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Reyes-Monasterio A, Möller MG, Lozada-Martinez ID, Narvaez-Rojas AR, De la Cruz Ku G, Metke R, Cabrera-Vargas LF, Torregrosa-Almonacid L, Lesmes LC, Eli A, Paulinelli RR. Bridging frontiers: The role of a Global Breast Research Working Group. J Surg Oncol 2024; 129:1507-1514. [PMID: 38685712 DOI: 10.1002/jso.27660] [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] [Received: 03/09/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
Breast cancer remains a significant cause of death for women globally, despite advancements in detection and treatment, low- and middle-income countries face unique obstacles. Role of Research Working Group (RWG) can expedite research progress by fostering collaboration between scientists, clinicians, and stakeholders. Benefits of a Global RWG include pooling resources and expertise to develop new research ideas, addressing disparities, and building local research capacity, with the potential to improve breast cancer research and outcomes.
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Affiliation(s)
- Antonio Reyes-Monasterio
- Universidad Nacional Experimental Francisco de Miranda, Coro, Venezuela
- Global Breast Research Working Group, Miami, USA
| | - Mecker Geraldine Möller
- Global Breast Research Working Group, Miami, USA
- DeWitt-Department of Surgery, Division of Surgical Oncology, Leonard M. Miller School of Medicine/Jackson Health System, University of Miami, Miami, Florida, USA
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Ivan David Lozada-Martinez
- Global Breast Research Working Group, Miami, USA
- Department of Graduate Studies in Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Alexis Rafael Narvaez-Rojas
- Global Breast Research Working Group, Miami, USA
- DeWitt-Department of Surgery, Division of Surgical Oncology, Leonard M. Miller School of Medicine/Jackson Health System, University of Miami, Miami, Florida, USA
- International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
| | - Gabriel De la Cruz Ku
- Global Breast Research Working Group, Miami, USA
- Universidad Científica del Sur, Lima, Perú
| | - Ricardo Metke
- Global Breast Research Working Group, Miami, USA
- Department of General Surgery, School of Medicine, Universidad Javeriana de Bogotá, Bogotá, Colombia
| | - Luis Felipe Cabrera-Vargas
- Global Breast Research Working Group, Miami, USA
- Department of Surgery, Fundación Santa Fe de Bogotá, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Lilian Torregrosa-Almonacid
- Global Breast Research Working Group, Miami, USA
- Department of General Surgery, School of Medicine, Universidad Javeriana de Bogotá, Bogotá, Colombia
| | | | - Avisar Eli
- Global Breast Research Working Group, Miami, USA
- DeWitt-Department of Surgery, Division of Surgical Oncology, Leonard M. Miller School of Medicine/Jackson Health System, University of Miami, Miami, Florida, USA
| | - Regis Resende Paulinelli
- Global Breast Research Working Group, Miami, USA
- Araujo Jorge Cancer Hospital, Albert Einstein Israeli Hospital Goiania, Federal University of Goias, Goiânia, Brazil
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2
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Velez MA, Glenn BA, Garcia-Jimenez M, Cummings AL, Lisberg A, Nañez A, Radwan Y, Lind-Lebuffe JP, Brodrick PM, Li DY, Fernandez-Turizo MJ, Gower A, Lindenbaum M, Hegde M, Brook J, Grogan T, Elashoff D, Teitell MA, Garon EB. Consent document translation expense hinders inclusive clinical trial enrolment. Nature 2023; 620:855-862. [PMID: 37532930 PMCID: PMC11046417 DOI: 10.1038/s41586-023-06382-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
Patients from historically under-represented racial and ethnic groups are enrolled in cancer clinical trials at disproportionately low rates in the USA1-3. As these patients often have limited English proficiency4-7, we hypothesized that one barrier to their inclusion is the cost to investigators of translating consent documents. To test this hypothesis, we evaluated more than 12,000 consent events at a large cancer centre and assessed whether patients requiring translated consent documents would sign consent documents less frequently in studies lacking industry sponsorship (for which the principal investigator pays the translation costs) than for industry-sponsored studies (for which the translation costs are covered by the sponsor). Here we show that the proportion of consent events for patients with limited English proficiency in studies not sponsored by industry was approximately half of that seen in industry-sponsored studies. We also show that among those signing consent documents, the proportion of consent documents translated into the patient's primary language in studies without industry sponsorship was approximately half of that seen in industry-sponsored studies. The results suggest that the cost of consent document translation in trials not sponsored by industry could be a potentially modifiable barrier to the inclusion of patients with limited English proficiency.
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Affiliation(s)
- Maria A Velez
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Beth A Glenn
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Center for Cancer Prevention and Control Research, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Kaiser Permanente Center for Health Equity, University of Califonia, Los Angeles, Los Angeles, CA, USA
| | - Maria Garcia-Jimenez
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Division of Hematology/Oncology, UCLA-Olive View Medical Center, Los Angeles, CA, USA
| | - Amy L Cummings
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Aaron Lisberg
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrea Nañez
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yazeed Radwan
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jackson P Lind-Lebuffe
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Paige M Brodrick
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Debory Y Li
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Arjan Gower
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Maggie Lindenbaum
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Manavi Hegde
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jenny Brook
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tristan Grogan
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael A Teitell
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Edward B Garon
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.
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3
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Diversity and transparency in gynecologic oncology clinical trials. Cancer Causes Control 2023; 34:133-140. [PMID: 36284031 DOI: 10.1007/s10552-022-01646-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/12/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Clinical trials advance the standard of care for patients. Patients enrolled in trials should represent the population who would benefit from the intervention in clinical practice. The aim of this study was to assess whether clinical trials enrolling patients with gynecologic cancers report racial and ethnic participant composition and to examine the level of diversity in clinical trials. METHODS Using ClinicalTrials.gov, we identified clinical trials enrolling patients with ovarian, uterine/endometrial, cervical, vaginal, and vulvar cancers from 1988 to 2019. Race and ethnicity data were extracted from participant demographics. Descriptive statistics on race, ethnicity, cancer type, location, study status, and sponsor type were calculated. Among trials which reported race and/or ethnicity, sub-analyses were performed on composition of race and ethnicity by funding source, location, and completed study status. RESULTS A total of 1,882 trials met inclusion criteria; only 179 trials (9.5%) reported race information. Of these, the racial distribution of enrollees was 66.9% White, 8.6% Asian, 8.5% Black/African American, 0.4% Indian/Alaskan Native, 0.1% Native Hawaiian/Pacific Islander, 1.0% more than one race, and 14.5% unknown. Only 100 (5.3%) trials reported ethnicity. Except for trials enrolling patients with cervical cancer which enrolled 65.2% White and 62.1% Non-Hispanic/Latino/a patients, enrollees in trials for other gynecologic cancers were over 80% White and 88% Non-Hispanic/Latino/a. Industry funded trials enrolled higher proportions of White (68.4%) participants than non-industry funded trials (57.5%). Domestic trials report race (11.5%) and ethnicity (7.6%) at higher rates than international trials (6.9% and 2.3%, respectively). Reporting of race (1.7% vs. 13.9%) and ethnicity (1.7% vs. 11.1%) has increased over time for patients enrolled in 2000 vs. 2018. CONCLUSION Less than 10% of trials enrolling patients with gynecologic malignancies report racial/ethnic participant composition on ClinicalTrials.gov. Accurate reporting of participant race/ethnicity is imperative to ensuring minority representation in clinical trials.
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Hertz DL, McShane LM, Hayes DF. Defining Clinical Utility of Germline Indicators of Toxicity Risk: A Perspective. J Clin Oncol 2022; 40:1721-1731. [PMID: 35324346 PMCID: PMC9148690 DOI: 10.1200/jco.21.02209] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Lisa M McShane
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Daniel F Hayes
- Stuart B. Padnos Professor of Breast Cancer Research, University of Michigan Rogel Cancer Center, Ann Arbor, MI
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5
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Wesson W, Galate VL, Sborov DW, McClune B, Goodman AM, Gyawali B, Prasad V, Abbasi S, Mohyuddin GR. Characteristics of clinical trials for haematological malignancies from 2015 to 2020: A systematic review. Eur J Cancer 2022; 167:152-160. [DOI: 10.1016/j.ejca.2021.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/02/2021] [Accepted: 12/18/2021] [Indexed: 01/19/2023]
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6
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Davies-Teye BB, Medeiros M, Chauhan C, Baquet CR, Mullins CD. Pragmatic patient engagement in designing pragmatic oncology clinical trials. Future Oncol 2021; 17:3691-3704. [PMID: 34337970 DOI: 10.2217/fon-2021-0556] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Oncology trials are the cornerstone of effective and safe therapeutic discoveries. However, there is increasing demand for pragmatism and patient engagement in the design, implementation and dissemination of oncology trials. Many researchers are uncertain about making trials more practical and even less knowledgeable about how to meaningfully engage patients without compromising scientific rigor to meet regulatory requirements. The present work provides practical guidance for addressing both pragmaticism and meaningful patient engagement. Applying evidence-based approaches like PRECIS-2-tool and the 10-Step Engagement Framework offer practical guidance to make future trials in oncology truly pragmatic and patient-centered. Consequently, such patient-centered trials have improved participation, faster recruitment and greater retention, and uptake of innovative technologies in community-based care.
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Affiliation(s)
- Bernard Bright Davies-Teye
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Michelle Medeiros
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Cynthia Chauhan
- The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Claudia Rose Baquet
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
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Osarogiagbon RU, Vega DM, Fashoyin-Aje L, Wedam S, Ison G, Atienza S, De Porre P, Biswas T, Holloway JN, Hong DS, Wempe MM, Schilsky RL, Kim ES, Wade JL. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the ASCO-Friends of Cancer Research Prior Therapies Work Group. Clin Cancer Res 2021; 27:2408-2415. [PMID: 33563637 PMCID: PMC8170959 DOI: 10.1158/1078-0432.ccr-20-3854] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Restrictive eligibility criteria induce differences between clinical trial and "real-world" treatment populations. Restrictions based on prior therapies are common; minimizing them when appropriate may increase patient participation in clinical trials. EXPERIMENTAL DESIGN A multi-stakeholder working group developed a conceptual framework to guide evaluation of prevailing practices with respect to using prior treatment as selection criteria for clinical trials. The working group made recommendations to minimize restrictions based on prior therapies within the boundaries of scientific validity, patient centeredness, distributive justice, and beneficence. RECOMMENDATIONS (i) Patients are eligible for clinical trials regardless of the number or type of prior therapies and without requiring a specific therapy prior to enrollment unless a scientific or clinically based rationale is provided as justification. (ii) Prior therapy (either limits on number and type of prior therapies or requirements for specific therapies before enrollment) could be used to determine eligibility in the following cases: a) the agents being studied target a specific mechanism or pathway that could potentially interact with a prior therapy; b) the study design requires that all patients begin protocol-specified treatment at the same point in the disease trajectory; and c) in randomized clinical studies, if the therapy in the control arm is not appropriate for the patient due to previous therapies received. (iii) Trial designers should consider conducting evaluation separately from the primary endpoint analysis for participants who have received prior therapies. CONCLUSIONS Clinical trial sponsors and regulators should thoughtfully reexamine the use of prior therapy exposure as selection criteria to maximize clinical trial participation.See related commentary by Giantonio, p. 2369.
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Affiliation(s)
| | | | | | - Suparna Wedam
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Gwynn Ison
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sol Atienza
- Advocate Aurora Health, Milwaukee, Wisconsin
| | | | - Tithi Biswas
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | | | | | | | | | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - James L Wade
- Cancer Care Specialists of Central Illinois, Decatur, Illinois
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8
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Lee SJC, Murphy CC, Gerber DE, Geiger AM, Halm E, Nair RG, Cox JV, Tiro JA, Skinner CS. Reimbursement Matters: Overcoming Barriers to Clinical Trial Accrual. Med Care 2021; 59:461-466. [PMID: 33492049 PMCID: PMC8026490 DOI: 10.1097/mlr.0000000000001509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Accrual to cancer clinical trials is suboptimal. Few data exist regarding whether financial reimbursement might increase accruals. OBJECTIVE The objective of this study was to assess perceptions about reimbursement to overcome barriers to trial accrual. RESEARCH DESIGN This was a cross-sectional survey. SUBJECTS Oncologists identified from the American Medical Association Physician Masterfile. MEASURES We report descriptive statistics, associations of physician characteristics with perceptions of reimbursement, domains, and subthemes of free-text comments. RESULTS Respondents (n=1030) were mostly medical oncologists (59.4%), ages 35-54 (67%), and male (75%). Overall, 30% reported discussing trials with >25% of patients. Barriers perceived were administrative/regulatory, physician/staff time, and eligibility criteria. National Cancer Institute cooperative group participants and practice owners were more likely to endorse higher reimbursement. Respondents indicated targeted reimbursement would help improve infrastructure, but also noted potential ethical problems with reimbursement for discussion (40.7%) and accrual (85.9%). Free-text comments addressed reimbursement sources, recipients, and concerns about the real and apparent conflict of interest. CONCLUSIONS Though concerns about a potential conflict of interest remain paramount and must be addressed in any new system of reimbursement, oncologists believe reimbursement to enhance infrastructure could help overcome barriers to trial accrual.
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Affiliation(s)
- Simon J. Craddock Lee
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Caitlin C. Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - David E. Gerber
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Ann M. Geiger
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Ethan Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Rasmi G. Nair
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center
| | - John V. Cox
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jasmin A. Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
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9
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Nury E, Bischoff K, Wollmann K, Nitschke K, Lohner S, Schumacher M, Rücker G, Blümle A. Impact of investigator initiated trials and industry sponsored trials on medical practice (IMPACT): rationale and study design. BMC Med Res Methodol 2020; 20:246. [PMID: 33008297 PMCID: PMC7532587 DOI: 10.1186/s12874-020-01125-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The German Research Foundation (DFG) and the Federal Ministry of Education and Research (BMBF) initiated large research programs to foster high quality clinical research in the academic area. These investigator initiated trials (IITs) cover important areas of medical research and often go beyond the scope of industry sponsored trials (ISTs). The purpose of this project was to understand to what extent results of randomized controlled IITs and ISTs have an impact on medical practice, measured by their availability for decisions in healthcare and their implementation in clinical practice. We aimed to determine study characteristics influencing a trial's impact such as type of sponsor and place of conduct. In this article, we describe the rationale and design of this project and present the characteristics of the trials included in our study cohort. METHODS The research impact of the following sub-cohorts was compared: German IITs (funded by DFG and BMBF or by other German non-commercial organizations), international IITs (without German contribution), German ISTs, and international ISTs. Trials included were drawn from the DFG-/BMBF-Websites, the German Clinical Trials Register, and from ClinicalTrials.gov . Research impact was measured as follows: 1) proportion of published trials, 2) time to publication, 3) proportion of publications appropriately indexed in biomedical databases, 4) proportion of openly accessible publications, 5) broadness of publication's target group, 6) citation of publications by systematic reviews or meta-analyses, and 7) appearance of publications or citing systematic reviews or meta-analyses in clinical practice guidelines. We also aimed to identify study characteristics associated with the impact of trials. RESULTS We included 691 trials: 120 German IITs, 200 International IITs, 171 German ISTs and 200 International ISTs. The median number of participants was 150, 30% were international trials and 70% national trials, 48% drug-trials and 52% non-drug trials. Overall, 72% of the trials had one pre-defined primary endpoint, 28% two or more (max. 36). CONCLUSIONS The results of this project deepen our understanding of the impact of biomedical research on clinical practice and healthcare policy, add important insights for the efficient allocation of scarce research resources and may facilitate providing accountability to the different stakeholders involved.
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Affiliation(s)
- E. Nury
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - K. Bischoff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - K. Wollmann
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - K. Nitschke
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - S. Lohner
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Rákóczi út 2, Pécs, 7623 Hungary
| | - M. Schumacher
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104 Freiburg, Germany
| | - G. Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104 Freiburg, Germany
| | - A. Blümle
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2, 79110 Freiburg, Germany
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10
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Smeltzer MP, Osarogiagbon RU. Out of the Darkness, Into Light: The Scientific Rigor of Lung Cancer Clinical Trials in the Age of Enlightenment. J Thorac Oncol 2020; 15:1110-1112. [PMID: 32593444 DOI: 10.1016/j.jtho.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee.
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11
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Nevens H, Harrison J, Vrijens F, Verleye L, Stocquart N, Marynen E, Hulstaert F. Budgeting of non-commercial clinical trials: development of a budget tool by a public funding agency. Trials 2019; 20:714. [PMID: 31829233 PMCID: PMC6907219 DOI: 10.1186/s13063-019-3900-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/08/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Investigator-led multicentre randomised trials are essential to generate evidence on the optimal use of medical interventions. These non-commercial trials are often hampered by underfunding, which may lead to difficulties in gathering a team with the necessary expertise, a delayed trial start, slow recruitment and even early trial discontinuation. As a new public funder of pragmatic clinical trials, the KCE Trials programme was committed to correctly pay all trial activities in order to assure timely delivery of high-quality trial results. As no appropriate trial budget tool was readily publicly available that took into account the costs for the sponsor as well as the costs for participating sites, we developed a tool to make the budgeting of a clinical trial efficient, transparent and fair across applicants. METHODS All trial-related activities of the sponsor and sites were categorised, and cost drivers were identified. All elements were included in a spreadsheet tool allowing the sponsor team to calculate in detail the various activities of a clinical trial and to appreciate the budget impact of specific cost drivers, e.g. a delay in recruitment. Hourly fees by role were adapted from published data. Fixed amounts per activity were developed when appropriate. RESULTS This publicly available tool has already been used for 17 trials funded since the start of the KCE Trials programme in 2016, and it continues to be used and improved. This budget tool is used together with additional risk-reducing measures such as a multistep selection process with advance payments, a recruitment feasibility check by sponsor and funder, a close monitoring of study progress and a milestone-based payment schedule with the last payment made when the manuscript is submitted. CONCLUSIONS The budget tool helps the KCE Trials programme to answer relevant research questions in a timely way, within budget and with high quality, a necessary condition to achieve impact of this programme for patients, clinical practice and healthcare payers.
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Affiliation(s)
- Hilde Nevens
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium.
| | - Jillian Harrison
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - France Vrijens
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Leen Verleye
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Nelle Stocquart
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Elisabeth Marynen
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Frank Hulstaert
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
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12
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Dogan S, Yamamoto-Ibusuki M, Andre F. Funding sources of practice-changing trials. Ann Oncol 2018; 29:1063-1065. [DOI: 10.1093/annonc/mdx798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Hind D, Reeves BC, Bathers S, Bray C, Corkhill A, Hayward C, Harper L, Napp V, Norrie J, Speed C, Tremain L, Keat N, Bradburn M. Comparative costs and activity from a sample of UK clinical trials units. Trials 2017; 18:203. [PMID: 28464930 PMCID: PMC5414193 DOI: 10.1186/s13063-017-1934-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The costs of medical research are a concern. Clinical Trials Units (CTUs) need to better understand variations in the costs of their activities. METHODS Representatives of ten CTUs and two grant-awarding bodies pooled their experiences in discussions over 1.5 years. Five of the CTUs provided estimates of, and written justification for, costs associated with CTU activities required to implement an identical protocol. The protocol described a 5.5-year, nonpharmacological randomized controlled trial (RCT) conducted at 20 centres. Direct and indirect costs, the number of full time equivalents (FTEs) and the FTEs attracting overheads were compared and qualitative methods (unstructured interviews and thematic analysis) were used to interpret the results. Four members of the group (funding-body representatives or award panel members) reviewed the justification statements for transparency and information content. Separately, 163 activities common to trials were assigned to roles used by nine CTUs; the consistency of role delineation was assessed by Cohen's κ. RESULTS Median full economic cost of CTU activities was £769,637 (range: £661,112 to £1,383,323). Indirect costs varied considerably, accounting for between 15% and 59% (median 35%) of the full economic cost of the grant. Excluding one CTU, which used external statisticians, the total number of FTEs ranged from 2.0 to 3.0; total FTEs attracting overheads ranged from 0.3 to 2.0. Variation in directly incurred staff costs depended on whether CTUs: supported particular roles from core funding rather than grants; opted not to cost certain activities into the grant; assigned clerical or data management tasks to research or administrative staff; employed extensive on-site monitoring strategies (also the main source of variation in non-staff costs). Funders preferred written justifications of costs that described both FTEs and indicative tasks for funded roles, with itemised non-staff costs. Consistency in role delineation was fair (κ = 0.21-0.40) for statisticians/data managers and poor for other roles (κ < 0.20). CONCLUSIONS Some variation in costs is due to factors outside the control of CTUs such as access to core funding and levels of indirect costs levied by host institutions. Research is needed on strategies to control costs appropriately, especially the implementation of risk-based monitoring strategies.
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Affiliation(s)
- Daniel Hind
- CTRU, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Barnaby C. Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Queens Building, Level 7, Bristol Royal Infirmary, Bristol, BS2 8HW UK
| | - Sarah Bathers
- Caudwell Children, Minton Hollins, Shelton Old Road, Stoke on Trent, Staffordshire, ST4 7RY UK
| | - Christopher Bray
- Diabetes Trials Unit, OCDEM, Churchill Hospital, Old Road, Oxford, OX3 7LJ UK
| | - Andrea Corkhill
- University of Southampton, Clinical Trials Unit, MP131, Southampton General Hospital, Tremona Road, Southampton, Hants SO16 6YD UK
| | - Christopher Hayward
- Peninsula Clinical Trials Unit, Peninsula College of Medicine & Dentistry, Room N14, ITTC Building 1, Tamar Science Park, Plymouth, Devon PL6 8BX UK
| | - Lynda Harper
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH UK
| | - Vicky Napp
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT UK
| | - John Norrie
- Centre for Healthcare Randomised Trials (CHaRT) Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD UK
| | - Chris Speed
- Newcastle Clinical Trials Unit, Newcastle University, 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Liz Tremain
- National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS UK
| | - Nicola Keat
- Cancer Research UK, Angel Building, 407 St. John Street, London, EC1V 4AD UK
| | - Mike Bradburn
- CTRU, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
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Schilsky RL. Finding the Evidence in Real-World Evidence: Moving from Data to Information to Knowledge. J Am Coll Surg 2016; 224:1-7. [PMID: 27989954 DOI: 10.1016/j.jamcollsurg.2016.10.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Richard L Schilsky
- Executive Office, American Society of Clinical Oncology, Alexandria, VA.
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15
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The generalizability of NCI-sponsored clinical trials accrual among women with gynecologic malignancies. Gynecol Oncol 2016; 143:611-616. [PMID: 27697287 DOI: 10.1016/j.ygyno.2016.09.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/24/2016] [Accepted: 09/27/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Enrollment of a representative population to cancer clinical trials ensures scientific reliability and generalizability of results. This study evaluated the similarity of patients enrolled in NCI-supported group gynecologic cancer trials to the incident US population. METHODS Accrual to NCI-sponsored ovarian, uterine, and cervical cancer treatment trials between 2003 and 2012 were examined. Race, ethnicity, age, and insurance status were compared to the analogous US patient population estimated using adjusted SEER incidence data. RESULTS There were 18,913 accruals to 156 NCI-sponsored gynecologic cancer treatment trials, ovarian (56%), uterine (32%), and cervical cancers (12%). Ovarian cancer trials included the least racial, ethnic and age diversity. Black women were notably underrepresented in ovarian trials (4% versus 11%). Hispanic patients were underrepresented in ovarian and uterine trials (4% and 5% versus 18% and 19%, respectively), but not in cervical cancer trials (14 versus 11%). Elderly patients were underrepresented in each disease area, with the greatest underrepresentation seen in ovarian cancer patients over the age of 75 (7% versus 29%). Privately insured women were overrepresented among accrued ovarian cancer patients (87% versus 76%), and the uninsured were overrepresented among women with uterine or cervical cancers. These patterns did not change over time. CONCLUSIONS Several notable differences were observed between the patients accrued to NCI funded trials and the incident population. Improving representation of racial and ethnic minorities and elderly patients on cancer clinical trials continues to be a challenge and priority.
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16
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Bruner DW, Pugh SL, Yeager KA, Bruner J, Curran W. Cartographic Mapping and Travel Burden to Assess and Develop Strategies to Improve Minority Access to National Cancer Clinical Trials. Int J Radiat Oncol Biol Phys 2015; 93:702-9. [PMID: 26281827 DOI: 10.1016/j.ijrobp.2015.06.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/22/2015] [Accepted: 06/28/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess how accrual to clinical trials is related to US minority population density relative to clinical trial site location and distance traveled to Radiation Therapy Oncology Group (RTOG) clinical trial sites. METHODS AND MATERIALS Data included member site address and ZIP codes, patient accrual, and patient race or ethnicity and ZIP code. Geographic Information System maps were developed for overall, Latino, and African American accrual to trials by population density. The Kruskal-Wallis test was used to assess differences in distance traveled by site, type of trial, and race or ethnicity. RESULTS From 2006 to 2009, 6168 patients enrolled on RTOG trials. The RTOG US site distribution is generally concordant with overall population density. Sites with highest accrual are located throughout the United States and parts of Canada and do not cluster, nor does highest minority accrual cluster in areas of highest US minority population density. Of the 4913 US patients with complete data, patients traveled a median of 11.6 miles to participate in clinical trials. Whites traveled statistically longer distances (12.9 miles; P<.0001) to participate, followed by Latinos (8.22 miles) and African Americans (5.85 miles). Patients were willing to drive longer distances to academic sites than community sites, and there was a trend toward significantly longer median travel for therapeutic versus cancer control or metastatic trials. CONCLUSIONS Location matters, but only to a degree, for minority compared with nonminority participation in clinical trials. Geographic Information System tools help identify gaps in geographic access and travel burden for clinical trials participation. Strategies that emerged using these tools are discussed.
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Affiliation(s)
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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17
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Nelson NC, Keating P, Cambrosio A, Aguilar-Mahecha A, Basik M. Testing devices or experimental systems? Cancer clinical trials take the genomic turn. Soc Sci Med 2014; 111:74-83. [PMID: 24768778 DOI: 10.1016/j.socscimed.2014.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 03/25/2014] [Accepted: 04/07/2014] [Indexed: 02/03/2023]
Abstract
Clinical trials are often described as machine-like systems for generating specific information concerning drug safety and efficacy, and are understood as a component of the industrial drug development processes. This paper argues that contemporary clinical trials in oncology are not reducible to mere drug testing. Drawing on ethnographic fieldwork and interviews with researchers in the field of oncology from 2010 to 2013, we introduce a conceptual contrast between trials as testing machines and trials as clinical experimental systems to draw attention to the ways trials are increasingly being used to ask open-ended scientific questions. When viewed as testing machines, clinical trials are seen as a means to produce answers to straightforward questions and deviations from the protocol are seen as bugs in the system; but practitioners can also treat trials as clinical experimental systems to investigate as yet undefined problems and where heterogeneity becomes a means to produce novel biological or clinical insights. The rise of "biomarker-driven" clinical trials in oncology, which link measurable biological characteristics such as genetic mutations to clinical features such as a patient's response to a particular drug, exemplifies a trend towards more experimental styles of clinical work. These transformations are congruent with changes in the institutional structure of clinical research in oncology, including a movement towards more flexible, networked research arrangements, and towards using individual patients as model systems for asking biological questions.
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Affiliation(s)
- Nicole C Nelson
- Department of the History of Science, University of Wisconsin-Madison, 1225 Linden Drive, Madison, WI 53706, USA.
| | - Peter Keating
- Department of History, Université du Québec à Montréal, Pavillon Lionel-Groulx, 3150 Jean-Brillant, Montréal, Quebec H3T 1N, Canada.
| | - Alberto Cambrosio
- Department of Social Studies of Medicine, McGill University, Peel 3647, Montreal, Quebec H3A 1X1, Canada.
| | - Adriana Aguilar-Mahecha
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Quebec H3T 1E2, Canada.
| | - Mark Basik
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Quebec H3T 1E2, Canada.
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18
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Off-label use of anticancer drugs in eastern Switzerland: a population-based prospective cohort study. Eur J Clin Pharmacol 2014; 70:719-25. [PMID: 24609468 DOI: 10.1007/s00228-014-1662-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 02/21/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE Prevalence data on the off-label use (OLU) of anticancer drugs are limited despite OLU being controversial for medical, pharmaco-economic, and ethical reasons. We therefore quantified and characterized the OLU of anticancer drugs and compared OLU based on the national drug label with international treatment recommendations. METHODS We prospectively collected data on patients receiving systemic anticancer therapy between October and December 2012 at hospitals affiliated with the Eastern Switzerland Oncology Network. Individual data on patient characteristics, tumor disease, and systemic treatment were collected, and each individual treatment was compared with the national drug label and international treatment guidelines. RESULTS A total of 985 consecutive patients receiving 1,737 anticancer drug treatments were included in the study. Overall, 32.4 % of all patients received at least one off-label drug, corresponding to 27.2 % of all anticancer drugs administered. Major reasons for OLU were the lack of approval for the specific disease entity (15.7 %) and modified application of the anticancer drug (10 %). OLU that was unsupported by the current European Society for Medical Oncology (ESMO) treatment recommendations was rare (6.6 %) but higher for bevacizumab (29.6 %) due to its use in treating advanced ovarian cancer beyond the second-line setting and advanced breast cancer beyond the first-line setting and for lenalidomide (22.6 %) due to its use in treating Non-Hodgkin lymphoma. CONCLUSIONS Based on data collected on our patient cohort, OLU of anticancer drugs in a European clinical setting applies to one-third of all cancer patients. ESMO-unsupported use of chemotherapies or molecularly-targeted drugs is rare, opposing concerns that the off-label use of newer anticancer drugs is a substantial clinical problem.
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Abstract
OBJECTIVES To review the significant advances in cancer prevention, detection, treatment, and symptom management among the National Cancer Institute (NCI)-supported clinical trials cooperative groups, the Institute of Medicine (IOM) recommendations for restructuring of the national clinical trials infrastructure, and to discuss the contributions nurses have made in national clinical trials. DATA SOURCE Published cooperative group manuscripts and NCI data. CONCLUSION The NCI-sponsored clinical trials cooperative groups have conducted major evidence-based, practice-changing clinical trials. Despite the advances, challenges in the process of clinical trials have caused the NCI to restructure the clinical trials network to improve efficiencies and decrease time from concept to protocol development to clinical trials completion. IMPLICATIONS FOR NURSING PRACTICE Nurse investigators work with the cooperative groups for a number of reasons, including access to a large multisite population of cancer patients, making findings more generalizable. There are also increasing opportunities for areas of research including biomechanistic understanding of symptoms and symptom therapies, survivorship, and cancer care delivery.
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20
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Doroshow JH, Sleijfer S, Stupp R, Anderson K. Cancer clinical trials--do we need a new algorithm in the age of stratified medicine? Oncologist 2013; 18:651-2. [PMID: 23814160 PMCID: PMC4063387 DOI: 10.1634/theoncologist.2013-0190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 12/31/2022] Open
Abstract
The explosion in genomic discovery science and its application in oncology in recent years is underpinning an unprecedented increase in our understanding of mechanisms underlying malignant processes. An increased understanding creates challenges pertinent to the area of cancer clinical trial development and application. Although the existing cancer clinical trial algorithm has served us well in the past, is it still fit for purpose in the 21st century?
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Affiliation(s)
- James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland 20892, USA.
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