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Gulden C, Macho P, Reinecke I, Strantz C, Prokosch HU, Blasini R. recruIT: A cloud-native clinical trial recruitment support system based on Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) and the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM). Comput Biol Med 2024; 174:108411. [PMID: 38626510 DOI: 10.1016/j.compbiomed.2024.108411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/17/2024] [Accepted: 04/02/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Clinical trials (CTs) are foundational to the advancement of evidence-based medicine and recruiting a sufficient number of participants is one of the crucial steps to their successful conduct. Yet, poor recruitment remains the most frequent reason for premature discontinuation or costly extension of clinical trials. METHODS We designed and implemented a novel, open-source software system to support the recruitment process in clinical trials by generating automatic recruitment recommendations. The development is guided by modern, cloud-native design principles and based on Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) as an interoperability standard with the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) being used as a source of patient data. We evaluated the usability using the system usability scale (SUS) after deploying the application for use by study personnel. RESULTS The implementation is based on the OMOP CDM as a repository of patient data that is continuously queried for possible trial candidates based on given clinical trial eligibility criteria. A web-based screening list can be used to display the candidates and email notifications about possible new trial participants can be sent automatically. All interactions between services use HL7 FHIR as the communication standard. The system can be installed using standard container technology and supports more sophisticated deployments on Kubernetes clusters. End-users (n = 19) rated the system with a SUS score of 79.9/100. CONCLUSION We contribute a novel, open-source implementation to support the patient recruitment process in clinical trials that can be deployed using state-of-the art technologies. According to the SUS score, the system provides good usability.
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Affiliation(s)
- Christian Gulden
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Medical Informatics, Biometrics and Epidemiology, Medical Informatics, Erlangen, Germany.
| | - Philipp Macho
- Medical Informatics, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ines Reinecke
- Carl Gustav Carus Faculty of Medicine, Center for Medical Informatics, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Cosima Strantz
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Medical Informatics, Biometrics and Epidemiology, Medical Informatics, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Medical Informatics, Biometrics and Epidemiology, Medical Informatics, Erlangen, Germany
| | - Romina Blasini
- Institute of Medical Informatics, Justus Liebig University, Giessen, Germany
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Ebrahimi H, Megally S, Plotkin E, Shivakumar L, Salgia NJ, Zengin ZB, Meza L, Chawla N, Castro DV, Dizman N, Bhagat R, Liv S, Li X, Rock A, Liu S, Tripathi A, Dorff T, Oyer RA, Boehmer L, Pal S, Chehrazi-Raffle A. Barriers to Clinical Trial Implementation Among Community Care Centers. JAMA Netw Open 2024; 7:e248739. [PMID: 38683608 PMCID: PMC11059033 DOI: 10.1001/jamanetworkopen.2024.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024] Open
Abstract
Importance While an overwhelming majority of patients diagnosed with cancer express willingness to participate in clinical trials, only a fraction will enroll onto a research protocol. Objective To identify critical barriers to trial enrollment to translate findings into actionable practice changes that increase cancer clinical trial enrollment. Design, Setting, and Participants This survey study included designated site contacts at oncology practices with teams who were highly involved with the Association of Community Cancer Centers (ACCC) Community Oncology Research Institute (ACORI) clinical trials activities, all American Society of Clinical Oncology (ASCO)-ACCC collaboration pilot sites, and/or sites providing care to at least 25% African American and Hispanic residents. To determine participation trends among health care practices in oncology-focused research, identify barriers to clinical trial implementation and operation, and establish unmet needs for cancer clinics interested in trial participation, a 34-question survey was designed. Survey questions were defined within 3 categories: cancer center demographic characteristics, clinical trial characteristics, and referral practices. The survey was distributed through email and was open from June 20 through October 5, 2022. Main Outcomes and Measures Participation in and barriers to conducting oncology trials in different community oncology settings. Results The survey was distributed to 100 cancer centers, with completion by 58 centers (58%) across 25 states. Fifty-two centers (88%) reported that they conduct therapeutic clinical trials, of which 33 (63%) were from urban settings, 11 (21%) were from suburban settings, and 8 (15%) were from rural settings. Only 25% of rural practices (2 of 8) offered phase 1 trials, compared with 67% of urban practices (22 of 33) (P = .01). Respondents noted challenges in conducting research, including patient recruitment (27 respondents [52%]), limited staffing (27 [52%]), and nonrelevant trials for their patient population (25 [48%]). Among sites not offering therapeutic trials, barriers to research conduct included limited infrastructure, funding, and staffing. Most centers (46 of 58 [79%]) referred patients to outside centers for clinical trial enrollment, particularly in the context of late-stage disease and/or disease progression. Only 17 of these sites (37%) had established protocols for patient follow-up subsequent to outside referral. Conclusions and Relevance In this national survey study of barriers to clinical trial implementation, most sites offered therapeutic trials, but there were significant disparities in trial availability across care settings. Furthermore, fundamental deficiencies in trial support infrastructure limited research activity, including within programs currently conducting research as well as at sites interested in future clinical research opportunities. These results identify crucial unmet needs for oncology clinics to effectively offer clinical trials to patients seeking care.
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Affiliation(s)
- Hedyeh Ebrahimi
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sandra Megally
- Association of Community Cancer Centers, Rockville, Maryland
| | - Elana Plotkin
- Association of Community Cancer Centers, Rockville, Maryland
| | | | | | - Zeynep B. Zengin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Luis Meza
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Neal Chawla
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Nazli Dizman
- Department of Internal Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Ruma Bhagat
- Genentech, Inc, South San Francisco, California
| | - Seila Liv
- Genentech, Inc, South San Francisco, California
| | - Xiaochen Li
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Adam Rock
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sandy Liu
- City of Hope Orange County Lennar Foundation Cancer Center, Irvine, California
| | | | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Randall A. Oyer
- Penn Medicine Ann B. Barshinger Cancer Institute, Lancaster, Pennsylvania
| | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, Maryland
| | - Sumanta Pal
- City of Hope Comprehensive Cancer Center, Duarte, California
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Marino ML, Kazmaier L, Krendelsberger A, Müller S, Kesting S, Fey T, Nasseh D. How can current oncological datasets be adjusted to support the automated patient recruitment in clinical trials? Health Informatics J 2024; 30:14604582241235632. [PMID: 38491907 DOI: 10.1177/14604582241235632] [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: 03/18/2024]
Abstract
OBJECTIVES This study aims to identify necessary adjustments required in existing oncological datasets to effectively support automated patient recruitment. METHODS We extracted and categorized the inclusion and exclusion criteria from 115 oncological trials registered on ClinicalTrials.gov in 2022. These criteria were then compared with the content of the oBDS (Oncological Base Dataset version 3.0), Germany's legally mandated oncological data standard. RESULTS The analysis revealed that 42.9% of generalized inclusion and exclusion criteria are typically present as data fields in the oBDS. On average, 54.6% of all criteria per trial were covered. Notably, certain criteria such as comorbidities, pregnancy status, and laboratory values frequently appeared in trial protocols but were absent in the oBDS. CONCLUSION The omission of criteria, notably comorbidities, within the oBDS restricts its functionality to support trial recruitment. Addressing this limitation would enhance its overall effectiveness. Furthermore, the implications of these findings extend beyond Germany, suggesting potential relevance and applicability to oncological datasets globally.
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Affiliation(s)
- Maria-Luisa Marino
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital, Munich, Germany
| | - Lara Kazmaier
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital, Munich, Germany
| | | | - Silvia Müller
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital, Munich, Germany; Comprehensive Cancer Center, Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - Sabine Kesting
- Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Department of Pediatrics and Children's Cancer Research Centre, TUM School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - Theres Fey
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital, Munich, Germany
| | - Daniel Nasseh
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital, Munich, Germany
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Meystre SM, Heider PM, Cates A, Bastian G, Pittman T, Gentilin S, Kelechi TJ. Piloting an automated clinical trial eligibility surveillance and provider alert system based on artificial intelligence and standard data models. BMC Med Res Methodol 2023; 23:88. [PMID: 37041475 PMCID: PMC10088225 DOI: 10.1186/s12874-023-01916-6] [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] [Received: 05/23/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To advance new therapies into clinical care, clinical trials must recruit enough participants. Yet, many trials fail to do so, leading to delays, early trial termination, and wasted resources. Under-enrolling trials make it impossible to draw conclusions about the efficacy of new therapies. An oft-cited reason for insufficient enrollment is lack of study team and provider awareness about patient eligibility. Automating clinical trial eligibility surveillance and study team and provider notification could offer a solution. METHODS To address this need for an automated solution, we conducted an observational pilot study of our TAES (TriAl Eligibility Surveillance) system. We tested the hypothesis that an automated system based on natural language processing and machine learning algorithms could detect patients eligible for specific clinical trials by linking the information extracted from trial descriptions to the corresponding clinical information in the electronic health record (EHR). To evaluate the TAES information extraction and matching prototype (i.e., TAES prototype), we selected five open cardiovascular and cancer trials at the Medical University of South Carolina and created a new reference standard of 21,974 clinical text notes from a random selection of 400 patients (including at least 100 enrolled in the selected trials), with a small subset of 20 notes annotated in detail. We also developed a simple web interface for a new database that stores all trial eligibility criteria, corresponding clinical information, and trial-patient match characteristics using the Observational Medical Outcomes Partnership (OMOP) common data model. Finally, we investigated options for integrating an automated clinical trial eligibility system into the EHR and for notifying health care providers promptly of potential patient eligibility without interrupting their clinical workflow. RESULTS Although the rapidly implemented TAES prototype achieved only moderate accuracy (recall up to 0.778; precision up to 1.000), it enabled us to assess options for integrating an automated system successfully into the clinical workflow at a healthcare system. CONCLUSIONS Once optimized, the TAES system could exponentially enhance identification of patients potentially eligible for clinical trials, while simultaneously decreasing the burden on research teams of manual EHR review. Through timely notifications, it could also raise physician awareness of patient eligibility for clinical trials.
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Affiliation(s)
- Stéphane M Meystre
- OnePlanet Research Center and imec, Toernooiveld 300, Nijmegen, 6525 EC, The Netherlands.
| | - Paul M Heider
- Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Cates
- Medical University of South Carolina, Charleston, SC, USA
| | - Grace Bastian
- Medical University of South Carolina, Charleston, SC, USA
| | - Tara Pittman
- Medical University of South Carolina, Charleston, SC, USA
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The Development of Investigator-Initiated Clinical Trials in Surgical Oncology. Surg Oncol Clin N Am 2023; 32:13-25. [PMID: 36410913 DOI: 10.1016/j.soc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Investigator-initiated trials (IITs) are designed by principal investigators who identify important, unaddressed clinical gaps and opportunities to answer these questions through clinical trials. Surgical oncologists are poised to lead IITs due to their multidisciplinary clinical practice and substantial research background. The process of developing, organizing, and implementing IITs is multifaceted and involves important steps including (but not limited to) navigating regulatory requirements, obtaining funding, and meeting enrollment targets. Here, the authors explore the steps, methodology, and barriers of IIT development by surgical oncologists and highlight the importance of IITs in oncology.
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Nagla A, Le B, White C, V Kiburg K, Philip J. Attitudes of Palliative Care Practitioners Towards Enrolling Patients in Clinical Trials. J Palliat Care 2022; 37:447-455. [PMID: 35546098 DOI: 10.1177/08258597211063057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Recruitment of participants for clinical trials remains a key consideration for investigators. This is particularly relevant in palliative care, where practitioners are sometimes reluctant to refer patients for consideration of enrolment. Reasons for this reluctance range from concerns about excessive burden to patients, through to debate about the appropriateness of undertaking trials in the palliative care setting. Aim: The aim of this study was (1) to explore palliative care practitioners' attitudes and views of clinical trials, (2) to compare these findings with those of a similar survey undertaken more than a decade earlier, and (3) to explore predictors associated with key concepts of interest associated with clinical trials. Design: The palliative care clinician's attitudes to clinical research survey undertaken in 2007 formed the basis of a repeat survey conducted in 2019. Setting/Participants: Australian and New Zealand palliative care practitioners were surveyed. Results: Surveys were completed by 135 palliative care practitioners. Comparing results of the current study and those findings of more than a decade earlier revealed that attitudes have either not substantially changed or indeed in some areas have become less accepting of clinical trials. This is despite the dramatic increase in the volume of research carried out within palliative care over the last decade. Conclusion: Our survey suggests that the reasons for engagement in research are complex and likely to differ according to local conditions. Careful attention to understanding of the local environment and particularly the attitudes of local practitioners is likely to be essential to be successful in this endeavour.
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Affiliation(s)
- Ahmed Nagla
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Brian Le
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Clare White
- Northern Ireland Hospice, Belfast, Northern Ireland and Belfast Health and Social Care Trust
| | | | - Jennifer Philip
- Peter MacCallum Cancer Centre, Melbourne, Australia.,St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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Kumar G, Chaudhary P, Quinn A, Su D. Barriers for cancer clinical trial enrollment: A qualitative study of the perspectives of healthcare providers. Contemp Clin Trials Commun 2022; 28:100939. [PMID: 35707483 PMCID: PMC9189774 DOI: 10.1016/j.conctc.2022.100939] [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: 10/20/2021] [Revised: 04/14/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022] Open
Abstract
Background Barriers to clinical trial enrollment have been the subject of extensive research; however, the rate of clinical trial participation has not improved significantly over time. Studies often emphasize patient-related barriers, but institutional and organizational barriers in the health care system may have a more substantial impact on clinical trial participation. Objective To qualitatively identify perceived barriers to clinical trial participation based on perspectives from healthcare providers. Design Qualitative research design with a phenomenological approach was used. A purposive sample of 18 healthcare providers participated in an in-depth focus group session. Participants were involved in cancer care and clinical research from a large hospital in the United States Midwest region. Data were transcribed, coded, and systematically analyzed through thematic content analysis. Results The data revealed four levels of barriers to clinical trial enrollment, with emergent themes within each level: patient (beliefs or trust, distance to trial sites, health insurance coverage, language, and immigration status), provider (limited awareness of trial, time constraint, and non-cooperation from colleagues), clinical (eligibility criteria and clinical design), and institutional (policy and limited logistic support). Conclusion Healthcare providers face complex, multifaceted, and interrelated barriers to clinical trial enrollment. To overcome these barriers, health care organizations need to commit more human and financial resources, break down boundaries for more efficient inter-departmental cooperation, develop more coordinated efforts in promoting trial awareness and participation, and remove unnecessary regulatory barriers.
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8
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Hagège M, Canouï-Poitrine F, Derbez B. Including older patients in cancer trials: A qualitative study of collaboration between geriatricians and oncologists. J Geriatr Oncol 2021; 12:945-951. [PMID: 33714724 DOI: 10.1016/j.jgo.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The under-representation of older patients in cancer trials remains an important obstacle to the generation of data on efficacy and safety in this growing patient population. In France, geriatric oncology coordination units (UCOGs) have been created to help oncologists and geriatricians work together on research, best practice, and continuing medical education. Taking these units as a case study, this paper sheds light on the collaboration between geriatricians and oncologists in the inclusion process of older patients in cancer trials. MATERIALS AND METHODS Empirical data were gathered in a series of sociological interviews with all 16 oncologists, geriatricians and unit coordinators in the five UCOGs in the greater Paris region of France. RESULTS The case of French geriatric oncology coordination units shows the gap between professional research cultures in oncology and geriatrics that may account for the low observed inclusion rates. It is easier to include patients in randomized clinical trials than in observational studies. UCOGs have the potential to improve research in geriatric oncology by catalyzing the development and implementation of effective collaboration tools (such as frailty assessments). The units also have the potential to promote Phase IV trials and observational research that are suitable for older patients with cancer. DISCUSSION Bridging the cultural gap between oncologists (the dominant force in setting the cancer research agenda) and geriatricians (a source of specific knowledge and know-how) is essential for producing relevant trial protocols that match the specific yet diverse features of older patient populations.
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Affiliation(s)
- Meoïn Hagège
- Université Paris Est Créteil, UFR Médecine, 8 Rue du Général Sarrail, 94000 Créteil, France; Hôpital Henri Mondor, CEpiA/Unité de Santé publique, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
| | - Florence Canouï-Poitrine
- Université Paris Est Créteil, UFR Médecine, 8 Rue du Général Sarrail, 94000 Créteil, France; Hôpital Henri Mondor, CEpiA/Unité de Santé publique, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Benjamin Derbez
- Université Paris 8, 2 avenue de la liberté, 93000 Saint Denis, France; CRESPPA-CSU, 59-61 rue Pouchet, 75018 Paris, France
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9
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Knelson LP, Cukras AR, Savoie J, Agarwal A, Guo H, Hu J, Fell G, Lederman R, Hughes ME, Winer EP, Lin NU, Tolaney SM. Barriers to Clinical Trial Accrual: Perspectives of Community-Based Providers. Clin Breast Cancer 2020; 20:395-401.e3. [PMID: 32605813 DOI: 10.1016/j.clbc.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/20/2020] [Accepted: 05/01/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Only a small proportion of patients with cancer enroll onto clinical trials. Previous studies have explored patient-related barriers to trial participation; however, few studies have focused on the provider perspective. We aimed to describe referral practices and barriers to referrals of patients with breast cancer for clinical trials, including the utilization of web-based trial-matching tools. MATERIALS AND METHODS In 2016, we distributed 120 surveys to attendees of a breast oncology continuing medical education course. The survey addressed referral patterns, trial knowledge, and perceptions of web-based trial-matching tools. After survey completion, participants were provided a link to the Dana-Farber Cancer Institute trial-matching tool. Three months later, a follow-up survey was sent to assess their use of this tool. Descriptive statistics were used to summarize survey data. RESULTS Ninety-six (80%) participants completed the first survey; 5 respondents did not actively treat patients with breast cancer and were excluded. Respondents included medical (30%) and surgical (22%) oncologists, nurse practitioners/physician assistants (26%), and other (22%). Neoadjuvant and metastatic trials were deemed the highest priority. The primary reported barriers included perceived lack of patient interest, lack of trial awareness, and logistical barriers. Emailing trial investigators directly was the preferred method of trial referral. Although 80% indicated that web-based tools would increase trial referrals, our follow-up survey revealed that only 18% of respondents used our web-based tool. CONCLUSION Our respondents valued trial participation for their patients but found it difficult to manage. Further research is needed regarding how to increase the likelihood that patients are presented with appropriate trial options.
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Affiliation(s)
- Lauren P Knelson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Anthony R Cukras
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jennifer Savoie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ankit Agarwal
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hao Guo
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Jiani Hu
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Geoffrey Fell
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Ruth Lederman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Melissa E Hughes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Eric P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
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Dickens DS, Roth ME, Pollock BH, Langevin AM. Understanding the Barriers to Pediatric Oncologist Engagement and Accrual to Clinical Trials in National Cancer Institute-Designated Community Oncology Research Programs. JCO Oncol Pract 2020; 16:e1060-e1066. [PMID: 32396490 PMCID: PMC7564137 DOI: 10.1200/jop.19.00707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE: Clinical trial participation leads to progress in cancer care. Principal investigators (PIs) and clinical research associates (CRAs) play key roles in the provision and maintenance of clinical trial portfolios at their sites. Previous studies have evaluated the educational and resource needs of adult oncology providers, but nothing to date has focused on providers of pediatric oncology care. We aimed to identify the educational needs and clinical trial participation barriers at National Cancer Institute Community Oncology Research Program (NCORP) Children’s Oncology Group (COG) sites to improve the quality of site investigator engagement. METHODS: Quality improvement surveys of pediatric clinical research staff at NCORP sites were performed. The first was a web-based inquiry of NCORP COG PIs and lead CRAs to assess their general understanding of NCORP organizational structure and needs. The second survey of COG PIs was conducted by one-on-one telephone interviews aimed at identifying specific barriers to physician engagement and patient enrollment in clinical trial research. RESULTS: The majority of NCORP COG PIs and CRAs (63%) reported an incomplete understanding of NCORP structure, with approximately half expressing interest in developing stronger collaborations and engagement. Most NCORP COG PIs reported at least one shared barrier to clinical trial enrollment (78%), with inadequate protected time and research support (39% each) being the most frequently cited barriers. CONCLUSIONS: Contributions to pediatric cancer clinical research at COG NCORP sites could be enhanced through improved education, resources, and time allocation.
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Affiliation(s)
- David S Dickens
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplantation, University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA
| | - Michael E Roth
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brad H Pollock
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Comprehensive Cancer Center, Davis, CA
| | - Anne-Marie Langevin
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Health San Antonio, San Antonio, TX
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11
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Wong AR, Sun V, George K, Liu J, Padam S, Chen BA, George T, Amini A, Li D, Sedrak MS. Barriers to Participation in Therapeutic Clinical Trials as Perceived by Community Oncologists. JCO Oncol Pract 2020; 16:e849-e858. [PMID: 32240068 DOI: 10.1200/jop.19.00662] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite considerable research on the barriers to enrollment in cancer therapeutic trials, few studies have elicited barriers from the perspective of community physicians, who provide the majority of cancer care. The purpose of this study was to characterize barriers to and facilitators of cancer therapeutic trials as perceived by oncologists in community practices. METHODS Twenty semistructured interviews were conducted with oncologists at six community sites affiliated with City of Hope National Medical Center from March to June 2018. Responses were recorded digitally and transcribed. Data were analyzed using qualitative content analysis. RESULTS Of the 20 participants, 4 (20%) were women, 13 (65%) had > 10 years of practice experience, and 16 (80%) reported that < 5% of their patients were enrolled in a therapeutic trial. Participants identified four system-level barriers: lack of appropriate trials for community-based settings, insufficient infrastructure support, restrictive eligibility criteria, and financial limitations; three physician-level barriers: lack of awareness of available trials, lack of knowledge of trial details, and lack of time; and two patient-level barriers: patient burden and negative beliefs/attitudes toward research. Efforts aimed to increase trial availability, clinical trial support personnel, and physician knowledge were identified as major facilitators. CONCLUSION Community oncologists face numerous complex, multifaceted barriers to cancer therapeutic trial enrollment. Although expanding clinical research beyond the academic setting allows access to a larger and more diverse patient population, increasing generalizability and relevance of trial findings, there remains a substantial need for new strategies to improve cancer research delivery in the community.
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Affiliation(s)
- Andrew R Wong
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Virginia Sun
- Department of Population Science, City of Hope, Duarte, CA
| | - Kevin George
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Simran Padam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Brandon A Chen
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Thomas George
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, CA
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
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Chen L, Payne JB, Dance KV, Imbody CB, Ho CD, Ayers AA, Flowers CR. Priorities for Rural Lymphoma Survivors: A Qualitative Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:47-52.e3. [PMID: 31708453 DOI: 10.1016/j.clml.2019.09.599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/23/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We gathered rural patient perspectives on lymphoma care and unmet needs throughout the treatment course to better understand their attitudes toward treatment and their barriers to participating in clinical research studies. PATIENTS AND METHODS We conducted 12 individual semi-structured telephone interviews in the spring of 2018 with lymphoma survivors from rural counties in Georgia. Patients were identified by a residential address in counties classified as rural according to the Rural-Urban Commuting Areas codes. Participants were recruited from regional patient education conferences and from current research participants at a university research hospital in Georgia. The interviews were recorded and transcribed verbatim. Thematic analysis and MAXQDA, version 18.0.8, were used to facilitate a constant comparative coding process during theme development. RESULTS The greatest barrier to care was the travel distance. The participants described difficulty navigating between local clinics and larger cancer centers. The lack of communication between the local and specialized clinics complicated the process, and participants had difficulty contacting or seeking advice from the team at the larger cancer centers. Seeking treatment from specialized clinics farther away introduced additional barriers. Most participants agreed that the use of technology was important for improved communication. Participants described lymphoma etiology, subtype-specific studies, alternative therapies, and quality of life as key research priorities. CONCLUSION These findings suggest that targeted research and interventions are necessary to address the specific needs of rural patients with and survivors of lymphoma. To address the disparity in health outcomes within rural populations, healthcare professionals and investigators can use these data to engage rural patients in treatment decision-making and research planning.
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Affiliation(s)
- Lillian Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jackelyn B Payne
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Kaylin V Dance
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Conner B Imbody
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cathy D Ho
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Amy A Ayers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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13
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Ellis S, Geana M, Griebling T, McWilliams C, Gills J, Stratton K, Mackay C, Shifter A, Zganjar A, Thrasher B. Development, acceptability, appropriateness and appeal of a cancer clinical trials implementation intervention for rural- and minority-serving urology practices. Trials 2019; 20:578. [PMID: 31590694 PMCID: PMC6781342 DOI: 10.1186/s13063-019-3658-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Few community urologists offer cancer patients the opportunity to participate in cancer clinical trials, despite national guidelines that recommend it, depriving an estimated 260,000 urological cancer patients of guideline-concordant care each year. Existing strategies to increase urologists’ offer of clinical trials are designed for resource-rich environments and are not feasible for many community urologists. We sought to design an implementation intervention for dissemination in under-resourced community urology practices and to compare its acceptability, appropriateness and adoption appeal among trial-naïve and trial-experienced urologists. Methods We used a design-for-dissemination approach, informed by the Theoretical Domains Framework and Behavior Change Wheel, to match determinants of the clinical trial offer to theoretically informed implementation strategies. We described the implementation intervention in evaluation workshops offered at urology professional society meetings. We surveyed participants to assess the implementation intervention’s acceptability and appropriateness using validated instruments. We also measured adoption appeal, intention to adopt and previous trial offer. Results Our design process resulted in a multi-modal implementation intervention, comprised of multiple implementation strategies designed to address six domains from the Theoretical Domains Framework. Evaluation workshops delivered at four meetings, convened five separate professional societies. Sixty-one percent of those offered an opportunity to participate in the implementation intervention indicated intention to adopt. Average implementation intervention acceptability and appropriateness ratings were 4.4 and 4.4 (out of 5), respectively. Acceptability scores were statistically significantly higher among those offering trials compared to those not (p = 0.03). Appropriateness scores did not differ between those offering trials and those not (p = 0.24). After urologists ranked their top three innovation attributes, 43% of urologists included practice reputation in their top three reasons for offering clinical trials; 30% listed practice differentiation among their top three reasons. No statistically significant differences were found between those who offered trials and those who did not among any of the innovation attributes. Conclusions LEARN|INFORM|RECRUIT is a promising implementation intervention to address low accrual to clinical trials, poised for implementation and effectiveness testing. The implementation intervention is appealing to its target audience and may have equal uptake among trial-naïve and trial-experienced practices. Electronic supplementary material The online version of this article (10.1186/s13063-019-3658-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shellie Ellis
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MS 3044, Kansas City, KS, 66160, USA.
| | - Mugur Geana
- School of Journalism and Mass Communications, University of Kansas, Lawrence, KS, USA
| | - Tomas Griebling
- Department of Urology and The Landon Center on Aging, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Charles McWilliams
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jessie Gills
- Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kelly Stratton
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christine Mackay
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MS 3044, Kansas City, KS, 66160, USA
| | - Ariel Shifter
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MS 3044, Kansas City, KS, 66160, USA
| | - Andrew Zganjar
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Brantley Thrasher
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS, USA
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14
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Winestone LE, Getz KD, Rao P, Li Y, Hall M, Huang YSV, Seif AE, Fisher BT, Aplenc R. Disparities in pediatric acute myeloid leukemia (AML) clinical trial enrollment. Leuk Lymphoma 2019; 60:2190-2198. [PMID: 30732497 PMCID: PMC6685754 DOI: 10.1080/10428194.2019.1574002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/22/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
Equal access to clinical trial enrollment is important to ensure that findings are generalizable to the broader population. This study aimed to evaluate disparities in enrollment on pediatric oncology clinical trials. We assessed the relationship between patient characteristics and enrollment on COG trial AAML1031 in a cohort of pediatric patients with AML in the Pediatric Health Information System. The associations of enrollment with outcomes were evaluated. Non-Hispanic Black patients, infants, and patients from zip codes with a lower proportion of poverty were less likely to enroll (30% vs. 61%, p = .004; 34% vs. 58%, p = .003; 46% vs. 58%, p = .02). On-therapy mortality was similar among enrolled and nonenrolled patients (7.3% vs. 8.9%, p = .47). Differences in early mortality were more pronounced among nonenrolled patients compared to enrolled patients (3.0% vs. 0.5%, p = .03). Understanding the etiology of these disparities will inform strategies to ensure balanced access to clinical trials across patient populations.
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Affiliation(s)
- Lena E. Winestone
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Division of AIBMT, Department of Pediatrics, University of California – San Francisco (UCSF) Benioff Children’s Hospital, San Francisco, CA, USA
| | - Kelly D. Getz
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Pooja Rao
- Division of Pediatric Hematology/Oncology, Penn State Children’s Hospital, Hershey, PA, USA
| | - Yimei Li
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS, USA
| | - Yuan-Shung V. Huang
- Healthcare Analytics Unit, Department of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alix E. Seif
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Brian T. Fisher
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard Aplenc
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Heider PM, Meystre SM. Patient-Pivoted Automated Trial Eligibility Pipeline: The First of Three Phases in a Modular Architecture. Stud Health Technol Inform 2019; 264:1476-1477. [PMID: 31438189 DOI: 10.3233/shti190492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Automated extraction of patient trial eligibility for clinical research studies can increase enrollment at a decreased time and money cost. We have developed a modular trial eligibility pipeline including patient-batched processing and an internal webservice backed by a uimaFIT pipeline as part of a multi-phase approach to include note-batched processing, the ability to query trials matching patients or patients matching trials, and an external alignment engine to connect patients to trials.
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Affiliation(s)
- Paul M Heider
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stéphane M Meystre
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
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16
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Lee SJC, Murphy CC, Geiger AM, Gerber DE, Cox JV, Nair R, Skinner CS. Conceptual Model for Accrual to Cancer Clinical Trials. J Clin Oncol 2019; 37:1993-1996. [PMID: 31166822 PMCID: PMC6879309 DOI: 10.1200/jco.19.00101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
| | | | | | - David E. Gerber
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - John V. Cox
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Rasmi Nair
- The University of Texas Southwestern Medical Center, Dallas, TX
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17
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Meystre SM, Heider PM, Kim Y, Aruch DB, Britten CD. Automatic trial eligibility surveillance based on unstructured clinical data. Int J Med Inform 2019; 129:13-19. [PMID: 31445247 DOI: 10.1016/j.ijmedinf.2019.05.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/06/2018] [Accepted: 05/21/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Insufficient patient enrollment in clinical trials remains a serious and costly problem and is often considered the most critical issue to solve for the clinical trials community. In this project, we assessed the feasibility of automatically detecting a patient's eligibility for a sample of breast cancer clinical trials by mapping coded clinical trial eligibility criteria to the corresponding clinical information automatically extracted from text in the EHR. METHODS Three open breast cancer clinical trials were selected by oncologists. Their eligibility criteria were manually abstracted from trial descriptions using the OHDSI ATLAS web application. Patients enrolled or screened for these trials were selected as 'positive' or 'possible' cases. Other patients diagnosed with breast cancer were selected as 'negative' cases. A selection of the clinical data and all clinical notes of these 229 selected patients was extracted from the MUSC clinical data warehouse and stored in a database implementing the OMOP common data model. Eligibility criteria were extracted from clinical notes using either manually crafted pattern matching (regular expressions) or a new natural language processing (NLP) application. These extracted criteria were then compared with reference criteria from trial descriptions. This comparison was realized with three different versions of a new application: rule-based, cosine similarity-based, and machine learning-based. RESULTS For eligibility criteria extraction from clinical notes, the machine learning-based NLP application allowed for the highest accuracy with a micro-averaged recall of 90.9% and precision of 89.7%. For trial eligibility determination, the highest accuracy was reached by the machine learning-based approach with a per-trial AUC between 75.5% and 89.8%. CONCLUSION NLP can be used to extract eligibility criteria from EHR clinical notes and automatically discover patients possibly eligible for a clinical trial with good accuracy, which could be leveraged to reduce the workload of humans screening patients for trials.
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Affiliation(s)
- Stéphane M Meystre
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States; Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, United States.
| | - Paul M Heider
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
| | - Youngjun Kim
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
| | - Daniel B Aruch
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Carolyn D Britten
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, United States
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18
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Polite BN, Cipriano-Steffens TM, Liao C, Miller EL, Arndt NL, Hahn EA. Investigation of a multimedia, computer-based approach to improve knowledge, attitudes, self-efficacy, and receptivity to cancer clinical trials among newly diagnosed patients with diverse health literacy skills. Cancer 2019; 125:2066-2075. [PMID: 30811591 DOI: 10.1002/cncr.31991] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Enrollment in therapeutic cancer trials remains low, and is especially challenging for patients with low health literacy. The authors tested an interactive technology designed for patients with diverse health literacy skills with the aim of improving patient receptiveness, willingness, knowledge, self-efficacy, and positive attitudes regarding clinical trials. METHODS Patients presenting for their first oncology appointment were eligible. Patients viewed an interactive teaching video concerning clinical trials that was adapted from the National Institutes of Health. Validated surveys assessing receptiveness, willingness, knowledge, self-efficacy, and positive attitudes regarding clinical trials were administered before and after the test. RESULTS A total of 120 patients with cancer were enrolled. Approximately 80% were non-Hispanic white, 33% were female, 69% had >high school education, and 8% reported an income <$20,000. Approximately 33% scored within the low health literacy range. Changes between pretest and posttest demonstrated increases in knowledge (P < .001), self-efficacy (P < .001), and positive beliefs (P = .004); a slight decrease in willingness (P = .009); and no difference in patient receptivity (P = .31). Higher health literacy was associated with improved willingness (P = .049) and non-Hispanic white race was associated with improved receptivity (P = .034). CONCLUSIONS Interactive technology that was designed for patients with diverse health literacy skills demonstrated the ability to improve knowledge, self-efficacy, and positive beliefs regarding cancer clinical trials. Contrary to the hypothesis of the current study, patients with lower health literacy did not appear to derive a greater advantage from this technology. There was no improvement noted with regard to patient willingness or receptivity, and clinical trial enrollment remained at historical institutional levels. Talking touchscreen technology has a potential role as an important element in informed decision making for patients, but likely needs to be coupled with more robust and multitargeted interventions.
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Affiliation(s)
- Blase N Polite
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Chuanhong Liao
- Department of Public Health Science, University of Chicago, Chicago, Illinois
| | - Edward L Miller
- Private Consultant, CancerHelp Institute, Wilmette, Illinois
| | - Nicole L Arndt
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Elizabeth A Hahn
- Medical Social Sciences and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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19
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Improving Oncology Clinical Trial Participation and Experience. Trends Cancer 2018; 4:793-796. [PMID: 30470299 DOI: 10.1016/j.trecan.2018.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022]
Abstract
Cancer patients are underrepresented in clinical trial populations because of protocol-, physician-, and patient-related barriers. We engaged focus groups of patients who had participated in breast and ovarian cancer trials to identify concerns regarding their experiences. The lessons learnt are applicable to improving patient experience during future trials.
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20
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Khunger M, Rakshit S, Hernandez AV, Pasupuleti V, Glass K, Galsky MD, Grivas P. Premature Clinical Trial Discontinuation in the Era of Immune Checkpoint Inhibitors. Oncologist 2018; 23:1494-1499. [PMID: 30068783 DOI: 10.1634/theoncologist.2018-0003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/31/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. We assessed factors of early terminated/withdrawn oncology trials focusing on trials with immune checkpoint inhibitors (ICI), hypothesizing that the latter may be associated with lower rates of premature discontinuation. MATERIALS AND METHODS We reviewed all adult, intervention, oncology trials registered in ClinicalTrials.gov (November 16, 2011, to April 16, 2015) to identify all terminated/withdrawn trials and reasons for termination. Logistics regression model was used to identify factors associated with early termination/withdrawal. Discontinuation rate was compared in trials with and without ICI. RESULTS We identified 12,875 trials (35% industry funded, 12% federal funded), of which 8.5% were prematurely terminated (5%) or withdrawn (3.5%); the main reasons were poor accrual (33%) and logistical (24%). ICI trials (n = 350) had a nonsignificant lower rate of termination or withdrawal compared with all other oncology trials (5.4% vs. 8.5%; p = .9) and were less likely to discontinue due to poor accrual (nonsignificant difference: 21% vs. 33%; p = .4). ICI trials were also less likely to discontinue compared with all other oncology drug trials (e.g., chemotherapy, targeted inhibitors, antiangiogenesis, biologics; 5.4% vs. 7.9%, respectively, nonsignificant difference). The 4-year cumulative incidence of failing to complete for reasons unrelated to toxicity or efficacy was 18% (95% confidence interval 16%-20%). There was no association between annual incidence across different tumor types or accrual goal and rate of trial termination. CONCLUSION Poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in ICI compared with other trials. Clinical trial completion remains a high priority and can be influenced by provider and patient factors. IMPLICATIONS FOR PRACTICE Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. This study assessed factors of early terminated/withdrawn oncology trials, focusing on trials with immune checkpoint inhibitors (ICI), and found that poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in immune checkpoint inhibitor trials compared to other trials. The discussion herein is focused on measures taken by the National Cancer Institute and other institutions to improve clinical trial accrual and prevent premature clinical trial discontinuation.
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Affiliation(s)
- Monica Khunger
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sagar Rakshit
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adrian V Hernandez
- University of Connecticut/Hartford Hospital Evidence-based Practice Center, Hartford, Connecticut, USA
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Kate Glass
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew D Galsky
- Department of Hematology/Oncology, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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21
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Godskesen TE, Petri S, Eriksson S, Halkoaho A, Mangset M, Pirinen M, Nielsen ZE. When Nursing Care and Clinical Trials Coincide: A Qualitative Study of the Views of Nordic Oncology and Hematology Nurses on Ethical Work Challenges. J Empir Res Hum Res Ethics 2018; 13:475-485. [DOI: 10.1177/1556264618783555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated the kinds of ethical challenges experienced by nurses in oncology and hematology when nursing care and research overlap in clinical trials, and how the nurses handle such challenges. Individual interviews with 39 nurses from Sweden, Denmark, and Finland indicated that all nurses were positive about research, considering it essential for developing the best care. Ethical challenges exist, however; the most difficult were associated with the end-of-life patients, no longer responsive to standard therapy, who eagerly volunteer for cutting-edge drug trials in the hope of gaining therapeutic benefit. Many nurses lacked systematic strategies for addressing such challenges but found support from their nursing colleagues and relied on the research protocols to guide them.
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Affiliation(s)
- Tove E. Godskesen
- Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Uppsala University, Sweden
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22
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Kunos CA, Massett HA, Galassi A, Walker JL, Good MJ, Díaz LB, McCaskill-Stevens W. Leveraging National Cancer Institute Programmatic Collaboration for Uterine Cervix Cancer Patient Accrual in Puerto Rico. Front Oncol 2018; 8:102. [PMID: 29692980 PMCID: PMC5902541 DOI: 10.3389/fonc.2018.00102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022] Open
Abstract
Women in the U.S. Commonwealth of Puerto Rico (PR) have a higher age-adjusted incidence rate for uterine cervix cancer than the U.S. mainland as well as substantial access and economic barriers to cancer care. The National Cancer Institute (NCI) funds a Minority/Underserved NCI Community Oncology Research Program in PR (PRNCORP) as part of a national network of community-based health-care systems to conduct multisite cancer clinical trials in diverse populations. Participation by the PRNCORP in NCI’s uterine cervix cancer clinical trials, however, has remained limited. This study reports on the findings of an NCI site visit in PR to assess barriers impeding site activation and accrual to its sponsored gynecologic cancer clinical trials. Qualitative, semi-structured individual, and group interviews were conducted at six PRNCORP-affiliated locations to ascertain: long-term trial accrual objectives; key stakeholders in PR that address uterine cervix cancer care; key challenges or barriers to activating and to enrolling patients in NCI uterine cervix cancer treatment trials; and resources, policies, or procedures in place or needed on the island to support NCI-sponsored clinical trials. An NCI-sponsored uterine cervix cancer radiation–chemotherapy intervention clinical trial (NCT02466971), already activated on the island, served as a test case to identify relevant patient accrual and site barriers. The site visit identified five key barriers to accrual: (1) lack of central personnel to coordinate referrals for treatment plans, medical tests, and medical imaging across the island’s clinical trial access points; (2) patient insurance coverage; (3) lack of a coordinated brachytherapy schedule at San Juan-centric service providers; (4) limited credentialed radiotherapy machines island-wide; and (5) too few radiology medical physicists tasked to credential trial-specified positron emission tomography scanners island-wide. PR offers a unique opportunity to study overarching and tactical strategies for improving accrual to NCI-sponsored gynecologic cancer clinical trials. Interview findings support adding and re-tasking personnel for coordinated trial-eligible patient referral, accrual, and treatment.
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Affiliation(s)
- Charles A Kunos
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, United States
| | - Holly A Massett
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, United States
| | - Annette Galassi
- Center for Global Health, National Cancer Institute, Bethesda, MD, United States
| | - Joan L Walker
- Gynecologic Oncology Section, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Marge J Good
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, United States
| | - Luis Báez Díaz
- Minority/Underserved NCI Community Oncology Research Program, San Juan, PR, United States
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Cook ED, Yeager KA, Cecchini RS, Boparai J, Brown CL, Duncan M, Cronin WM, Paskett ED. Recruitment practices for U.S. minority and underserved populations in NRG oncology: Results of an online survey. Contemp Clin Trials Commun 2018; 10:100-104. [PMID: 30023443 PMCID: PMC6046466 DOI: 10.1016/j.conctc.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Cancer clinical trials (CCT) provide much of the evidence for clinical guidelines and standards of care. But low levels of CCT participation are well documented, especially for minorities. Methods and materials We conducted an online survey of 556 recruitment practices across the NRG Oncology network. Survey aims were 1) to learn how sites recruit minority/underserved populations; 2) to better understand the catchment areas of the NRG institutions; and 3) to aid in planning education programs for accrual of minority/underserved populations. Results The survey response rate was 34.9%. The most effective methods reported for recruiting minority/underserved participants were patient navigators (44.4%) and translators (38.9%). All institutions reported using a mechanism for eligibility screening and 71% of institutions reported using a screening/enrollment tracking system. CCT training was required at 78.1% and cultural competency training was required at 47.5% of responding institutions. Only 19.9% of sites used community partners to assist with minority recruitment and just 37.1% of respondents reported a defined catchment area. Sites reported very little race and ethnicity data. Conclusion This NRG Oncology online survey provides useful data for improvements in trial enrollment and training to recruit minority/underserved populations to CCT. Areas for further investigation include web-based methods for recruitment and tracking, cultural competency training, definition of catchment areas, use of patient navigators, and community partnerships. The survey results will guide recruitment training programs.
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Affiliation(s)
- Elise D Cook
- Department of Clinical Cancer Prevention, Unit 1360, UT M. D. Anderson Cancer Center, P. O. Box 301439, Houston, TX 77230-1439, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Winship Cancer Institute, USA
| | - Reena S Cecchini
- NRG Oncology Statistics and Data Management Center, USA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, USA
| | | | - Carol L Brown
- Office of Diversity Programs, Memorial Sloan Kettering Cancer Center, USA
| | - Martha Duncan
- Clinical Coordinating Department (CCD), NRG Oncology, Pittsburgh Office, USA
| | - Walter M Cronin
- NRG Oncology, Statistics and Data Management Center, University of Pittsburgh, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Ohio State University, USA.,Population Sciences, Comprehensive Cancer Center, Ohio State University, USA
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Ibraheem A, Polite B. Improving the accrual of racial and ethnic minority patients in clinical trials: Time to raise the stakes. Cancer 2017; 123:4752-4756. [DOI: 10.1002/cncr.31073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 01/08/2023]
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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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Rosenberg SM, Gelber S, Gelber RD, Krop E, Korde LA, Pagani O, Partridge AH. Oncology Physicians' Perspectives on Practices and Barriers to Fertility Preservation and the Feasibility of a Prospective Study of Pregnancy After Breast Cancer. J Adolesc Young Adult Oncol 2017; 6:429-434. [PMID: 28686476 PMCID: PMC5649410 DOI: 10.1089/jayao.2017.0031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE POSITIVE (Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer) is a prospective clinical trial assessing safety and pregnancy outcomes in premenopausal hormone receptor-positive breast cancer survivors (age ≤42) who interrupt endocrine therapy (ET) to attempt pregnancy. We sought to assess interest in this study and perspectives on fertility preservation (FP) among United States medical oncologists who had previously enrolled women at their institutions on select premenopausal endocrine studies. METHODS From August 2015 to December 2015, 301 investigators were invited to complete a web-based survey on behalf of their institution. We assessed FP practices and attitudes, barriers to discussing FP, and willingness to open/enroll women on POSITIVE. RESULTS Of 93 respondents (31%), most were affiliated with an National Cancer Institute (NCI)-designated comprehensive cancer center (44%). Almost all said they usually or always discussed the issue of future fertility with patients (98%) and referred patients with fertility questions to specialists (97%). Over half of respondents cited discomfort with recommending women to stop ET, as well as perceived patient concern regarding ET interruption, as factors seen as influencing POSITIVE enrollment; however, 84% were willing to recommend trial participation for selected patients. CONCLUSIONS Most providers reported discussing fertility with their young patients, indicating awareness of FP guidelines for cancer patients. While most oncologists said that they would be willing to recommend POSITIVE, many also expressed discomfort in endorsing women to stop ET temporarily, underscoring the need for prospective data regarding the safety of ET interruption. High willingness to recommend POSITIVE suggests the potential for successful accrual to this study, which addresses a critical issue for young breast cancer survivors.
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Affiliation(s)
| | - Shari Gelber
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Boston, Massachusetts
| | - Richard D. Gelber
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Boston, Massachusetts
| | - Ethan Krop
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, Massachusetts
| | - Larissa A. Korde
- Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Olivia Pagani
- Institute of Oncology and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
| | - Ann H. Partridge
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, Massachusetts
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Goel S, Paoli C, Iurlo A, Pereira A, Efficace F, Barbui T, Tefferi A, Vannucchi AM, Cervantes F. Socioeconomic burden of participation in clinical trials in patients with myeloproliferative neoplasms. Eur J Haematol 2017; 99:36-41. [PMID: 28370510 DOI: 10.1111/ejh.12887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the financial and psycho-social impact of participation in clinical trials of patients with BCR/ABL-negative myeloproliferative neoplasms (MPN). METHODS An international, observational cross-sectional study was performed in 143 consecutive MPN patients (51% myelofibrosis, 36% polycythemia vera, 13% essential thrombocythemia), 68% from Italy, 17% from USA, and 15% from Spain. RESULTS Thirty-five percent of patients reported having spent more money during the trial than in previous treatments and 21% having missed more workdays. Twelve percent replied that they would not have participated in the trial if the financial consequences would have been known beforehand. In 10% of the patients, the interpersonal relationships were more affected during the trial than in previous treatment but, overall, 91% subjects believed that participating in the clinical trial was worth the financial or emotional suffering. Concerning patients' suggestions, 54% of them indicated that the number of visits required for the trial should be clearly specified in the informed consent, 60% recommended travel cost reimbursement, and 23% hotel cost reimbursement. CONCLUSIONS Physicians and pharmaceutical companies involved in clinical trials with patients with hematological diseases should be aware of these problems and make efforts to attenuate the socioeconomic burden of participation in the trials.
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Affiliation(s)
- Swati Goel
- Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Chiara Paoli
- Center of Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - Alessandra Iurlo
- Oncohematology Division, IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Arturo Pereira
- Hemostasis Department, Hospital Clínic, Barcelona, Spain
| | - Fabio Efficace
- GIMEMA Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Tiziano Barbui
- Research Foundation, Ospedale Papa Giovanni XXII, Bergamo, Italy
| | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alessandro M Vannucchi
- Center of Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
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Mackay CB, Antonelli KR, Bruinooge SS, Saint Onge JM, Ellis SD. Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate. Cancer 2017; 123:2893-2900. [DOI: 10.1002/cncr.30689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Christine B. Mackay
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
- University of Kansas Cancer Center; Fairway Kansas
| | | | | | - Jarron M. Saint Onge
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
| | - Shellie D. Ellis
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
- University of Kansas Cancer Center; Fairway Kansas
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Nipp RD, Lee H, Powell E, Birrer NE, Poles E, Finkelstein D, Winkfield K, Percac-Lima S, Chabner B, Moy B. Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program. Oncologist 2016; 21:467-74. [PMID: 26975867 DOI: 10.1634/theoncologist.2015-0481] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/15/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cancer clinical trial (CT) participation rates are low and financial barriers likely play a role. We implemented a cancer care equity program (CCEP) to address financial burden associated with trial participation. We sought to examine the impact of the CCEP on CT enrollment and to assess barriers to participation. METHODS We used an interrupted time series design to determine trends in CT enrollment before and after CCEP implementation. Linear regression models compared trial enrollment before and after the CCEP. We also compared patient characteristics before and after the CCEP and between CCEP and non-CCEP participants. We surveyed CCEP and non-CCEP participants to compare pre-enrollment financial barriers. RESULTS After accounting for increased trial availability and the trends in accrual for prior years, we found that enrollment increased after CCEP implementation (18.97 participants per month greater than expected; p < .001). A greater proportion of CCEP participants were younger, female, in phase I trials, lived farther away, had lower incomes, and had metastatic disease. Of 87 participants who completed the financial barriers survey, 49 CCEP and 38 matched, non-CCEP participants responded (63% response rate). CCEP participants were more likely to report concerns regarding finances (56% vs. 11%), medical costs (47% vs. 14%), travel (69% vs. 11%), lodging (60% vs. 9%), and insurance coverage (43% vs. 14%) related to trial participation (all p < .01). CONCLUSION CT participation increased following implementation of the CCEP and the program enrolled patients experiencing greater financial burden. These findings highlight the need to address the financial burden associated with CT participation. IMPLICATIONS FOR PRACTICE Financial barriers likely discourage patients from participating in clinical trials. Implementation of a cancer care equity program (CCEP) seeking to reduce financial barriers by assisting with travel and lodging costs was associated with increased trial accrual. The CCEP provided assistance to patients particularly in need, including those living farther away, those with lower incomes, and those reporting financial barriers related to trial participation. These findings suggest that financial concerns represent a major barrier to patient participation in clinical trials and underscore the importance of efforts to address these concerns.
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Affiliation(s)
- Ryan D Nipp
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Hang Lee
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Elizabeth Powell
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Nicole E Birrer
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Emily Poles
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Daniel Finkelstein
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Karen Winkfield
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Sanja Percac-Lima
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Bruce Chabner
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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Brooks SE, Muller CY, Robinson W, Walker EM, Yeager K, Cook ED, Friedman S, Somkin CP, Brown CL, McCaskill-Stevens W. Increasing Minority Enrollment Onto Clinical Trials: Practical Strategies and Challenges Emerge From the NRG Oncology Accrual Workshop. J Oncol Pract 2015; 11:486-90. [PMID: 26464496 DOI: 10.1200/jop.2015.005934] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Racial and ethnic diversity has historically been difficult to achieve in National Cancer Institute-sponsored clinical trials, even while as many as 80% of those trials have faced difficulty in meeting overall recruitment targets. In an attempt to address these issues, NRG Oncology recently convened a comprehensive workshop titled "Clinical Trials Enrollment: Challenges and Opportunities." Discussants at the workshop included representatives of the three legacy groups of the NRG (ie, Gynecologic Oncology Group, National Surgical Adjuvant Breast and Bowel Program, and Radiation Therapy Oncology Group), a minority-based community clinical oncology program, a large integrated health care system, the leadership of the National Cancer Institute, and a large patient advocacy group. This article summarizes the concepts discussed at the workshop, which included: needs assessments, infrastructural support, training of investigators and research staff, specific clinical trial recruitment strategies (both system and community based), and development and mentoring of young investigators. Many new, more specific tactics, including use of diverse cancer care settings, direct-to-consumer communication, and the need for centralized information technology such as the use of software to match trials to special populations, are presented. It was concluded that new, innovative trial designs and the realities of limited funding would require the adoption of effective and efficient recruiting strategies, specialized training, and stakeholder engagement. US clinical research programs must generate and embrace new ideas and pilot test novel recruitment strategies if they are to maintain their historic role as world leaders in cancer care innovation and delivery.
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Affiliation(s)
- Sandra E Brooks
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carolyn Y Muller
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - William Robinson
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Eleanor M Walker
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Kate Yeager
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Elise D Cook
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Sue Friedman
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carol P Somkin
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carol Leslie Brown
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Worta McCaskill-Stevens
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
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Abel GA, Cronin AM, Earles K, Gray SW. Accessibility and Quality of Online Cancer-Related Clinical Trial Information for Naïve Searchers. Cancer Epidemiol Biomarkers Prev 2015; 24:1629-31. [DOI: 10.1158/1055-9965.epi-15-0274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/14/2015] [Indexed: 11/16/2022] Open
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Turkman YE, Sakibia Opong A, Harris LN, Knobf MT. Biologic, demographic, and social factors affecting triple negative breast cancer outcomes. Clin J Oncol Nurs 2015; 19:62-7. [PMID: 25689650 DOI: 10.1188/15.cjon.62-67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype that disproportionately affects women who are African American, younger, or carriers of the BRCA1 gene. No targeted treatments exist for the disease, which has distinct features and presents unique challenges to patients who have been diagnosed with it. OBJECTIVES TNBC is reviewed in this article according to incidence, tumor grade, stage of diagnosis, biologic and social risk factors, mortality, and treatment. METHODS Published articles pertaining to TNBC and located through online database searches were reviewed. Articles were selected either because they offered the most current information about TNBC or contributed to the understanding of TNBC. FINDINGS Biologic, demographic, and social factors present unique challenges in the treatment of women with TNBC. Knowing about the characteristics of TNBC and the populations who are most at risk for the disease might help healthcare providers better respond to their patients. It may also facilitate responsiveness to patients' needs and enhance their quality of life.
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Abstract
Social media has potential in clinical trials for pointing out trial issues, addressing barriers, educating, and engaging multiple groups involved in cancer clinical research. Social media is being used in clinical trials to highlight issues such as poor accrual and barriers; educate potential participants and physicians about clinical trial options; and is a potential indirect or direct method to improve accrual. We are moving from a passive "push" of information to patients to a "pull" of patients requesting information. Patients and advocates are often driving an otherwise reluctant health care system into communication. Online patient communities are creating new information repositories. Potential clinical trial participants are using the Twittersphere and other sources to learn about potential clinical trial options. We are seeing more organized patient-centric and patient-engaged forums with the potential to crowd source to improve clinical trial accrual and design. This is an evolving process that will meet many individual, institutional, and regulatory obstacles as we move forward in a changed research landscape.
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