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Survey of oncologists' perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials†
Article first published online: 19 AUG 2002
Copyright © 2002 American Cancer Society
Volume 95, Issue 5, pages 989–996, 1 September 2002
How to Cite
Kornblith, A. B., Kemeny, M., Peterson, B. L., Wheeler, J., Crawford, J., Bartlett, N., Fleming, G., Graziano, S., Muss, H., Cohen, H. J. and Cancer and Leukemia Group B (2002), Survey of oncologists' perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials. Cancer, 95: 989–996. doi: 10.1002/cncr.10792
The authors are indebted to all of the physicians who took the time to participate in this survey. It also was clear that this study could not have been done without the clinical research associates and nurses at the major participating sites who juggled the complicated research procedures of the larger pilot study, including this survey. The authors' special thanks go to the following individuals: Ms. Sarah Beddingfield (Duke University Medical Center), Ms. Donna Galgano (North Shore-Long Island Jewish Medical Center), Ms. Jan Marie McEvilly (University of Chicago Medical Center), Ms. Donna Silver (Vermont Cancer Center), Ms. Laurie Smith (Washington University Medical Center), and Ms. Diane Gould (State University of New York Upstate Medical University).
- Issue published online: 19 AUG 2002
- Article first published online: 19 AUG 2002
- Manuscript Accepted: 15 APR 2002
- Manuscript Revised: 28 FEB 2002
- Manuscript Received: 10 DEC 2001
- National Institute on Aging
- National Cancer Institute. Grant Number: CA31946
- clinical trials;
- breast carcinoma;
- elderly patients;
- physician perspective
Prior research has documented the under-representation in clinical trials of older patients with cancer. In part of a larger study to test the magnitude of these barriers to entering eligible older patients with carcinoma of the breast into clinical trials (Cancer and Leukemia Group B [CALGB] trial 9670), barriers to accruing eligible older patients to clinical trials were obtained from the physician's perspective.
One hundred fifty-six physicians (85% oncologists) who treated patients with breast carcinoma at 10 CALGB institutions completed a questionnaire concerning what they perceived as barriers to enrolling older patients with breast carcinoma on clinical trials and possible interventions that may improve accrual.
Physicians' perceptions of the most important barriers to accrual of older patients were: 1) elderly patients have significant comorbid conditions that are not excluded by the protocol but that may affect how they would respond to treatment (16%); elderly patients have difficulty understanding what is required in a complicated treatment trial, resulting in poor compliance (16%); treatment toxicity (14%); and elderly patients often do not meet the eligibility criteria (15%). Oncologists most frequently suggested that the most effective interventions for improving the accrual of elderly patients to trials included making personnel available in the clinic to explain clinical trials to older patients and their families (25%) and providing physicians with educational materials concerning treatment toxicity in the elderly (18%).
Physicians viewed barriers to accruing older patients with breast carcinoma to clinical trials as multidimensional, with the most important involving protocol requirements, treatment specific issues, and older patients' medical and cognitive characteristics. Thus, a variety of interventions would be needed to improve accrual of older patients to clinical trials, including increasing physicians' knowledge concerning treatment toxicity in the elderly, simplifying protocol requirements, and reducing treatment toxicity. Cancer 2002;95:989–96. © 2002 American Cancer Society.