Abstract
Purpose
Patient participation in cancer clinical trials is imperative to the advancement of medical science. Physicians play an important role in recruitment by discussing clinical trials with their cancer patients. Patient–physician discussion is influenced by many factors relating to the physician, the patient, and the healthcare system.
Methods
Physicians selected from the 2008–2009 American Medical Association Physician Masterfile who practiced in California, Florida, Illinois, or New York and specialized in medical oncology, surgery, or radiation oncology were surveyed about their attitudes and practices with respect to breast cancer clinical trials. Practice types were categorized according to the classifications provided by the American College of Surgeons, and clinical trial and practice addresses were geocoded.
Results
Surveys were completed by 706 of 1,534 eligible physicians (46 %). Medical oncologists were more likely than surgical or radiation oncologists to discuss the possibility, benefits, and risks of clinical trial enrollment with their breast cancer patients. Physicians who spent the most time in patient care were least likely to discuss clinical trials with their patients. Distance from a physician’s practice to the nearest clinical trial site was inversely associated with referral and recruitment. Perceived barriers to clinical trial participation were associated with greater referral activity suggesting that physicians who were more involved in trials were also more likely to understand barriers to participation.
Conclusions
Multilevel interventions may be successful at increasing participation of women in clinical trials.
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References
Foley JF, Moertel CG (1991) Improving accrual into cancer clinical trials. J Cancer Educ 6:165–173
Siminoff LA, Zhang A, Colabianchi N, Sturm CM, Shen Q (2000) Factors that predict the referral of breast cancer patients onto clinical trials by their surgeons and medical oncologists. J Clin Oncol 18:1203–1211
Nguyen TT, Somkin CP, Ma Y (2005) Participation of Asian-American women in cancer chemoprevention research: physician perspectives. Cancer 104:3006–3014
Howerton MW, Gibbons MC, Baffi CR, Gary TL, Lai GY, Bolen S, Tilburt J, Tanpitukpongse TP, Wilson RF, Powe NR, Bass EB, Ford JG (2007) Provider roles in the recruitment of underrepresented populations to cancer clinical trials. Cancer 109:465–476
Sherwood PR, Given BA, Scholnik A, Given CW (2004) To refer or not to refer: factors that affect primary care provider referral of patients with cancer to clinical treatment trials. J Cancer Educ 19:58–65
Simon MS, Du W, Flaherty L, Philip PA, Lorusso P, Miree C, Smith D, Brown DR (2004) Factors associated with breast cancer clinical trials participation and enrollment at a large academic medical center. J Clin Oncol 22:2046–2052
Lara P, Higdon R, Lim N, Kwan K, Tanaka M, Lau D, Wun T, Welborn J, Meyers FJ, Christensen S (2001) Prospective evaluation of cancer clinical trial accrual patterns: identifying potential barriers to enrollment. J Clin Oncol 19:1728–1733
Mannel RS, Walker J, Gould N, Scribner DR, Kamelle S, Tillmanns T, McMeeking S, Gold M (2003) Impact of individual physicians on enrollment of patients into clinical trials. Am J Clin Oncol 26:171–173
Martin RC, Polk HC, Jaques DP (2003) Does additional surgical training increases participation in randomized controlled trials? Am J Surg 185:239–243
Ramirez AG, Wildes K, Talavera G, Napoles-Springer A, Gallion K, Perez-Stable EJ (2008) Clinical trials attitudes and practices of Latino physicians. Contemp Clin Trials 29:482–492
Klabunde CN, Keating NL, Potosky AL, Ambs A, He Y, Hornbrook MC, Ganz PA (2011) A population-based assessment of specialty physician involvement in cancer clinical trials. J Natl Cancer Inst 103:384–397
Leitch AM, Beitsch PD, McCall LM, Posther K, Newman LA, Herndon JE 2nd, Hunt KK, Giuliano AE (2005) Patterns of participation and successful patient recruitment to American College of Surgeons Oncology Group Z0010, a phase II trial for patients with early-stage breast cancer. Am J Surg 190:539–542
Melisko ME, Hassin F, Metzroth L, Moore DH, Brown B, Patel K, Rugo HS, Tripathy D (2005) Patient and physician attitudes toward breast cancer clinical trials: developing interventions based on understanding barriers. Clin Breast Cancer 6:45–54
Pinto HA, McCaskill-Stevens W, Wolfe P, Marcus AC (2000) Physician perspectives on increasing minorities in cancer clinical trials: an Eastern Cooperative Oncology Group (ECOG) Initiative. Ann Epidemiol 10:S78–S84
Malat J, van Ryn M (2005) African-American preference for same-race healthcare providers: the role of healthcare discrimination. Ethn Dis 15:740–747
American Cancer Society (2012) Clinical trials: state laws about insurance coverage. American Cancer Society, Atlanta
Monheit AC, Vistnes JP (2000) Race/ethnicity and health insurance status: 1987 and 1996. Med Care Res Rev 57(Suppl 1):11–35
Kornblith AB, Kemeny M, Peterson BL, Wheeler J, Crawford J, Bartlett N, Fleming G, Graziano S, Muss H, Cohen HJ (2002) Survey of oncologists’ perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials. Cancer 95:989–996
Acknowledgments
This research was funded by Breast Cancer Research Programs as part of the Department of Defense Congressionally Directed Medical Research Programs (grant # W81XWH-06-0254).
Conflict of interest
Dr. Hwang discloses a consultant interest with Genomic Health, Inc. All other authors declare that they have no conflict of interest.
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Kaplan, C.P., Nápoles, A.M., Dohan, D. et al. Clinical trial discussion, referral, and recruitment: physician, patient, and system factors. Cancer Causes Control 24, 979–988 (2013). https://doi.org/10.1007/s10552-013-0173-5
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DOI: https://doi.org/10.1007/s10552-013-0173-5