the accrual and evaluation process (or queue). DESIGN The process modeled, the phase 1 queue (IQ), includes patient interarrival time, screening, and dose-limiting toxicity evaluation. For this proof of principle, the rules of the 3 + 3 and rolling 6 phase 1 designs were modified to improve patient flow through the queue without exceeding the maximum risk permitted in the parent designs. The resulting designs, the IQ 3 + 3 and the IQ rolling 6, were each compared with their parent design by simulations in 12 different scenarios. MAIN OUTCOMES AND MEASURES (1) The time from study opening to determination of the maximum tolerated dose (MTD), (2) the number of patients treated to determine the MTD, and (3) the association of the design with the dose selected as the MTD. RESULTS Based on 800 simulations, for all 12 scenarios considered, the IQ 3 + 3 and the IQ rolling 6 designs were associated with reduced expected study durations compared with the parent design. The expected IQ 3 + 3 reduction ranged from 1.6 to 10.4 months (with 3.7 months for the standard scenario), and the expected reduction associated with IQ rolling 6 ranged from 0.4 to 10.5 months (with 3.4 months for the standard scenario). The increase in the mean number of patients treated in the IQ 3 + 3 compared with the 3 + 3 ranged from 0.6 to 3.2 patients. No increase in the number of patients was associated with the IQ rolling 6 compared with the rolling 6 design. The probability of selecting a dose level as the MTD changed by less than 3% for all dose levels and scenarios in both parent designs. CONCLUSIONS AND RELEVANCE This study found that IQ designs were associated with reduced mean duration of phase 1 studies compared with their parent designs without changing the risk limits or MTD selection operating characteristics. These approaches have been successfully implemented in both hematology and solid tumor phase 1 studies.
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Affiliation(s)
- Paul H. Frankel
- Division of Biostatistics, Department of Research Information Sciences, City of Hope, Duarte, California
| | - Vincent Chung
- Department of Medical Oncology, City of Hope, Duarte, California
| | - Joseph Tuscano
- Hematology/Oncology, University of California, Davis, Davis
| | - Tanya Siddiqi
- Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Sagus Sampath
- Radiation Oncology, City of Hope, Duarte, California
| | - Jeffrey Longmate
- Division of Biostatistics, Department of Research Information Sciences, City of Hope, Duarte, California
| | - Susan Groshen
- Biostatistics Core, Norris Cancer Center, University of Southern California, Los Angeles
| | - Edward M. Newman
- Department of Medical Oncology, City of Hope, Duarte, California
- Developmental Cancer Therapeutics Program, Division of Molecular Pharmacology, City of Hope, Duarte, California
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Carey M, Boyes AW, Smits R, Bryant J, Waller A, Olver I. Access to clinical trials among oncology patients: results of a cross sectional survey. BMC Cancer 2017; 17:653. [PMID: 28923028 PMCID: PMC5604159 DOI: 10.1186/s12885-017-3644-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials are necessary for the advancement of cancer treatment and care, however low rates of participation in such trials limit the generalisability of findings. The objective of this study was to examine the proportion of medical oncology outpatients in Australia who are invited and consent to participate in clinical trials and the factors associated with this. METHODS A sample of adult medical oncology patients was recruited from three Australian cancer treatment centres. Consenting patients completed two paper-and-pencil surveys; one at the time of consent and another approximately 1 month later. A multivariate logistic regression was conducted to explore factors associated with invitation and participation in a trial. RESULTS Thirty-eight percent (n = 146) of the 383 participants reported they had been invited to take part in a clinical trial. Of those invited, 93% reported consenting to participate in the trial, with the majority indicating that they did not regret their decision (89%). Treatment centre and time since diagnosis were significantly associated with being invited to take part in a clinical trial. None of the factors examined were associated with clinical trial consent rates. CONCLUSIONS The main barrier to clinical trial participation is not being invited to do so, with the centre the patient attends being a modifiable determinant of whether or not they are invited. Increasing the resources available to treatment centres to ensure all patients are offered participation in trials they are eligible for may help to improve rates of trial participation.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Allison W. Boyes
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Rochelle Smits
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Amy Waller
- Priority Research Centre for Health Behaviour, School of Medicine & Public Health, Faculty of Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, New Lambton, NSW Australia
| | - Ian Olver
- Samson Institute for Health Research, University of South Australia, Adelaide, South Australia Australia
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Tang C, Sherman SI, Price M, Weng J, Davis SE, Hong DS, Yao JC, Buzdar A, Wilding G, Lee JJ. Clinical Trial Characteristics and Barriers to Participant Accrual: The MD Anderson Cancer Center Experience over 30 years, a Historical Foundation for Trial Improvement. Clin Cancer Res 2017; 23:1414-1421. [PMID: 28275168 DOI: 10.1158/1078-0432.ccr-16-2439] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 12/30/2022]
Abstract
Purpose: Slow-accruing clinical trials delay the translation of basic biomedical research, contribute to increasing health care costs, and may prohibit trials from reaching their original goals.Experimental Design: We analyzed a prospectively maintained institutional database that tracks all clinical studies at the MD Anderson Cancer Center (Houston, TX). Inclusion criteria were activated phase I-III trials, maximum projected accrual ≥10 participants, and activation prior to March 25, 2011. The primary outcome was slow accrual, defined as <2 participants per year. Correlations of trial characteristics with slow accrual were assessed with logistic regression.Results: A total of 4,269 clinical trials met inclusion criteria. Trials were activated between January 5, 1981, and March 25, 2011, with a total of 145,214 participants enrolled. Median total enrolment was 16 [interquartile range (IQR), 5-34], with an average enrolment rate of 8.7 participants per year (IQR, 3.3-17.7). There were 755 (18%) trials classified as slow accruing. On multivariable analysis, slow accrual exhibited robust associations with national cooperative group trials (OR = 4.16, P < 0.0001 vs. industry sponsored), time from trial activation to first enrolment (OR = 1.13 per month, P < 0.0001), and maximum targeted accrual (OR = 0.16 per log10 increase, P < 0.0001). Recursive partitioning analysis identified trials requiring more than 70 days (2.3 months) between activation and first participant enrolment as having higher odds of slow accrual (23% vs. 5%, OR = 5.56, P < 0.0001).Conclusions: We identified factors associated with slow trial accrual. Given the lack of data on clinical trials at the institutional level, these data will help build a foundation from which targeted initiatives may be developed to improve the clinical trial enterprise. Clin Cancer Res; 23(6); 1414-21. ©2017 AACR.
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Affiliation(s)
- Chad Tang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, Houston, Texas
| | - Mellanie Price
- Office of Vice Provost for Clinical and Interdisciplinary Research, MD Anderson Cancer Center, Houston, Texas
| | - Jun Weng
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Suzanne E Davis
- Office of Vice Provost for Clinical and Interdisciplinary Research, MD Anderson Cancer Center, Houston, Texas
| | - David S Hong
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston, Texas
| | - James C Yao
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Aman Buzdar
- Department of Breast Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - George Wilding
- Office of Vice Provost for Clinical and Interdisciplinary Research, MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas.
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7
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Tang C, Hess KR, Sanders D, Davis SE, Buzdar AU, Kurzrock R, Lee JJ, Meric-Bernstam F, Hong DS. Modifying the Clinical Research Infrastructure at a Dedicated Clinical Trials Unit: Assessment of Trial Development, Activation, and Participant Accrual. Clin Cancer Res 2016; 23:1407-1413. [PMID: 27852698 DOI: 10.1158/1078-0432.ccr-16-1936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/09/2016] [Accepted: 11/06/2016] [Indexed: 11/16/2022]
Abstract
Purpose: Information on processes for trials assessing investigational therapeutics is sparse. We assessed the trial development processes within the Department of Investigational Cancer Therapeutics (ICT) at MD Anderson Cancer Center (Houston, TX) and analyzed their effects on the trial activation timeline and enrolment.Experimental Design: Data were from a prospectively maintained registry that tracks all clinical studies at MD Anderson. From this database, we identified 2,261 activated phase I-III trials; 221 were done at the ICT. ICT trials were matched to trials from other MD Anderson departments by phase, sponsorship, and submission year. Trial performance metrics were compared with paired Wilcoxon signed rank tests.Results: We identified three facets of the ICT research infrastructure: parallel processing of trial approval steps; a physician-led research team; and regular weekly meetings to foster research accountability. Separate analyses were conducted stratified by sponsorship [industry (133 ICT and 133 non-ICT trials) or institutional (68 ICT and 68 non-ICT trials)]. ICT trial development was faster from IRB approval to activation (median difference of 1.1 months for industry-sponsored trials vs. 2.3 months for institutional) and from activation to first enrolment (median difference of 0.3 months for industry vs. 1.2 months for institutional; all matched P < 0.05). ICT trials also accrued more patients (median difference of 8 participants for industry vs. 33.5 for institutional) quicker (median difference 4.8 participants/year for industry vs. 11.1 for institutional; all matched P < 0.05).Conclusions: Use of a clinical research-focused infrastructure within a large academic cancer center was associated with efficient trial development and participant accrual. Clin Cancer Res; 23(6); 1407-13. ©2016 AACR.
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Affiliation(s)
- Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dwana Sanders
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Suzanne E Davis
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aman U Buzdar
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Office of Vice Provost for Clinical and Interdisciplinary Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Razelle Kurzrock
- Division of Hematology and Oncology, Center for Personalized Therapy, University of San Diego, La Jolla, California
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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8
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Massett HA, Mishkin G, Rubinstein L, Ivy SP, Denicoff A, Godwin E, DiPiazza K, Bolognese J, Zwiebel JA, Abrams JS. Challenges Facing Early Phase Trials Sponsored by the National Cancer Institute: An Analysis of Corrective Action Plans to Improve Accrual. Clin Cancer Res 2016; 22:5408-5416. [PMID: 27401246 DOI: 10.1158/1078-0432.ccr-16-0338] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/16/2022]
Abstract
Accruing patients in a timely manner represents a significant challenge to early phase cancer clinical trials. The NCI Cancer Therapy Evaluation Program analyzed 19 months of corrective action plans (CAP) received for slow-accruing phase I and II trials to identify slow accrual reasons, evaluate whether proposed corrective actions matched these reasons, and assess the CAP impact on trial accrual, duration, and likelihood of meeting primary scientific objectives. Of the 135 CAPs analyzed, 69 were for phase I trials and 66 for phase II trials. Primary reasons cited for slow accrual were safety/toxicity (phase I: 48%), design/protocol concerns (phase I: 42%, phase II: 33%), and eligibility criteria (phase I: 41%, phase II: 35%). The most commonly proposed corrective actions were adding institutions (phase I: 43%, phase II: 85%) and amending the trial to change eligibility or design (phase I: 55%, phase II: 44%). Only 40% of CAPs provided proposed corrective actions that matched the reasons given for slow accrual. Seventy percent of trials were closed to accrual at time of analysis (phase I = 48; phase II = 46). Of these, 67% of phase I and 70% of phase II trials met their primary objectives, but they were active three times longer than projected. Among closed trials, 24% had an accrual rate increase associated with a greater likelihood of meeting their primary scientific objectives. Ultimately, trials receiving CAPs saw improved accrual rates. Future trials may benefit from implementing CAPs early in trial life cycles, but it may be more beneficial to invest in earlier accrual planning. Clin Cancer Res; 22(22); 5408-16. ©2016 AACRSee related commentary by Mileham and Kim, p. 5397.
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Affiliation(s)
| | | | | | - S Percy Ivy
- National Cancer Institute, Bethesda, Maryland
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Zon RT, Bruinooge SS, Lyss AP. The changing face of research in community practice. J Oncol Pract 2014; 10:155-60. [PMID: 24839272 DOI: 10.1200/jop.2014.001424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The historical strengths of community-based research and dedication to improving patients outcomes and cancer care experience provide the perseverance to face uncertainties such as advances in science and technology, changes in practice environment, and demonstrating quality and value-based performance.
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Affiliation(s)
- Robin T Zon
- Michiana Hematology Oncology; Northern Indiana Cancer Research Consortium Community Clinical Oncology Program (CCOP), South Bend, IN; American Society of Clinical Oncology, Alexandria, VA; and Missouri Baptist Cancer Center and Heartland Cancer Research CCOP, Saint Louis, MO
| | - Suanna S Bruinooge
- Michiana Hematology Oncology; Northern Indiana Cancer Research Consortium Community Clinical Oncology Program (CCOP), South Bend, IN; American Society of Clinical Oncology, Alexandria, VA; and Missouri Baptist Cancer Center and Heartland Cancer Research CCOP, Saint Louis, MO
| | - Alan P Lyss
- Michiana Hematology Oncology; Northern Indiana Cancer Research Consortium Community Clinical Oncology Program (CCOP), South Bend, IN; American Society of Clinical Oncology, Alexandria, VA; and Missouri Baptist Cancer Center and Heartland Cancer Research CCOP, Saint Louis, MO
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