Abstract P5-13-02: Decision making from multidisciplinary team meetings to bedside: factors predicting for physicians' and breast cancer patients' acceptance of clinical trials proposed by MTMs
Authors: J Deneuve, C Mazouni, M Arnedos, F Prenois, M Saghatchian, F André, C Bourrgier, S Delaloge
Journal: Cancer Research (2012)

Abstract Background: In University hospitals or Comprehensive Cancer Centers (CCC), breast cancer (BC) patients have a theoretically large access to clinical trials as part of the management and treatment of their localized or advanced disease. Though, most patients are not proposed inclusion into suitable trials or studies or do not accept them. We aimed at determining the factors that influence physicians and patient's choice to respectively propose or enter clinical trials for which the patients were considered eligible by MTM. Methods: Patients who were considered eligible for a clinical trial by a BC-specific multidisciplinary team meeting (MTM) assessing their cases were prospectively registered during a 6 months period. The complete files of these patients were prospectively registered following initial written proposal by the MTM. The 27 clinical trials proposed were classified in 5 categories: cognitive studies, imaging, radiation therapy, diagnostic/prognostic biology, or interventional therapeutic studies. Detailed analysis of factors predicting physician's proposal and patient's final inclusion was conducted. Candidate factors were age, socio-demographic characteristics, PS, type of clinician, time intervals, stage of disease, type of disease, type of study, single vs multiple study proposal. Results: MTM proposed 547 inclusions into clinical trials for 397 patients between March 3rd and Sept 21st, 2011. 267 pts were considered eligible for 1 trial, 100 for 2, 25 for 3, 4 for 4 and 1 for 5 trials; 211 for cognitive studies, 13 for imaging, 71 for radiation therapy, 136 for diagnostic/prognostic biology, 116 for interventional therapeutic studies. Upon referral physician's visit, the trial was only proposed in 39.3% and pts were finally included in 29.1% of the cases. Reasons for non inclusion were patients' refusal in only 5–11%, but absence of proposal by physician in 45–81%, according to the types of studies. The only factor predicting both proposal by the referral physician's and final inclusion into trials was type of study (both p &amp;lt; 0.001). Diagnostic/prognostic biology trials were proposed in 71%, while interventional therapeutic and cognitive studies were only respectively proposed in 35 and 19% of the cases. The factors predicting non-inclusion upon physicians' proposal were professional status (p = 0.03) and type of study (p = 0.0007). The highest inclusion rates were among retired pts and those with executive work (84 and 76% respectively). Conclusion: The main reason for non inclusion into clinical trials remains absence of physicians' proposal, while professional status and type of study influence both the physicians' and the patients' decision. Educative measures dedicated mostly to treating physicians might be proposed. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-13-02.