Recruitment of patients into head and neck clinical trials: acceptability of studies to patients from perspective of the research team

Comparison of Patients With Head and Neck Cancer in Randomized Clinical Trials and Clinical Practice: A Systematic Review

Importance

When patient populations in randomized clinical trials deviate too much from the general population, it undermines the relevance for daily practice.

Objective

To investigate if patients with head and neck cancer in randomized clinical trials are representative of the clinically treated population.

Evidence Review

A systematic literature search was performed for randomized clinical trials on head and neck cancer evaluating an intervention to improve outcome with total sample size of 100 patients or greater and published between 2009 and 2019. Outcome measures were age, performance status, and recruitment rate. National cancer registries provided reference data. Databases that were searched included MEDLINE and Epub Ahead of Print; Embase; Cochrane Central Register of Controlled Trials; and ClinicalTrials.gov. Abstracts of search results were retrieved to assess selection criteria by 2 reviewers independently. After the selection procedure was completed by both reviewers, the results were compared and reviewed once more to reach consensus. Full articles were downloaded to retrieve general study information and outcome data.

Findings

A total of 16 927 publications were identified, resulting in 87 compliant randomized clinical trials with a total of 34 241 patients. Half of the trials included all major head and neck sites, and one-third were exclusively for nasopharynx cancers. The experimental intervention was systemic treatment in 47 (54%) studies, radiotherapy in 23 (26%), and other in 17 (20%). Median sample size was 332, and median duration of accrual was 4.6 years. Median accrual per center per year for head and neck and nasopharynx trials was 5.4 and 39.7 patients, respectively. Median age of patients in head and neck trials was 57 years, which was 7 years younger than in cancer registries. More than 70% of patients had a World Health Organization performance score of 0 to 1 or a Karnofsky performance status of 90 to 100.

Conclusions and Relevance

In this systematic review, patients in head and neck randomized clinical trials had a very good performance status, and half of them were younger than 57 years, while half of the clinical population was older than 64 years. In more than 50% of the head and neck trials, the yearly accrual per center was less than 6 patients, suggesting overly restrictive recruitment. Critical appraisal of trial population characteristics is recommended before results are implemented in clinical guidelines and general practice.

Patient Recruitment in Radiation Therapy Research: An Evaluation of Local Challenges

INTRODUCTION

Locally-initiated research studies in radiation therapy (RT) aim to substantiate clinical processes and are an effective approach to gather evidence for advances in patient care, new techniques, and protocols. The aim of this study was to retrospectively quantify recruitment challenges at a radiation oncology network (RON).

METHODS

Five locally initiated studies were included for analysis through the criteria of being undertaken within 2001-2017, initiated through local research teams, and having recruitment records available. Data extraction from each study included duration, aims, patient activities, recruitment strategy, target number of participants, and number of participants who were recruited/not recruited and who withdrew from the study. Reasons for nonregistration and withdrawal were recorded if available. Two studies are presented as case studies.

RESULTS

Included studies were diverse in patient population and study aim and included patient immobilization (lung and breast cancer), evaluation of radiation-induced esophagitis, documentation of anatomical and dosimetric changes in patients with head and neck cancer, and education (breast cancer). The exclusion of non-English-speaking patients, which is significant for the RON, which covers a wide cultural and linguistic diversity, was an important limiting factor, along with RT patients' disinterest in participation.

DISCUSSION

Challenges experienced in the evaluated RON studies are similar to non-RT clinical trials and included difficulties with patients interacting with study protocol, health practitioners' influence, and patient-related inclusion issues.

CONCLUSION

The resulting database provides a foundation for continued monitoring and documentation of study recruitment practice, which could elicit positive effects on planning and implementation of future patient recruitment strategies in RT locally initiated studies.