Blog Entry: January 26th, 2010

A Washington Post op-ed by Georgetown University's John L. Marshall, MD, and a letter published in response, outline just some of the difficulties in making progress against cancer-not least of which is persuading adult cancer patients to take part in clinical trials.

In a 2009 Research!America poll of the general public, 30 percent of Americans say that they would be very likely to participate in a clinical trial, yet just six percent say their doctor has ever suggested it. Willingness in concept and actual participation may be vastly different things, but for cancer patients, whose incentive to participate in clinical research should be strong, the numbers are disconcertingly low. Although 20 percent of all cancer patients are eligible, fewer than five percent take part in cancer clinical trials-and the numbers are even lower among minorities and medically underserved populations. 1,2,3,4  Nearly 40 percent of National Cancer Institute cooperative group trials close early.5

As Dr. Marshall wrote in the Post, "Our understanding of cancer therapies comes from the five percent of patients who enroll in trials, a tiny database when we consider the highly variable nature of the disease." Given this, our slow rate of progress against cancer may be less surprising, but frustration with that pace should be a wake-up call.

Proven solutions do exist. Trial participation can be enhanced through community-driven education and advocacy efforts, by helping to change attitudes and behaviors of providers and patients. ENACCT is the only national organization solely focused on identifying community-centered approaches to cancer clinical trials education. ENACCT's well-regarded training programs have helped community leaders, primary care providers and cancer research staff break down some of the complex barriers to getting more patients involved in research. Implementing such programs on a broader scale is a crucial step to making greater strides against all types of cancer and particularly in reducing the disproportionate impact on some of the most vulnerable Americans.

Special thanks to ENACCT Board Member Heather Jameson of Research!America for her work on this posting
 


Sources:

1 Harnessing Science: Advancing Care by Accelerating the Rate of Cancer Clinical Trial Participation Hearing before the Committee on Government Reform House of Representatives One Hundred Eight Congress Second Session May 13, 2004 Serial No. 108-189 Retrieved 2007 from GPO Access Web site: http://www.gpoaccess.gov/congress/index.html; http://oversight.house.gov

2 Sateren, W. B., et al. (2002). How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials. Journal of Clinical Oncology, 20, 2109-2117.
Christian, M. C., & Trimble, E. L. (2003). Increasing participation of physicians and patients from
underrepresented racial and ethnic groups in National Cancer Institute-sponsored clinical trials. Cancer Epidemiology Biomarkers & Prevention, 12, 277s-283s.; Cancer clinical trials: A resource guide for outreach, education, and advocacy. Retrieved 2006 from National Cancer Institute Web site: www.cancer.gov/clinicaltrials/resources/outreach-education-advocacy; Digest Page: Boosting Cancer Trial Participation. Retrieved 2006 from National Institutes of Health, National Cancer Institute Web site: http://cancer.gov/clinicaltrials/digestpage/boosting-trial-participation

3 Brawley, O. The study of accrual to clinical trials: Can we learn from studying who enters our studies? Journal of Clinical Oncology, 2004. 22(11), 2039-2040.

4 Murthy VH, Krumholz HM, Gross CP Participation in cancer clinical trials: race-, sex-, and age-based disparities.; JAMA. 2004 Jun 9;291(22):2720-6.
Stewart et al Participation in Surgical Oncology Clinical Trials:Gender-, Race/Ethnicity-, and Age-based Disparities Annals of Surgical Oncology 14(12):3328-3334

5 Dilts, D. (2008). (Vanderbilt University) Personal correspondence based on unpublished data of CALGB and ECOG; February 2, 2008.