Who Enrolls in Clinical Oncology Trials? A National Cancer Institute-Sponsored Patterns of Care Study Analysis
SALT LAKE CITY, UTAH (October 21, 2003) — A new study sponsored by the National Cancer Institute shows that a patient's race and the kind of institution where a patient seeks cancer treatment both influence the likelihood of that patient enrolling in an oncology clinical trial. The results were presented today by Benjamin Movsas, MD, vice chairman of radiation oncology at Fox Chase Cancer Center, at the 45th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) in Salt Lake City, Utah.
"The purpose of this study was to identify factors that significantly influence accrual to clinical research protocols by analyzing Patterns of Care Study surveys of 3,047 randomly selected radiation patients," explained Movsas.
The new study analyzed Patterns of Care Study surveys done between 1992-94 and 1996-99. Of the patients surveyed, 1,080 had breast cancer, 1,149 had prostate cancer and 818 had esophageal cancer. As part of this NCI-funded national survey, institutions that offer radiation therapy were randomly selected for the study. The patients analyzed in this study had non-metastatic disease and received radiation therapy as definitive or adjuvant therapy.
Trained research associated reviewed 3,047 patient records. The study examined age, gender, race, type of insurance and practice type of treating institution (academic or not) as well as participation in clinical trials.
Overall, only 2.7 percent of all patients were accrued to clinical protocols, which is consistent with national estimates.
"After accounting for the patients' age, gender, race, type of insurance and the type of treating institution via a multivariate analysis, we can see that the practice type and a patient's race were highly significant predictors of whether or not a patient joined a clinical trial," Movsas explained.
More specifically, 9.4 percent of patients treated with radiation therapy at an academic practice enrolled in trials versus 1.7 percent of patients at non-academic sites, yet the vast majority, 87 percent of all patients, was seen at non-academic sites. Also significant, white patients enrolled onto studies more than African-Americans (2.8 percent versus 0.8 percent).
"Our results suggest that increased communication and education regarding research protocols will be essential to enhance accrual," said Movsas. "There will need to be a particular focus on physicians in non-academic settings and minority patients."
A higher percentage of patients with esophageal cancer (9.8 percent) took part in trials compared to patients with either breast cancer (2.2 percent) or prostate cancer (1.98 percent). Patients at younger ages demonstrated a trend towards increased enrollment (3.5 percent for patients younger than 70 year versus 1.5 percent for patients 70 or older). However, gender and type of insurance were not predictive.
In addition to Movsas, other authors of the study include Jennifer Moughan, and Jean Owen, of the American College of Radiology, Philadelphia, Pa.; Lawrence Coia, of the Community Medical Center, Toms River, N.J.; Michael Zelefsky, of Memorial Sloan Kettering Cancer Center, New York City; Gerald E. Hanks, retired from Fox Chase Cancer Center; and J. Frank Wilson, of the Medical College of Wisconsin, Milwaukee, Wis.
Fox Chase Cancer Center, part of Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase also was among the first institutions to receive the National Cancer Institute’s prestigious comprehensive cancer center designation in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are routinely recognized in national rankings, and the Center’s nursing program has achieved Magnet status for excellence three consecutive times. Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research and oversees programs in cancer prevention, detection, survivorship, and community outreach. For more information, call 1-888-FOX-CHASE (1-888-369-2427).