Abstract A106: Patient, provider, protocol, and health systems barriers to cancer clinical trial accrual at an academic medical center: Identifying interventions to increase representation of racial/ethnic minorities
Authors: Ward James , Polite Blase 
Published: June 2012

Background: Cancer is currently the second leading cause of death in the USA, however many gains are being made in cancer therapeutics due in large part to patient participation in clinical trials. It is estimated that 20% of patients nationwide are eligible for a clinical trial, but only 3% are actually enrolled. At the University of Chicago, almost 50% of new patients are eligible for a cancer clinical trial, but only 15% are enrolled. Furthermore, only half of eligible patients are offered enrollment. African-Americans have worse outcomes across the cancer care continuum compared to Caucasians; however these outcomes can be ameliorated when patients receive standardized care according to a clinical trial. African-Americans are underrepresented amongst cancer clinical trial participants, despite evidence from our institution that African-Americans were more than twice as likely as Caucasians to enroll in a cancer clinical trial when offered. We hypothesize that a provider-directed intervention will increase rates of cancer clinical trial enrollment amongst African-Americans. In order to identify potential intervention strategies, we surveyed staff in the Section of Hematology/Oncology at the University of Chicago regarding clinical trial accrual.

Methods: A short, seven question, survey was distributed to all employees in the Section of Hematology/Oncology who were directly involved in clinical care or research. The survey queried respondents about their opinions on the current impediments to and facilitators of cancer clinical trial accrual at the University of Chicago as well as asking for their opinions on ways to improve the process.

Results: 52/128 (41%) of the surveys were completed and returned, including 37/62 (60%) of MD's surveyed. We divided the results into four categories, patient barriers, provider barriers, protocol barriers and health system barriers. The following numbers reflect the percentage of survey respondents that mentioned a specific barrier. Per this metric, the most common patient-related barriers to enrollment were: distance of travel (27%), lack of interest (19%), perceived bias against trials (11.5%). The most common protocol related barriers were: strict eligibility criteria (19%), prolonged screening time (17%), complexity of trials (13.5%), and lack of trials (11.5%). The most common provider-related barriers were: busy schedule (21%) and lack of knowledge about trials (13.5%). The most common health systems related barriers were: insufficient staff (23%), clinic inefficiency (19%) and lack of advertising/communication in the community (17%).

Conclusions: This survey revealed many barriers to cancer clinical trial accrual at an academic medical center. This was a hypothesis generating study and interventions based on these barriers should be further studied. Based on this data further work is planned in order to test the hypothesis that a provider-directed, reminder-based intervention will increase the rate that a trial is offered and increase the rate of trial enrollment amongst African-Americans.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A106.