Coaching intervention as a strategy for minority recruitment to cancer clinical trials

PURPOSE

Lack of trust and rapport with health care providers has been identified in the under-representation of racial/ethnic minorities within clinical trials. Our study used a coach to promote trust among minority patients with advanced cancer.

PATIENTS AND METHODS

Minority patients with advanced breast, colorectal, lung, or prostate carcinoma were randomly assigned to receive a coach Intervention (CI) or usual care (UC). All patients completed baseline and 6-month telephone interviews to assess demographics, trust in health care providers, attitudes toward clinical trials, and quality of life. Patients randomly assigned to CI were assigned a coach, who made biweekly contacts for 6 months to address general issues, progress or development in cancer care, and available resources. Patients randomly assigned to UC received the standard of care, without this intervention. Clinical trial enrollment was assessed.

RESULTS

Over 21 months, we screened 268 patients and enrolled 73 African Americans and two Asian Americans. Patients were randomly assigned to CI (n = 38) or to UC (n = 37). Longitudinal analyses were conducted on 69 patients who completed the 6-month follow-up assessment. Trial enrollment was 16 and 13 patients for the CI and UC groups, respectively. This difference was not significant (P = .351). Higher quality of life (1-point odds ratio on Functional Assessment of Cancer Treatment-General = 1.033, P = .036) and positive attitudes toward trials predicted enrollment. There was no significant difference between these groups in quality of life, attitudes toward clinical trials, perceptions of racism, trust in doctors, or depression.

CONCLUSIONS

Quality of life and positive attitude toward trials predicted trial enrollment, regardless of assignment to CI or UC.

An institutional strategy to increase minority recruitment to therapeutic trials

PURPOSE

Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We present a framework for institutional enhancement of minority clinical trial accrual.

METHODS

We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: (1) leadership support; (2) center-wide policy change; (3) infrastructural process control, data analysis, and reporting; and (4) follow-up with clinical investigators. A Protocol Review and Monitoring Committee reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities leads efforts for proportional accrual, supporting the system through data tracking, Web tools, and feedback to investigators.

RESULTS

Following implementation in 2005, minority accrual to therapeutic trials increased from 12.0 % in 2005 to 14.0 % in 2010. The "rolling average" minority cancer incidence at the institution during this timeframe was 17.5 %. In addition to therapeutic trial accrual rates, we note significant increase in the number of minorities participating in all trials (therapeutic and nontherapeutic) from 2005 to 2010 (346-552, 60 % increase, p < 0.05) compared to a 52 % increase for Caucasians.

CONCLUSIONS

Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring of accrual, offers a successful strategy that can be replicated in other cancer centers, an approach that may extend to other clinical and translational research centers.

Abstract A40: An institutional strategy to increase minority recruitment to therapeutic trials

Purpose: Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet NIH-mandated goals, strategies to increase participation are required. Here, we present a framework for institutional enhancement of minority clinical trial accrual that provides linkages to other interventions. We report implementation of this framework at the Siteman Cancer Center, an NCI-designated Comprehensive Cancer Center.

Methods: We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: 1) leadership support, 2) center-wide policy change, 3) infrastructural process control, data analysis and reporting and 4) follow up with clinical investigators. The Protocol Review and Monitoring Committee (PRMC) reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities (PECaD) leads efforts for proportional accrual, supporting the system through data tracking and web tools.

Results: Following implementation in 2005, minority accrual to trials (therapeutic and nontherapeutic) increased from 13.7% in 2005, to 14.4% in 2006,15.9% in 2007 and 16.8% in 2008. The “rolling average” minority cancer incidence at the Cancer Center during this four-year timeframe was 17.3%. There has been an increase in the number of minorities participating in clinical trials in the years 2005 to 2008 (from 346 to 630,82%) compared to a 43% increase in the number of Caucasians during the same time period. Minority accrual in therapeutic clinical trials increased from 11.4% to 14.6%.

Conclusion: Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring accrual, offers a successful strategy that can be replicated in other cancer centers. This approach may also be extendable to other clinical and translational centers.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A40.

Factors influencing enrollment in clinical trials for cancer treatment

BACKGROUND

Recruitment of cancer patients to clinical trials is an ongoing challenge. In this study, we assess factors that may influence enrollment in clinical trials for cancer treatment.

METHODS

Between June 1997 and January 1998, data were collected on all adult cancer patients evaluated for enrollment in National Cancer Institute-sponsored clinical trials at 15 medical facilities in the southeastern United States.

RESULTS

More than 2,300 cancer patients were evaluated; 7% were enrolled. Neither patient sex nor race predicted enrollment. Patients with fee-for-service coverage were more than twice as likely to be enrolled compared with patients with other types of coverage, including managed care. Patient refusal accounted for the nonenrollment of nearly 40% of those clinically eligible.

CONCLUSIONS

Although multiple factors influence enrollment in clinical trials for cancer treatment, results suggest that insurance coverage plays a role. Patient refusal, a substantial reason for nonenrollment, points to the need for continued efforts to educate physicians and the public in the value of clinical trials.