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Khan MMM, Munir MM, Woldesenbet S, Khalil M, Endo Y, Katayama E, Altaf A, Dillhoff M, Obeng-Gyasi S, Pawlik TM. Disparities in clinical trial enrollment among patients with gastrointestinal cancer relative to minority-serving and safety-netting hospitals. J Gastrointest Surg 2024:S1091-255X(24)00381-0. [PMID: 38555017 DOI: 10.1016/j.gassur.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND For results to be generalizable to all patients with cancer, clinical trials need to include a diverse patient demographic that is representative of the general population. We sought to characterize the effect of receiving care at a minority-serving hospital (MSH) and/or safety-net hospital on clinical trial enrollment among patients with gastrointestinal (GI) malignancies. METHODS Adult patients with GI cancer who underwent oncologic surgery and were enrolled in institutional-/National Cancer Institute-funded clinical trials between 2012 and 2019 were identified in the National Cancer Database. Multivariable regression was used to assess the relationship between MSH and safety-net status relative to clinical trial enrollment. RESULTS Among 1,112,594 patients, 994,598 (89.4%) were treated at a non-MSH, whereas 117,996 (10.6%) were treated at an MSH. Only 1857 patients (0.2%) were enrolled in a clinical trial; most patients received care at a non-MSH (1794 [96.6%]). On multivariable analysis, the odds of enrollment in a clinical trial were markedly lower among patients treated at an MSH vs non-MSH (odds ratio [OR], 0.32; 95% CI, 0.22-0.46). In addition, even after controlling for receipt of care at MSH, Black patients remained at lower odds of enrollment in a clinical trial than White patients (OR, 0.57; 95% CI, 0.45-0.73; both P < .05). CONCLUSION Overall, clinical trial participation among patients with GI cancer was extremely low. Patients treated at an MSH and high safety-net burden hospitals and Black individuals were much less likely to be enrolled in a clinical trial. Efforts should be made to improve trial enrollment and address disparities in trial representation.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Selamawit Woldesenbet
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Mujtaba Khalil
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Erryk Katayama
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Abdullah Altaf
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Mary Dillhoff
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States.
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Odedina FT, Wieland ML, Barbel-Johnson K, Crook JM. Community Engagement Strategies for Underrepresented Racial and Ethnic Populations. Mayo Clin Proc 2024; 99:159-171. [PMID: 38176825 DOI: 10.1016/j.mayocp.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 01/06/2024]
Abstract
The representation of racial and ethnic minority populations in clinical trials continues to be a challenge despite mandates, good intentions, and concerted efforts by funding agencies, regulatory bodies, and researchers to close the clinical trials gap. A lack of diversity in research results in both continued disparities and poorer health outcomes. It is thus imperative that investigators understand and effectively address the challenges of clinical trials participation by underrepresented populations. In this paper, we expound on best practices for participatory research by clearly defining the community, highlighting the importance of proper identification and engagement of strong community partners, and exploring patient- and provider-level barriers and facilitators that require consideration. A clearer understanding of the balance of power between researchers and community partners is needed for any approach that addresses clinical trials representation. Unintended biases in study design and methods may continue to prevent racial and ethnic minority participants from taking part, and significant organizational changes are necessary for efficient and transparent relationships. Comprehensive community engagement in research includes dissemination of clinical trial results within and in partnership with community partners. Through careful deliberation and honest reflection, investigators, institutions, and community partners can develop the tailored blueprints of research collaborations essential for true equity in clinical trials.
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Affiliation(s)
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN
| | | | - Jennifer M Crook
- Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, FL
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3
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Commaroto S, Camacho-Rivera M, Guo Y, Hong YR, Turner K, Islam IK, Rivera A, Islam JY. Racial and ethnic disparities in knowledge, attitudes, and invitation to participate in clinical trials among cancer survivors in the United States: An analysis of the 2020 U.S. HINTS. Prev Med Rep 2024; 37:102564. [PMID: 38205172 PMCID: PMC10776641 DOI: 10.1016/j.pmedr.2023.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Background Despite the use of clinical trials to provide gold-standard evidence of cancer treatment and intervention effectiveness, racial/ethnic minorities are frequently underrepresented participants. Our objective was to evaluate racial/ethnic differences in knowledge and attitudes towards clinical trials among U.S. cancer survivors. Methods We leveraged the 2020 Health Informational National Trends Survey (HINTS) data (February-June 2020), which is a weighted, nationally representative survey of 3865 adults (≥18 years), including cancer survivors. We descriptively evaluated cancer survivor's (n = 553) knowledge of clinical trials, and trusted sources of information regarding clinical trials. Using Poisson regression, we estimated predictors of self-reported knowledge of clinical trials. Results Among cancer survivors, 82 % were NH-White and 60 % self-reported to at least have some knowledge about clinical trials. When asked about factors that would influence their decision to participate in clinical trials, participants across racial groups frequently chose "I would want to get better" and "If the standard care was not covered by my insurance." NH-White (76 %), NH-Black (78 %), and Hispanic/Latinx (77 %) cancer survivors reported their trusted source of information about clinical trials was their health care provider; NH-Asian cancer survivors reported their health care provider (51 %) as well as government health agencies (30 %) as trusted sources. Cancer survivors with only a high school degree were less likely to have any knowledge of clinical trials compared to those with a Baccalaureate degree or more (aPR:0.61;95 % CI:0.45-0.83). Conclusion Health care providers are a trusted source of clinical trial information.
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Affiliation(s)
- Sarah Commaroto
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- University of South Florida Morsani College of Medicine, USA
| | - Marlene Camacho-Rivera
- Department of Community Health, SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- UF Health Cancer Center, Gainesville, FL, USA
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, FL, 33635, USA
| | - Imran K. Islam
- College of Letters and Science, University of Wisconsin Oshkosh, Oshkosh, WI, USA
| | - Argelis Rivera
- Department of Hospital Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, FL, 33635, USA
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Warner E, Marron JM, Peppercorn JM, Abel GA, Hantel A. Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research. THE JOURNAL OF CLINICAL ETHICS 2024; 35:8-22. [PMID: 38373334 PMCID: PMC10983799 DOI: 10.1086/728144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
AbstractThere is societal consensus that cancer clinical trial participation is unjust because some sociodemographic groups have been systematically underrepresented. Despite this, neither a definition nor an ethical explication for the justice norm of equity has been clearly articulated in this setting, leading to confusion over its application and goals. Herein we define equity as acknowledging sociodemographic circumstances and apportioning resource and opportunity allocation to eliminate disparities in outcomes, and we explore the issues and tensions this norm generates through practical examples. We assess how equality-based enrollment structures in clinical cancer research have perpetuated historical disparities and what equity-based alternatives are necessary to achieve representativeness and an expansive conception of participatory justice in clinical cancer research. This framework addresses the breadth from normative to applied by defining the justice norm of equity and translating it into practical strategies for addressing participation disparities in clinical cancer research.
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Nguyen RH, Silva Y, Lu J, Chen Z, Gadi V. Race and Ethnicity Reporting and Enrollment Disparities in Clinical Trials Leading to FDA Approvals for Breast Cancer Between 2010 and 2020. Clin Breast Cancer 2023:S1526-8209(23)00096-4. [PMID: 37296063 DOI: 10.1016/j.clbc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND We determined the race and ethnicity demographics and reporting trends of clinical trials leading to Food and Drug Administration (FDA) approvals for breast cancer. METHODS We collected enrollment and reporting data from clinical trials leading to FDA novel and new use approvals for breast cancer from 2010 to 2020 from Drugs@FDA, ClinicalTrials.gov, and associated journal manuscripts. Enrollment demographics were compared to the US cancer population estimates obtained using National Cancer Institute-Surveillance, Epidemiology, and End Results and 2010 US Census databases. RESULTS Seventeen drugs received approval based on 18 clinical trials with a total enrollment of 12,334. For approvals from 2010 to 2015 and from 2016 to 2020, there was no significant difference in race (80% vs. 91.6%, P = .34) or ethnicity reporting (20% vs. 33.3%, P = .5) on ClinicalTrials.Gov, manuscripts, and FDA labels. For trials that reported race and ethnicity, White, Asian, Black, and Hispanic patients represented 73.8%, 16.4%, 3.7%, and 10.4% of trial participants. Relative to their US cancer incidence, Black (31% of expected) patients were underrepresented compared with White (90% of expected), Hispanic (115%), and Asian (327% of expected) patients. CONCLUSION We observed no significant difference in race and ethnicity reporting in pivotal clinical trials leading to FDA approval for breast cancer from 2010 to 2020. Black patients were underrepresented in these pivotal trials relative to White, Hispanic, and Asian patients. Ethnicity reporting remained low throughout the study period. Innovative approaches are needed to ensure equitable benefit of novel therapeutics.
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Affiliation(s)
- Ryan H Nguyen
- Division of Hematology and Oncology, University of Illinois Chicago, Chicago, IL.
| | - Yomaira Silva
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Jun Lu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL; Biostatistics Shared Resource Core, University of Illinois Cancer Center, Chicago, IL
| | - Zhengjia Chen
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL; Biostatistics Shared Resource Core, University of Illinois Cancer Center, Chicago, IL
| | - Vijayakrishna Gadi
- Division of Hematology and Oncology, University of Illinois Chicago, Chicago, IL
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Barry D, Steinberg JR, Towner M, Barber EL, Simon M, Roque DR. Enrollment of Racial and Ethnic Minoritized Groups in Gynecologic Oncology Clinical Trials: A Review of the Scope of the Problem, Contributing Factors, and Strategies to Improve Inclusion. Clin Obstet Gynecol 2023; 66:22-35. [PMID: 36657045 PMCID: PMC9869456 DOI: 10.1097/grf.0000000000000765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Racial inequities are well-documented across the gynecologic oncology care continuum, including the representation of racial and ethnic minoritized groups (REMGs) in gynecologic oncology clinical trials. We specifically reviewed the scope of REMG disparities, contributing factors, and strategies to improve inclusion. We found systematic and progressively worsening under-enrollment of REMGs, particularly of Black and Latinx populations. In addition, race/ethnicity data reporting is poor, yet a prerequisite for accountability to recruitment goals. Trial participation barriers are multifactorial, and successful remediation likely requires multi-level strategies. More rigorous, transparent data on trial participants and effectiveness studies on REMG recruitment strategies are needed to improve enrollment.
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Affiliation(s)
- Danika Barry
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jecca R Steinberg
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary Towner
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emma L Barber
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Melissa Simon
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Dario R Roque
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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7
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Recruitment of diverse community health center patients in a pragmatic weight gain prevention trial. J Clin Transl Sci 2023; 7:e22. [PMID: 36755547 PMCID: PMC9879902 DOI: 10.1017/cts.2022.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Pragmatic trials are needed to establish evidence-based obesity treatment in primary care settings, particularly in community health centers (CHCs) that serve populations at heightened risk of obesity. Recruiting a representative trial sample is a critical first step to informing care for diverse communities. We described recruitment strategies utilized in a pragmatic obesity trial and assessed the sociodemographic characteristics and odds of enrollment by recruitment strategy. Methods We analyzed data from Balance, a pragmatic trial implemented within a network of CHCs. We recruited participants via health center-based and electronic health record (EHR)-informed mail recruitment. We analyzed associations between sociodemographic characteristics and the return rate of patient authorization forms (required for participation) from EHR-informed mail recruitment. We also compared sociodemographic characteristics and randomization odds by recruitment strategy after returning authorization forms. Results Of the individuals recruited through EHR-informed mail recruitment, females were more likely than males to return authorization forms; however, there were no differences in rates of return by preferred language (English/Spanish) or age. Females; underrepresented racial and ethnic groups; Spanish speakers; younger adults; and those with lower education levels were recruited more successfully in the health center. In contrast, their counterparts were more responsive to mail recruitment. Once authorization forms were returned, the odds of being randomized did not significantly differ by recruitment method. Conclusion Health center-based recruitment was essential to meeting recruitment targets in a pragmatic weight gain prevention trial, specifically for Hispanic and Spanish-speaking communities. Future pragmatic trials should consider leveraging in-person recruitment for underrepresented groups in research.
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8
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Coley AK, Fong ZV. Toward Achieving Equity in Cancer Clinical Trials. JCO Oncol Pract 2023; 19:154-156. [PMID: 36630662 DOI: 10.1200/op.22.00785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Avril K Coley
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Zhi Ven Fong
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA
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9
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Racial disparities in pancreatic cancer clinical trials: Defining the problem and identifying solutions. Adv Cancer Res 2023. [DOI: 10.1016/bs.acr.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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Garg T, Gong AJ, Khalil A, Gowda PC, Weinstein RM, Holly BP, Weiss CR. Racial and Ethnic Disparities among Participants in Hepatocellular Carcinoma Clinical Studies Evaluating Transarterial Therapies. J Vasc Interv Radiol 2023; 34:4-10.e3. [PMID: 36167300 DOI: 10.1016/j.jvir.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/31/2022] [Accepted: 09/17/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the racial and ethnic representation of transarterial therapy for hepatocellular carcinoma (HCC) clinical trials in the United States. MATERIALS AND METHODS The ClinicalTrials.gov database was examined to identify all completed studies with transarterial therapies for the management of HCC in the United States and extract information about the observed number of participants for each racial and ethnic group (based on the Office of Management and Budget definitions). The expected number of participants was calculated by multiplying the total number of participants in a trial with the U.S.-population HCC-based proportion for each group. The effects of the study phase, funding source, number of centers involved in the study, and the location of the participating center on racial and ethnic distribution were explored. RESULTS Seventy-nine relevant studies were identified, of which 27 (34.2%) and 18 (22.8%) reported ethnic and race characteristics, respectively. Most study participants were White (81%, 1,591/1,964) by ethnicity and not Hispanic or Latino (93%, 937/1,008) by race. In terms of the observed-to-expected ratios by race and ethnicity in all trials, White and not Hispanic or Latino participants were overrepresented with a ratio of 1.22 (1.10-1.37) and 1.33 (1.26-1.41), respectively, and all other racial and ethnic groups were underrepresented. The enrollment of African Americans and Asian Americans varied by the study phase, and a higher enrollment of African Americans was noted in the National Institutes of Health-funded and multicenter studies (P < .05). CONCLUSIONS This cross-sectional study demonstrates that in HCC transarterial therapy clinical trials, racial and ethnic minorities were underrepresented and the majority of the studies identified failed to report this demographic information.
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Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland. https://twitter.com/gargtushark
| | - Anna J Gong
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adham Khalil
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Prateek C Gowda
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert M Weinstein
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian P Holly
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Nouvini R, Parker PA, Malling CD, Godwin K, Costas-Muñiz R. Interventions to increase racial and ethnic minority accrual into cancer clinical trials: A systematic review. Cancer 2022; 128:3860-3869. [PMID: 36107740 PMCID: PMC10456972 DOI: 10.1002/cncr.34454] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Racial and ethnic minorities (REMs) continue to be underrepresented in clinical trials despite the 1993 National Institutes of Health's Revitalization Act mandating the representation of women and underrepresented minority groups in clinical trials. Although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates are disproportionately low at 4% to 6% and 3% to 6%, respectively. A systematic review exploring interventions aimed at improving cancer clinical trial (CCT) enrollment for REMs was conducted. METHODS A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English-language studies since 1993. Inclusion criteria included peer-reviewed, US-based studies with interventions aimed to recruit underrepresented minority adult patients into cancer clinical trials. REM groups were defined as Black, Hispanic, Asian, American Indian, and Native Hawaiian/other Pacific Islander. RESULTS The systematic search identified 3123 studies, of which nine met inclusion criteria. Interventions included patient navigation/coaching (n = 4), a clinical trial educational video (n = 2), institutional research infrastructure changes (n = 1), a relationship building and social marketing recruitment model (n = 1), and cultural competency training for providers (n = 1). A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos and an institutional research infrastructure change. CONCLUSIONS This systematic review illustrates several potential mechanisms by which to increase CCT recruitment for patients of REM backgrounds in various clinical settings. More randomized controlled trials are needed to further explore the benefits of these interventions for REMs.
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Affiliation(s)
- Rosa Nouvini
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Kendra Godwin
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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12
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Hue JJ, Katayama ES, Markt SC, Elshami M, Saltzman J, Bajor D, Hosmer A, Mok S, Dumot J, Ammori JB, Rothermel LD, Hardacre JM, Winter JM, Ocuin LM. A nationwide analysis of pancreatic cancer trial enrollment reveals disparities and participation problems. Surgery 2022; 172:257-264. [PMID: 34839935 DOI: 10.1016/j.surg.2021.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/22/2021] [Accepted: 10/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Our research group recently surveyed the clinical trial landscape in pancreatic adenocarcinoma and identified 430 active trials. These represent an opportunity to expand treatment options for patients with pancreatic adenocarcinoma. Our primary objective was to detail clinical trial participation among patients with pancreatic adenocarcinoma. Our secondary objective was to evaluate survival. METHODS We queried the National Cancer Database (2004-2016) for patients with pancreatic adenocarcinoma. Patients were stratified by trial participation: clinical trial or non-trial. Multivariable logistic regression was used to identify variables associated with trial participation. The Kaplan-Meier method and multivariable Cox hazards regression were used to analyze survival. RESULTS In total, 261,483 patients were included: 1,110 (0.4%) were enrolled in a clinical trial. A total of 57 Black patients participated in a clinical trial (0.19% of Black patients). This was lower compared to White patients (n = 955, 0.49% of White patients, P < .001). After adjusting for demographic and clinical factors, Black patients were less likely to be enrolled in a clinical trial (odds ratio = 0.387, P < .001). Patients treated at nonacademic medical centers were less likely to be in a clinical trial. Trial participation was associated with an increased median survival relative to non-trial patients (stage IV: 9.0 vs 3.8 months, P < .001), and this association remained on multivariable regression (hazard ratio = 0.779, P < .001). CONCLUSION Fewer than 1% of patients with pancreatic adenocarcinoma participated in a clinical trial. There are racial and sociodemographic disparities in clinical trial enrollment. An association was observed between clinical trial participants and prolonged survival.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | | | - Sarah C Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Mohamedraed Elshami
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Joel Saltzman
- Department of Medicine, Division of Medical Oncology, University Hospitals Cleveland Medical Center, OH
| | - David Bajor
- Department of Medicine, Division of Medical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Amy Hosmer
- Department of Medicine, Division of Gastroenterology, University Hospitals Cleveland Medical Center, OH
| | - Shaffer Mok
- Department of Medicine, Division of Gastroenterology, University Hospitals Cleveland Medical Center, OH
| | - John Dumot
- Department of Medicine, Division of Gastroenterology, University Hospitals Cleveland Medical Center, OH
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Lee M Ocuin
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH.
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13
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Espinoza-Gutarra MR, Duma N, Aristizabal P, Segarra-Vazquez B, Borno H, Halbert CH, Simon MA, Velazquez AI. The Problem of Hispanic/Latinx Under-Representation in Cancer Clinical Trials. JCO Oncol Pract 2022; 18:380-384. [PMID: 35544652 DOI: 10.1200/op.22.00214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Narjust Duma
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Paula Aristizabal
- University of California San Diego, Department of Pediatrics, Division of Pediatric Hematology/Oncology, San Diego, CA.,Rady Children's Hospital San Diego, Peckham Center for Cancer and Blood Disorders, San Diego, CA.,University of California San Diego Moores Cancer Center, Population Sciences Disparities and Community Engagement, San Diego, CA
| | | | - Hala Borno
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | - Melissa A Simon
- Northwestern University, Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
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14
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Eche IJ, Yusufov M, Isibor DA, Wolfe J. A systematic review and meta-analytic evaluation of psychosocial interventions in parents of children with cancer with an exploratory focus on minority outcomes. Pediatr Blood Cancer 2021; 68:e29328. [PMID: 34523798 DOI: 10.1002/pbc.29328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/28/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022]
Abstract
Parents of children with cancer are prone to psychosocial distress, yet little is known about intervention response among diverse parents. Our systematic review and meta-analysis evaluated the efficacy of psychosocial interventions on anxiety and depression among parents of children with cancer and explored race and/or ethnicity differences in the efficacy of these interventions. Twenty articles met inclusion. The aggregate effect size on anxiety (-0.01, 95% CI: -0.95, 0.93, p = .97) and depression (-0.56, 95% CI: -1.65, 0.54, p = .32) showed micro to medium effects, with larger negative effect sizes indicating that anxiety and depression scores after treatment were lower for parents in intervention group as compared to control group. Neither aggregate effect size was statistically significantly different from zero. Due to underrepresentation of minorities, we could not perform subgroup or moderator analyses. Several efficacious psychosocial interventions were found to reduce parental anxiety. Future studies to examine psychosocial interventions in minority parents are warranted.
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Affiliation(s)
- Ijeoma Julie Eche
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Miryam Yusufov
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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15
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Fogacci F, Borghi C, Di Micoli A, Degli Esposti D, Cicero AFG. Inequalities in enrollment of women and racial minorities in trials testing uric acid lowering drugs. Nutr Metab Cardiovasc Dis 2021; 31:3305-3313. [PMID: 34656384 DOI: 10.1016/j.numecd.2021.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
AIMS We investigated sex and racial inequalities in clinical trials testing serum uric acid (SUA) lowering drugs and analyzed the temporal trends of participation among the pre-specified demographic groups. Data were collected from publications of clinical trials testing SUA-lowering drugs. Linear regression analysis was performed to assess the relation between drug approval year and proportion of women and minorities enrolled in clinical studies. DATA SYNTHESIS The mean percentage enrollment of women in clinical trials significantly decreased over the time (r = -0.43, P-value = 0.02). Moreover, there was a statistically significant difference in mean percentage enrollment of women among trials testing different SUA-lowering drugs, with the highest representation in rasburicase (71.1%) and the lowest representation of women in dotinurad (0.8%). Over the time, also the mean percentage enrollment of racial minorities decreased, passing from 8.7% to 2.2% in a 10-year period. Women were proportionally underrepresented compared with their share of the population with asymptomatic hyperuricemia, overall (participation-to-prevalence ratio (PPR) = 0.34), in trials testing xanthine oxiase inhibitors (PPR = 0.38) and uricosurics (PPR = 0.29), and in trials with febuxostat, allopurinol, pegloticase, halofenate/arhalofenate, verinurad, lesinurad and dotinurad. Women were proportionally underreppresented also compared with their share of the population with gout, overall (PPR = 0.69) and in trials testing XOIs (PPR = 0.69), uricosurics (PPR = 0.68), and all SUA-lowering drugs excepted for rasburicase, pegloticase and topiroxostat. CONCLUSIONS Our analysis shows that women and racial and ethnical minorities are underrepresented in controlled clinical trials testing SUA-lowering drugs, with similar pattern across drug classes.
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Affiliation(s)
- Federica Fogacci
- Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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16
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Keruakous AR, Day S, Garcia-Ramiu K, Yarbrough M, Asch AS. Research Staff Perspectives on Cancer Clinical Trials and Barriers to Recruitment: A Qualitative Research. Cureus 2021; 13:e17202. [PMID: 34540430 PMCID: PMC8439775 DOI: 10.7759/cureus.17202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Clinical trials are key elements of the processes that account for many of the recent advances in cancer care. Unfortunately, they are becoming more challenging to conduct. Furthermore, a large number of clinical trials in oncology close early due to poor accrual. To identify opportunities for continued improvement in clinical trial enrollment, we sought to identify the obstacles encountered by our clinical trial research staff in these activities. Methods This is a prospective qualitative study, using Grounded Theory Methodology that was concluded at Stephenson Cancer Center (SCC). SCC has been the lead accruer to National Cancer Institute-Lead Academic Participating Sites (NCI-LAPS) trials over the past three years, and in addition, fields investigator-initiated and industry-sponsored trials. We conducted a survey of our research staff including all research nurses and disease site coordinators who participate in recruitment, screening, consenting, data collection, and compliance for interventional clinical trials. We then performed a follow-up meeting with our research coordinators to clarify responses. The study objectives were to highlight common barriers to recruiting adult cancer patients, encountered by research coordinators from all disease sites and to propose effective solutions to identified barriers. Results We are reporting our results of investigating barriers to clinical trials enrollment from a new perspective. The most commonly reported obstacles for clinical trials enrollment from our research staff's perspective were categorized into five themes: clinical trials protocol, communication barriers and cultural beliefs, financial barriers, patients' comorbidities and performance status, and physicians’ commitment. Conclusions Although assessing barriers encountered by clinical research staff is an infrequently used metric for improving clinical trial enrollment, it provides an important perspective in the field. Implementing interventions to improve clinical trial feasibility and accrual is critical to improving cancer care.
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Affiliation(s)
- Amany R Keruakous
- Hematology and Medical Oncology, Augusta University Medical College of Georgia, Augusta, USA.,Hematology and Medical Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Silas Day
- Hematology and Medical Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Kenny Garcia-Ramiu
- Hematology and Medical Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Melissa Yarbrough
- Hematology and Medical Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Adam S Asch
- Hematology and Medical Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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17
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DeGroote NP, Allen KE, Falk EE, Velozzi-Averhoff C, Wasilewski-Masker K, Johnson K, Brock KE. Relationship of race and ethnicity on access, timing, and disparities in pediatric palliative care for children with cancer. Support Care Cancer 2021; 30:923-930. [PMID: 34409499 DOI: 10.1007/s00520-021-06500-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Pediatric palliative care (PPC) improves quality of life for children and adolescents with cancer. Little is known about disparities between different racial and ethnic groups in the frequency and timing of PPC referrals. We evaluated the impact of race and ethnicity on the frequency and timing of PPC referral after initiation of an embedded PPO clinic where no formal consultation triggers exist. METHODS Patients with cancer between 0 and 25 years at diagnosis who experienced a high-risk event between July 2015 and June 2018 were eligible. Demographic, disease, and PPC information were obtained. Descriptive statistics and logistic regression were used to assess likelihood of receiving PPC services by race/ethnicity. RESULTS Of 426 patients who experienced a high-risk event, 48% were non-Hispanic White, 31% were non-Hispanic Black, 15% were Hispanic of any race, and 4% were non-Hispanic Asian. No significant differences were found between race/ethnicity and age at diagnosis/death, sex, and diagnosis. PPC consultation (p = 0.03) differed by race. Non-Hispanic Black patients were 1.7 times more likely than non-Hispanic White patients to receive PPC after adjustment (p = 0.01). White patients spent less days in the hospital in the last 90 days of life (3.0 days) compared with Black (8.0), Asian (12.5), or Hispanic patients (14.0, p = 0.009) CONCLUSION: Disparities exist in patients receiving pediatric oncology and PPC services. Cultural tendencies as well as unconscious and cultural biases may affect PPC referral by race and ethnicity. Better understanding of cultural tendencies and biases may improve end-of-life outcomes for children and young adults with cancer.
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Affiliation(s)
- Nicholas P DeGroote
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristen E Allen
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Erin E Falk
- Department of Emergency Medicine, Columbia University, New York, NY, USA
| | | | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University, 2015 Uppergate Drive, HSRB W-352, Atlanta, GA, 30322, USA
| | - Khaliah Johnson
- Department of Pediatrics, Emory University, 2015 Uppergate Drive, HSRB W-352, Atlanta, GA, 30322, USA
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Pediatrics, Emory University, 2015 Uppergate Drive, HSRB W-352, Atlanta, GA, 30322, USA.
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18
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Sae-Hau M, Disare K, Michaels M, Gentile A, Szumita L, Treiman K, Weiss ES. Overcoming Barriers to Clinical Trial Participation: Outcomes of a National Clinical Trial Matching and Navigation Service for Patients With a Blood Cancer. JCO Oncol Pract 2021; 17:e1866-e1878. [PMID: 34077244 DOI: 10.1200/op.20.01068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE There are numerous barriers to cancer clinical trial participation in the United States. This paper describes the approach and outcomes of The Leukemia & Lymphoma Society's Clinical Trial Support Center (CTSC), whose nurse navigators assist patients with a blood cancer and their oncologists by identifying all appropriate trials based on clinical data and patient preference, facilitating informed and shared decision making, and minimizing enrollment barriers. METHODS Data on patients served from October 2017 to October 2019 were analyzed using bivariate and multivariate analyses to determine demographic and clinical characteristics associated with enrollment. Reasons for nonenrollment were examined. RESULTS The CTSC opened 906 patient cases during this time frame. Among all US patients with a closed case (n = 750), the clinical trial enrollment rate was 16.1%. Among those with a known enrollment outcome after a trial search (n = 537), the enrollment rate was 22.5%. Multivariate analysis controlling for variables significant in bivariate analyses (insurance, treatment status, Eastern Cooperative Oncology Group performance status, and urban or rural residence) revealed that patients with Medicaid were less likely to enroll than those with private or commercial insurance (adjusted odds ratio, 0.054; CI, 0.003 to 0.899), and patients in treatment or maintenance were less likely to enroll than those relapsed or refractory to most recent therapy (adjusted odds ratio, 0.312; CI, 0.139 to 0.702). Primary reasons for nonenrollment were preference for standard of care (66.3%) and patient passed away (16.1%). CONCLUSION The CTSC is an effective, replicable model for addressing multilevel barriers to clinical trial participation. The findings highlight the need to increase opportunities for trial participation sooner after diagnosis and among patients with Medicaid.
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Affiliation(s)
| | - Kate Disare
- The Leukemia & Lymphoma Society, Rye Brook, NY
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19
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Perni S, Hong K, Hong TS, Nipp RD. Toward a Science of Personalized Informed Consent in Cancer Clinical Trials. JCO Oncol Pract 2021; 17:655-661. [PMID: 33974444 DOI: 10.1200/op.20.00975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Subha Perni
- Harvard Radiation Oncology Program, Massachusetts General Hospital and Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA.,Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Kessely Hong
- Harvard Kennedy School, Harvard University, Boston, MA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
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20
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Dhawan N, LeBlanc TW. Lean Into the Uncomfortable: Using Trauma-Informed Care to Engage in Shared Decision-Making With Racial Minorities With Hematologic Malignancies. Am J Hosp Palliat Care 2021; 39:4-8. [PMID: 33910380 DOI: 10.1177/10499091211008431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Discussions involving racial health disparities must include pathways for engaging in shared decision-making with racial/ethnic minorities. Research demonstrates glaring racial and ethnic disparities when it comes to hematologic malignancies from the time of diagnosis to treatment and even at the end of life. Unfortunately, decision-making in these circumstances may be streamlined, given the urgency of the disease, prognostic uncertainty, and varying treatment options. Being diagnosed with cancer is undoubtedly a traumatic experience and a patient's race and/or ethnicity add an important dimension to their experience. The tenets of trauma-informed care (TIC) are anchored in recognizing that trauma can manifest in several ways and acknowledging the impact of past trauma on a patient's present and future behaviors. We argue that using a TIC approach may help hematologists create a space for decision-making while minimizing the risk of re-traumatization and perpetuating racial disparities. Using the foundation of TIC, an interprofessional team can begin addressing manifestations of trauma and hopefully mitigate racial and ethnic disparities.
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Affiliation(s)
- Natasha Dhawan
- 22916Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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21
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Are ethnic and racial minority women less likely to participate in clinical trials? Gynecol Oncol 2020; 157:323-328. [DOI: 10.1016/j.ygyno.2020.01.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 11/18/2022]
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22
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Increasing Diversity in Clinical Trials: Overcoming Critical Barriers. Curr Probl Cardiol 2019; 44:148-172. [DOI: 10.1016/j.cpcardiol.2018.11.002] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 01/01/2023]
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23
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Nipp RD, Hong K, Paskett ED. Overcoming Barriers to Clinical Trial Enrollment. Am Soc Clin Oncol Educ Book 2019; 39:105-114. [PMID: 31099636 DOI: 10.1200/edbk_243729] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Clinical trials are imperative for testing novel cancer therapies, advancing the science of cancer care, and determining the best treatment strategies to enhance outcomes for patients with cancer. However, barriers to clinical trial enrollment contribute to low participation in cancer clinical trials. Many factors play a role in the persistently low rates of trial participation, including financial barriers, logistical concerns, and the lack of resources for patients and clinicians to support clinical trial enrollment and retention. Furthermore, restrictive eligibility criteria often result in the exclusion of certain patient populations, which thus adds to the widening disparities seen between patients who enroll in trials and those treated in routine practice. Moreover, additional factors, such as difficulty by patients and clinicians in coping with the uncertainty inherent to clinical trial participation, contribute to low trial enrollment and represent key components of the decision-making process. Specifically, patients and clinicians may struggle to assess the risk-benefit ratio and may incorrectly estimate the probability and severity of challenges associated with clinical trial participation, thus complicating the informed consent process. Importantly, research has increasingly focused on overcoming barriers to clinical trial enrollment. A promising solution involves the use of patient navigators to help enhance clinical trial recruitment, enrollment, and retention. Although clinical trials are essential for improving and prolonging the lives of patients with cancer, barriers exist that can impede trial enrollment; yet, efforts to recognize and address these barriers and enhance trial enrollment are being investigated.
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Affiliation(s)
- Ryan D Nipp
- 1 Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Kessely Hong
- 2 Harvard Kennedy School, Harvard University, Boston, MA
| | - Electra D Paskett
- 3 Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine and Comprehensive Cancer Center, Ohio State University, Columbus, OH
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24
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Barrett NJ, Ingraham KL, Vann Hawkins T, Moorman PG. Engaging African Americans in Research: The Recruiter's Perspective. Ethn Dis 2017; 27:453-462. [PMID: 29225447 DOI: 10.18865/ed.27.4.453] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine barriers recruiters encounter when enrolling African American study participants, identify motivating factors to increase research participation, and provide recommendations to facilitate successful minority recruitment. Background Recruiters are often the first point of contact between the research study and potential African American participants. While challenges in enrolling African Americans into clinical and epidemiologic research has been reported in numerous studies the non-physician recruiter's role as a determinant of overall participation rates has received minimal attention. Methods We conducted four 90-minute teleconference focus groups with 18 recruiters experienced in enrolling African Americans for clinical and epidemiologic studies at five academic/medical institutions. Participants represented diverse racial and ethnic backgrounds and were asked to reflect on barriers preventing African Americans from participating in research studies, factors that motivated participation, and recommendations to increase participation of African Americans in research. Multi-coder and thematic data analysis was implemented using the Braun and Clarke method. Results Prominent concerns in recruitment of African Americans in research include fear and mistrust and inflexible research protocols. The participants suggest that improved recruitment could be achieved through cross-cultural and skillset building training opportunities for recruiters, greater community engagement among researchers, and better engagement with clinic staff and research teams.
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Affiliation(s)
- Nadine J Barrett
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Kearston L Ingraham
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Tracey Vann Hawkins
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Patricia G Moorman
- Cancer Control and Population Sciences, Duke Cancer Institute, Duke University Medical Center, Durham, NC
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25
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Hamel LM, Penner LA, Albrecht TL, Heath E, Gwede CK, Eggly S. Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer. Cancer Control 2016; 23:327-337. [PMID: 27842322 PMCID: PMC5131730 DOI: 10.1177/107327481602300404] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. METHODS Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor-patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. RESULTS Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. CONCLUSION To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.
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Affiliation(s)
- Lauren M Hamel
- Wayne State University, Karmanos Cancer Institute, Department of Oncology, Population Studies Disparities Research Program, Detroit, MI, USA.
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26
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Cook ED, Moody-Thomas S, Anderson KB, Campbell R, Hamilton SJ, Harrington JM, Lippman SM, Minasian LM, Paskett ED, Craine S, Arnold KB, Probstfield JL. Minority recruitment to the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Clin Trials 2016; 2:436-42. [PMID: 16315648 DOI: 10.1191/1740774505cn111oa] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Previous large chemoprevention studies have not recruited significant numbers of minorities. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is a large phase III study evaluating the impact of selenium and vitamin E on the clinical incidence of prostate cancer. Over 400 SELECT study sites in the USA, Canada, and Puerto Rico recruited men to this trial. The SELECT recruitment goal was 24% minorities, with 20% black, 3% Hispanic, and 1% Asian participants. The goal for black participants was set at 20% because of their proportion in the United States population and their prevalence of prostate cancer. Methods The minority recruitment strategies in SELECT were to: 1) consider minority recruitment during site selection; 2) expand the eligibility criteria by lowering the age criterion for black men and including men with controlled co-morbid illnesses; 3) develop a national infrastructure; 4) give additional funds to sites with the potential to increase black enrollment; and 5) provide resources to maximize free media opportunities to promote SELECT. Results SELECT recruitment began in August 2001 and was intended to last five years, but concluded two years ahead of schedule in June 2004. Of the 35 534 participants enrolled, 21% were minorities, with 15% black, 5% Hispanic, and 1% Asian. Conclusions Careful planning, recruitment of large numbers of clinical centers and adequate resources accomplished by the combined efforts of the National Cancer Institute (NCI), Southwest Oncology Group (SWOG), SELECT Recruitment and Adherence Committee (RAC), SELECT Minority and Medically Underserved Subcommittee (MMUS), and the local SELECT sites resulted in attainment of the estimated sample size ahead of schedule and recruitment of the largest percentage of black participants ever randomized to a cancer prevention trial.
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Affiliation(s)
- Elise D Cook
- Department of Clinical Cancer Prevention, Unit 1360, The University of Texas M D Anderson Cancer Center, Houston 77230-1439, USA.
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27
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Ahaghotu C, Tyler R, Sartor O. African American Participation in Oncology Clinical Trials--Focus on Prostate Cancer: Implications, Barriers, and Potential Solutions. Clin Genitourin Cancer 2015; 14:105-16. [PMID: 26786562 DOI: 10.1016/j.clgc.2015.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 12/17/2022]
Abstract
In the United States, the incidence and mortality rates of many cancers, especially prostate cancer, are disproportionately high among African American men compared with Caucasian men. Recently, mortality rates for prostate cancer have declined more rapidly in African American versus Caucasian men, but prostate cancer is still the most common cancer and the second leading cause of cancer deaths in African American men in the United States. Compared with Caucasian men, prostate cancer occurs at younger ages, has a higher stage at diagnosis, and is more likely to progress after definitive treatments in African American men. Reasons for racial discrepancies in cancer are multifactorial and potentially include socioeconomic, cultural, nutritional, and biologic elements. In addition to improving access to novel therapies, clinical trial participation is essential to adequately establish the risks and benefits of treatments in African American populations. Considering the disproportionately high mortality rates noted in these groups, our understanding of the natural history and responses to therapies is limited. This review will explore African American underrepresentation in clinical trials with a focus on prostate cancer, and potentially effective strategies to engage African American communities in prostate cancer research. Solutions targeting physicians, investigators, the community, and health care systems are identified. Improvement of African American participation in prostate cancer clinical trials will benefit all stakeholders.
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Affiliation(s)
- Chiledum Ahaghotu
- Department of Urology, College of Medicine, Howard University, Washington, DC.
| | | | - Oliver Sartor
- Departments of Urology and Medicine, Tulane University School of Medicine, New Orleans, LA
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28
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Sankaré IC, Bross R, Brown AF, Del Pino HE, Jones LF, Morris DM, Porter C, Lucas-Wright A, Vargas R, Forge N, Norris KC, Kahn KL. Strategies to Build Trust and Recruit African American and Latino Community Residents for Health Research: A Cohort Study. Clin Transl Sci 2015; 8:412-20. [PMID: 26094679 DOI: 10.1111/cts.12273] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study used Community Partnered Participatory Research (CPPR) to address low participation of racial and ethnic minorities in medical research and the lack of trust between underrepresented communities and researchers. METHODS Using a community and academic partnership in July 2012, residents of a South Los Angeles neighborhood were exposed to research recruitment strategies: referral by word-of-mouth, community agencies, direct marketing, and extant study participants. RESULTS Among 258 community members exposed to recruitment strategies, 79.8% completed the study. Exposed individuals identified their most important method for learning about the study as referral by study participants (39.8%), community agencies (30.6%), word-of-mouth (17.5%), or direct marketing promotion (12.1%). Study completion rates varied by recruitment method: referral by community agencies (88.7%), referral by participants (80.4%), direct marketing promotion (86.2%), word of mouth (64.3%). CONCLUSIONS Although African American and Latino communities are often described as difficult to engage in research, we found high levels of research participation and completion when recruitment strategies emerged from the community itself. This suggests recruitment strategies based on CPPR principles represent an important opportunity for addressing health disparities and our high rates of research completion should provide optimism and a road map for next steps.
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Affiliation(s)
- Ibrahima C Sankaré
- David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Rachelle Bross
- Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Arleen F Brown
- David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Homero E Del Pino
- David Geffen School of Medicine at University of California, Los Angeles, California, USA.,Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Loretta F Jones
- Healthy African American Families, Los Angeles, California, USA
| | | | | | | | - Roberto Vargas
- David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Nell Forge
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Keith C Norris
- David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Katherine L Kahn
- David Geffen School of Medicine at University of California, Los Angeles, California, USA.,RAND Corporation, Santa Monica, California, USA
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29
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Tanner A, Kim SH, Friedman DB, Foster C, Bergeron CD. Barriers to medical research participation as perceived by clinical trial investigators: communicating with rural and african american communities. JOURNAL OF HEALTH COMMUNICATION 2014; 20:88-96. [PMID: 25204763 DOI: 10.1080/10810730.2014.908985] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Clinical trials help advance public health and medical research on prevention, diagnosis, screening, treatment, and quality of life. Despite the need for access to quality care in medically underserved areas, clinical trial participation remains low among individuals in rural and African American communities. This study assessed clinical trial research in South Carolina's five main academic medical centers, focusing specifically on clinical trial investigators' perceived barriers to recruitment in the general population and in rural and African American communities. Online survey responses (N = 119) revealed that it was most difficult for investigators to recruit from rural areas and that rural residents were least likely to be represented in medical research, behind both the general public and African Americans. Barriers focusing on communication or awareness proved to be the biggest hurdles to finding potential participants in both the general public and rural communities. Psychological barriers to recruitment were perceived to be most prevalent in African American communities. Study findings provide important insights from the perspective of the clinical trial investigator that will aid in the development of effective communication and education strategies for reaching rural and African American residents with information about clinical trials.
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Affiliation(s)
- Andrea Tanner
- a School of Journalism and Mass Communications , University of South Carolina , Columbia , South Carolina , USA
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Owens OL, Jackson DD, Thomas TL, Friedman DB, Hébert JR. African American men's and women's perceptions of clinical trials research: focusing on prostate cancer among a high-risk population in the South. J Health Care Poor Underserved 2014; 24:1784-800. [PMID: 24185170 DOI: 10.1353/hpu.2013.0187] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
While African Americans are at a significantly higher risk for developing certain cancers, they also have low rates of participation in cancer research, particularly clinical trials. This study assessed both African American men's and African American women's (1) knowledge of and participation in cancer-related clinical research and (2) barriers to and motivations for participating in clinical research. Data were collected from a total of 81 participants. Phase I of this research consisted of qualitative focus groups (all 81 participants). Phase II included quantitative pre/post survey data from an education program (56 participants). Findings from the study revealed that African American men and women had poor knowledge about clinical trials and the informed consent process, limited experience in participating in clinical trials, and they feared and mistrusted cancer research. Participants identified incentives, assurance of safety, knowledge and awareness, and benefiting others as motivators to participate in clinical trials research.
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Fleisher L, Ruggieri DG, Miller SM, Manne S, Albrecht T, Buzaglo J, Collins MA, Katz M, Kinzy TG, Liu T, Manning C, Charap ES, Millard J, Miller DM, Poole D, Raivitch S, Roach N, Ross EA, Meropol NJ. Application of best practice approaches for designing decision support tools: the preparatory education about clinical trials (PRE-ACT) study. PATIENT EDUCATION AND COUNSELING 2014; 96:63-71. [PMID: 24813474 PMCID: PMC4171039 DOI: 10.1016/j.pec.2014.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/14/2014] [Accepted: 04/05/2014] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This article describes the rigorous development process and initial feedback of the PRE-ACT (Preparatory Education About Clinical Trials) web-based- intervention designed to improve preparation for decision making in cancer clinical trials. METHODS The multi-step process included stakeholder input, formative research, user testing and feedback. Diverse teams (researchers, advocates and developers) participated including content refinement, identification of actors, and development of video scripts. Patient feedback was provided in the final production period and through a vanguard group (N=100) from the randomized trial. RESULTS Patients/advocates confirmed barriers to cancer clinical trial participation, including lack of awareness and knowledge, fear of side effects, logistical concerns, and mistrust. Patients indicated they liked the tool's user-friendly nature, the organized and comprehensive presentation of the subject matter, and the clarity of the videos. CONCLUSION The development process serves as an example of operationalizing best practice approaches and highlights the value of a multi-disciplinary team to develop a theory-based, sophisticated tool that patients found useful in their decision making process. Practice implications Best practice approaches can be addressed and are important to ensure evidence-based tools that are of value to patients and supports the usefulness of a process map in the development of e-health tools.
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Affiliation(s)
- Linda Fleisher
- Children's Hospital of Philadelphia, USA; Fox Chase Cancer Center/Temple University Health System, USA.
| | | | | | | | - Terrance Albrecht
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, USA
| | | | | | | | - Tyler G Kinzy
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, USA
| | - Tasnuva Liu
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, USA
| | | | | | | | - Dawn M Miller
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, USA
| | - David Poole
- Fox Chase Cancer Center/Temple University Health System, USA
| | | | | | - Eric A Ross
- Fox Chase Cancer Center/Temple University Health System, USA
| | - Neal J Meropol
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, USA
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What do people really know and think about clinical trials? A comparison of rural and urban communities in the South. J Community Health 2014; 38:642-51. [PMID: 23468319 DOI: 10.1007/s10900-013-9659-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Clinical trials (CTs) have the potential to provide the most advanced medical treatments and screening options and help medically underserved individuals, including those in rural communities, obtain the medical care they need. Despite the need for access to care, CT participation remains low in rural communities. This study examined what individuals in both rural and urban communities of a Southeastern state know and think about CTs. Nineteen focus groups and eight interviews were conducted statewide with a total of 212 men and women. Discussions assessed participants' beliefs, perceptions, and sources of information about CTs, and their willingness to participate in a CT. Focus group and interview transcripts were analyzed qualitatively for themes. Urban and rural participants expressed similar beliefs about CTs. Common misperceptions were that CTs were intended for people who could not afford care and that completing a survey or participating in a focus group constituted a CT. Rural residents believed that CTs involved deception more often than urban residents, and they were less willing than urban residents to participate in a CT in the future. Urban residents more frequently discussed their distrust of the medical system as a reason for not wanting to participate. Many individuals expressed that their participation would depend on whether their doctor recommended it or whether the trial would benefit a family member's health. Findings have important implications for health communication. Messages should be developed to address misperceptions of rural and urban communities and convey the importance of CT participation to promote and protect the health of their communities.
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Denicoff AM, McCaskill-Stevens W, Grubbs SS, Bruinooge SS, Comis RL, Devine P, Dilts DM, Duff ME, Ford JG, Joffe S, Schapira L, Weinfurt KP, Michaels M, Raghavan D, Richmond ES, Zon R, Albrecht TL, Bookman MA, Dowlati A, Enos RA, Fouad MN, Good M, Hicks WJ, Loehrer PJ, Lyss AP, Wolff SN, Wujcik DM, Meropol NJ. The National Cancer Institute-American Society of Clinical Oncology Cancer Trial Accrual Symposium: summary and recommendations. J Oncol Pract 2013; 9:267-76. [PMID: 24130252 PMCID: PMC3825288 DOI: 10.1200/jop.2013.001119] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Many challenges to clinical trial accrual exist, resulting in studies with inadequate enrollment and potentially delaying answers to important scientific and clinical questions. METHODS The National Cancer Institute (NCI) and the American Society of Clinical Oncology (ASCO) cosponsored the Cancer Trial Accrual Symposium: Science and Solutions on April 29-30, 2010 to examine the state of accrual science related to patient/community, physician/provider, and site/organizational influences, and identify new interventions to facilitate clinical trial enrollment. The symposium featured breakout sessions, plenary sessions, and a poster session including 100 abstracts. Among the 358 attendees were clinical investigators, researchers of accrual strategies, research administrators, nurses, research coordinators, patient advocates, and educators. A bibliography of the accrual literature in these three major areas was provided to participants in advance of the meeting. After the symposium, the literature in these areas was revisited to determine if the symposium recommendations remained relevant within the context of the current literature. RESULTS Few rigorously conducted studies have tested interventions to address challenges to clinical trials accrual. Attendees developed recommendations for improving accrual and identified priority areas for future accrual research at the patient/community, physician/provider, and site/organizational levels. Current literature continues to support the symposium recommendations. CONCLUSIONS A combination of approaches addressing both the multifactorial nature of accrual challenges and the characteristics of the target population may be needed to improve accrual to cancer clinical trials. Recommendations for best practices and for future research developed from the symposium are provided.
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Affiliation(s)
- Andrea M. Denicoff
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Worta McCaskill-Stevens
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Stephen S. Grubbs
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Suanna S. Bruinooge
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Robert L. Comis
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Peggy Devine
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - David M. Dilts
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Michelle E. Duff
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Jean G. Ford
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Steven Joffe
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Lidia Schapira
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Kevin P. Weinfurt
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Margo Michaels
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Derek Raghavan
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Ellen S. Richmond
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Robin Zon
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Terrance L. Albrecht
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Michael A. Bookman
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Afshin Dowlati
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Rebecca A. Enos
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Mona N. Fouad
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Marjorie Good
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - William J. Hicks
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Patrick J. Loehrer
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Alan P. Lyss
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Steven N. Wolff
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Debra M. Wujcik
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Neal J. Meropol
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
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Anwuri VV, Hall LE, Mathews K, Springer BC, Tappenden JR, Farria DM, Jackson S, Goodman MS, Eberlein TJ, Colditz GA. An institutional strategy to increase minority recruitment to therapeutic trials. Cancer Causes Control 2013; 24:1797-809. [PMID: 23846282 DOI: 10.1007/s10552-013-0258-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We present a framework for institutional enhancement of minority clinical trial accrual. METHODS We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: (1) leadership support; (2) center-wide policy change; (3) infrastructural process control, data analysis, and reporting; and (4) follow-up with clinical investigators. A Protocol Review and Monitoring Committee reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities leads efforts for proportional accrual, supporting the system through data tracking, Web tools, and feedback to investigators. RESULTS Following implementation in 2005, minority accrual to therapeutic trials increased from 12.0 % in 2005 to 14.0 % in 2010. The "rolling average" minority cancer incidence at the institution during this timeframe was 17.5 %. In addition to therapeutic trial accrual rates, we note significant increase in the number of minorities participating in all trials (therapeutic and nontherapeutic) from 2005 to 2010 (346-552, 60 % increase, p < 0.05) compared to a 52 % increase for Caucasians. CONCLUSIONS Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring of accrual, offers a successful strategy that can be replicated in other cancer centers, an approach that may extend to other clinical and translational research centers.
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Affiliation(s)
- Victoria V Anwuri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Virani S, Burke L, Remick SC, Abraham J. Barriers to recruitment of rural patients in cancer clinical trials. J Oncol Pract 2013; 7:172-7. [PMID: 21886499 DOI: 10.1200/jop.2010.000158] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The National Cancer Institute estimates that less than 5% of adult patients with cancer participate in clinical trials. This statistic has to improve in order for clinical trials to be more accurate and generalizable. Several studies have looked into the barriers to accrual among various patient subgroups. However, there are scant data regarding factors that act as barriers to accrual of rural patients. Our study aims to identify these barriers. PATIENTS AND METHODS Among patients seen at the Mary Babb Randolph Cancer Center at West Virginia University, 1,000 were randomly selected to receive a questionnaire by mail. Data obtained consisted of demographic and clinical information, as well as awareness about clinical trials, willingness to participate, and factors influencing participation. Patients had 6 weeks to respond. RESULTS Two hundred forty-one (24.1%) patients responded to the survey. Of these, 66.9% had heard about clinical trials, 19.6% reported that their health care team had discussed clinical trials, and 9.1% had participated in clinical trials. Respondents were more likely to be willing to participate in cancer prevention/screening trials than therapeutic trials. Regarding the decision not to participate in a clinical trial, patients cited discouragement from their oncologist, monetary burden, discouragement from family physician, commute, and lack of information as strongly or extremely influential factors. CONCLUSION Our findings specify the need for patient and physician education through community outreach programs. Oncologists should be trained to discuss clinical trials and to address concerns regarding their availability, utility, and accessibility. Financial counseling may play an important role in improving accrual rates as well.
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Affiliation(s)
- Shamsuddin Virani
- Mary Babb Randolph Cancer Center, Department of Medicine and School of Medicine, West Virginia University
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Kaplan CP, Nápoles AM, Dohan D, Shelley Hwang E, Melisko M, Nickleach D, Quinn JA, Haas J. Clinical trial discussion, referral, and recruitment: physician, patient, and system factors. Cancer Causes Control 2013; 24:979-88. [PMID: 23420328 DOI: 10.1007/s10552-013-0173-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 02/08/2013] [Indexed: 11/29/2022]
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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Affiliation(s)
- Celia P Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0856, USA.
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Miller SM, Hudson SV, Egleston BL, Manne S, Buzaglo JS, Devarajan K, Fleisher L, Millard J, Solarino N, Trinastic J, Meropol NJ. The relationships among knowledge, self-efficacy, preparedness, decisional conflict, and decisions to participate in a cancer clinical trial. Psychooncology 2012; 22:481-9. [PMID: 22331643 DOI: 10.1002/pon.3043] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 01/04/2012] [Accepted: 01/14/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cancer clinical trials (CCTs) are important tools in the development of improved cancer therapies; yet, participation is low. Key psychosocial barriers exist that appear to impact a patient's decision to participate. Little is known about the relationship among knowledge, self-efficacy, preparation, decisional conflict, and patient decisions to take part in CCTs. OBJECTIVE The purpose of this study was to determine if preparation for consideration of a CCT as a treatment option mediates the relationship between knowledge, self-efficacy, and decisional conflict. We also explored whether lower levels of decisional conflict are associated with greater likelihood of CCT enrollment. METHOD In a pre-post test intervention study, cancer patients (N = 105) were recruited before their initial consultation with a medical oncologist. A brief educational intervention was provided for all patients. Patient self-report survey responses assessed knowledge, self-efficacy, preparation for clinical trial participation, decisional conflict, and clinical trial participation. RESULTS Preparation was found to mediate the relationship between self-efficacy and decisional conflict (p = 0.003 for a test of the indirect mediational pathway for the decisional conflict total score). Preparation had a more limited role in mediating the effect of knowledge on decisional conflict. Further, preliminary evidence indicated that reduced decisional conflict was associated with increased clinical trial enrollment (p = 0.049). CONCLUSIONS When patients feel greater CCT self-efficacy and have more knowledge, they feel more prepared to make a CCT decision. Reduced decisional conflict, in turn, is associated with the decision to enroll in a clinical trial. Our results suggest that preparation for decision-making should be a target of future interventions to improve participation in CCTs.
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Affiliation(s)
- S M Miller
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Spears CR, Nolan BV, O'Neill JL, Arcury TA, Grzywacz JG, Feldman SR. Recruiting underserved populations to dermatologic research: a systematic review. Int J Dermatol 2011; 50:385-95. [PMID: 21413946 DOI: 10.1111/j.1365-4632.2010.04813.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Recruitment of participants to dermatologic research studies can be challenging, particularly with historically underserved populations. Recruitment of these groups is essential to ethical, valid, and useful dermatologic research. This article discusses findings from a review of 78 studies that examined factors influencing participation in health research studies with an emphasis on underserved populations, particularly women and ethnic minorities. The most commonly encountered barriers to research participation are mistrust of research, lack of access to research programs, and culturally incompetent research design. Motives to participate in research include receipt of benefit from participation, perceived opportunities to help others, and culturally competent research design. Practical methods for addressing barriers and enhancing research participation include culturally competent research design, community-based recruitment, and easily understandable informed consent. These factors should be considered when recruiting subjects for dermatologic research, especially when recruitment of underserved populations is desired. In addition, the literature demonstrates a paucity of research among rural residents, infants, and children, as well as within clinical dermatologic research.
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Affiliation(s)
- Chaya R Spears
- Departments of Family Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Cruz-Flores S, Rabinstein A, Biller J, Elkind MSV, Griffith P, Gorelick PB, Howard G, Leira EC, Morgenstern LB, Ovbiagele B, Peterson E, Rosamond W, Trimble B, Valderrama AL. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:2091-116. [PMID: 21617147 DOI: 10.1161/str.0b013e3182213e24] [Citation(s) in RCA: 331] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. METHODS Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. RESULTS There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage, mistrust of the healthcare system, the relatively limited number of providers who are members of minority groups, and system limitations may contribute to disparities in access to or quality of care, which in turn might result in different rates of stroke morbidity and mortality. Cultural and language barriers probably also contribute to some of these disparities. Minorities use emergency medical services systems less, are often delayed in arriving at the emergency department, have longer waiting times in the emergency department, and are less likely to receive thrombolysis for acute ischemic stroke. Although unmeasured factors may play a role in these delays, the presence of bias in the delivery of care cannot be excluded. Minorities have equal access to rehabilitation services, although they experience longer stays and have poorer functional status than whites. Minorities are inadequately treated with both primary and secondary stroke prevention strategies compared with whites. Sparse data exist on racial-ethnic disparities in access to surgical care after intracerebral hemorrhage and subarachnoid hemorrhage. Participation of minorities in clinical research is limited. Barriers to participation in clinical research include beliefs, lack of trust, and limited awareness. Race is a contentious topic in biomedical research because race is not proven to be a surrogate for genetic constitution. CONCLUSIONS There are limitations in the current definitions of race and ethnicity. Nevertheless, racial and ethnic disparities in stroke exist and include differences in the biological determinants of disease and disparities throughout the continuum of care, including access to and quality of care. Access to and participation in research is also limited among minority groups. Acknowledging the presence of disparities and understanding the factors that contribute to them are necessary first steps. More research is required to understand these differences and find solutions.
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Kahn K, Ryan G, Beckett M, Taylor S, Berrebi C, Cho M, Quiter E, Fremont A, Pincus H. Bridging the gap between basic science and clinical practice: a role for community clinicians. Implement Sci 2011; 6:34. [PMID: 21463516 PMCID: PMC3087703 DOI: 10.1186/1748-5908-6-34] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 04/04/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Translating the extraordinary scientific and technological advances occurring in medical research laboratories into care for patients in communities throughout the country has been a major challenge. One contributing factor has been the relative absence of community practitioners from the US biomedical research enterprise. Identifying and addressing the barriers that prevent their participation in research should help bridge the gap between basic research and practice to improve quality of care for all Americans. METHODS We interviewed over 200 clinicians and other healthcare stakeholders from 2004 through 2005 to develop a conceptual framework and set of strategies for engaging a stable cadre of community clinicians in a clinical research program. RESULTS Lack of engagement of community practitioners, lack of necessary infrastructure, and the current misalignment of financial incentives and research participation emerged as the three primary barriers to community clinician research participation. Although every effort was made to learn key motivators for engagement in clinical research from interviewees, we did not observe their behavior and self-report by clinicians does not always track with their behavior. CONCLUSIONS A paradigm shift involving acknowledgement of the value of clinicians in the context of community research, establishment of a stable infrastructure to support a cohort of clinicians across time and research studies, and realignment of incentives to encourage participation in clinical research is required.
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Affiliation(s)
- Katherine Kahn
- RAND Health, Santa Monica, California, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Gery Ryan
- RAND Health, Santa Monica, California, USA
| | | | | | | | | | - Elaine Quiter
- UCLA School of Public Health, Los Angeles, California, USA
| | | | - Harold Pincus
- RAND Health-University of Pittsburgh Health Institute, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, Columbia University, New York, New York, USA
- Division of Quality and Safety, New York-Presbyterian Hospital, New York, New York, USA
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Beckett M, Quiter E, Ryan G, Berrebi C, Taylor S, Cho M, Pincus H, Kahn K. Bridging the gap between basic science and clinical practice: the role of organizations in addressing clinician barriers. Implement Sci 2011; 6:35. [PMID: 21463517 PMCID: PMC3086857 DOI: 10.1186/1748-5908-6-35] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 04/04/2011] [Indexed: 11/17/2022] Open
Abstract
Background New National Institutes of Health policies call for expansion of practice-based research to improve the clinical research enterprise and facilitate dissemination of evidence-based medicine. Objective This paper describes organizational strategies that influence clinicians' decisions to participate in clinical research. Design We reviewed the literature and interviewed over 200 clinicians and stakeholders. Results The most common barriers to community clinician participation in clinical research relate to beliefs that clinical research is too burdensome and has little benefit for the participating clinician or patient. We identified a number of approaches healthcare organizations can use to encourage clinicians to participate in research, including an outreach campaign to promote the benefits of clinical research; selection of study topics of interest to clinicians; establishment and enforcement of a set of research principles valuing the clinician and patient; development of a transparent schedule of reimbursement for research tasks; provision of technological and technical assistance to practices as needed; and promotion of a sense of community among clinicians involved in practice-based research. Conclusions Many types of existing healthcare organizations could provide the technical and intellectual assistance community clinicians need to participate in clinical research. Multiple approaches are possible.
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Klabunde CN, Keating NL, Potosky AL, Ambs A, He Y, Hornbrook MC, Ganz PA. A population-based assessment of specialty physician involvement in cancer clinical trials. J Natl Cancer Inst 2011; 103:384-97. [PMID: 21317382 PMCID: PMC3107589 DOI: 10.1093/jnci/djq549] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 11/19/2010] [Accepted: 12/07/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical trials are critical for evaluating new cancer therapies, but few adult patients participate in them. Physicians have an important role in facilitating patient participation in clinical trials. We examined the characteristics of specialty physicians who participate in clinical trials by enrolling or referring patients, the types of trials in which they participate, and factors associated with physicians who report greater involvement in clinical trials. METHODS We analyzed data from the Cancer Care Outcomes Research and Surveillance Consortium. The study included 1533 specialty physicians who cared for colorectal and lung cancer patients (496 medical oncologists, 228 radiation oncologists, and 809 surgeons) and completed a survey conducted during 2005-2006 (response rate = 61.0%). Descriptive statistics were used to characterize physicians' personal and practice characteristics, and regression models were used to examine associations between these characteristics and physician participation in clinical trials. All statistical tests were two-sided. RESULTS A total of 87.8% of medical oncologists, 66.1% of radiation oncologists, and 35.0% of surgeons reported referring or enrolling one or more patients in clinical trials during the previous 12 months. The mean number of patients referred or enrolled by these physicians was 17.2 (95% confidence interval [CI] = 15.5 to 18.9) for medical oncologists, 9.5 (95% CI = 7.7 to 11.3) for radiation oncologists, and 12.2 (95% CI = 9.8 to 14.6) for surgeons (P < .001). Specialty type, involvement in teaching, and affiliation with a Community Clinical Oncology Program (CCOP) and/or a National Cancer Institute-designated cancer center were associated with physician trial participation and enrolling more patients (all Ps < .05). Two-thirds of physicians with a CCOP or National Cancer Institute-designated cancer center affiliation reported participating in trials. CONCLUSIONS Features of specialty physicians' practice environments are associated with their trial participation, but many physicians at CCOPs and cancer centers do not participate.
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Affiliation(s)
- Carrie N Klabunde
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA.
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Ulrich CM, James JL, Walker EM, Stine SH, Gore E, Prestidge B, Michalski J, Gwede CK, Chamberlain R, Bruner DW. RTOG physician and research associate attitudes, beliefs and practices regarding clinical trials: implications for improving patient recruitment. Contemp Clin Trials 2010; 31:221-8. [PMID: 20215046 DOI: 10.1016/j.cct.2010.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 02/10/2010] [Accepted: 03/01/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Timely recruitment and retention of human subjects remains a leading problem in oncology clinical trials even among the national oncology clinical trial cooperative groups. The Radiation Therapy Oncology Group (RTOG) developed an exploratory survey to assess member attitudes, beliefs, and practices (ABPs) towards clinical trials that might influence patient accrual to clinical trials. METHODS The survey was developed using Survey Monkey(c) and emailed to principal investigators (PIs) and research associates (RAs) at 267 RTOG member institutions. Survey items were selected based on a review of the literature. PI and RA responses were matched by institution to determine whether responses varied due to job responsibilities and/or institutional practices. Principal component analysis was used to achieve variable reduction in further describing respondents' ABPs. RESULTS PIs and RAs reported similar recruitment concerns [kappa=0.55, 95% CI (0.51, 0.60)]. Five components related to recruitment concerns were identified: presentation of trials to patients, barriers and recruitment risks, staff involvement, access for underrepresented populations, and familial involvement (patient). Nearly one of four (24%) respondents perceived that patients did not understand what randomization means. Staff issues included nearly a third of respondents not having a formal mechanism at their institution for eligibility screening, and similarly, about one of three respondents felt that unrepresented patient populations would benefit from translated consent forms. CONCLUSIONS Findings of this survey inform RTOG strategies for addressing opportunities for improvement, including clinician/patient education and a best practices tool box that in the future would include successful mechanisms for eligibility screening and recruitment.
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Affiliation(s)
- Connie M Ulrich
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States.
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Du W, Mood D, Gadgeel S, Simon MS. An educational video to increase clinical trials enrollment among breast cancer patients. Breast Cancer Res Treat 2009; 117:339-47. [PMID: 19152024 DOI: 10.1007/s10549-009-0311-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 01/06/2009] [Indexed: 11/24/2022]
Abstract
Only 3% of women with breast cancer participate in cancer clinical trials nationwide. The lack of awareness about clinical trials is a significant barrier towards clinical trials participation. A study was conducted at a large urban Comprehensive Cancer Center to test (1) the effectiveness of an 18-min educational video on improving attitudes toward clinical trials and trials enrollment among new breast cancer patients seen at the Karmanos Cancer Institute, and (2) to assess racial differences in attitudes regarding clinical trials. Participants were randomized to either the educational intervention prior to their first oncology clinic appointment or to standard care. A baseline and 2-week post-intervention survey to assess attitudes toward clinical trials participation was completed by participants. Of 218 subjects recruited, 196 (55% white vs. 45% African American (AA)) eligible patients were included in the analysis. A small increase in therapeutic clinical trial enrollment was observed in the intervention arm but was not statistically significant (10.4% vs. 6.1%; P = 0.277). The intervention also did not result in a clear improvement in patients' attitudes toward clinical trials at posttest. However, a lower enrollment rate for the AA women was noted after adjusting for stage (OR = 0.282, P = 0.049). Significantly more negative scores were noted in 3 out of the 5 baseline attitudinal scales for AA women. The educational video did not significantly increase enrollment in breast cancer clinical trials. The findings that AA women had significantly more negative attitudes toward clinical trials than white women may partially explain the racial disparity in enrollment. An educational video remains a simple and cost-effective way to educate patients. Future studies should focus on designing a new educational video to specifically target cultural and attitudinal barriers in the AA population to more effectively change attitudes and increase trial enrollment.
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Affiliation(s)
- Wei Du
- Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI, USA.
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Ramirez AG, Miller AR, Gallion K, San Miguel de Majors S, Chalela P, García Arámburo S. Testing three different cancer genetics registry recruitment methods with Hispanic cancer patients and their family members previously registered in local cancer registries in Texas. ACTA ACUST UNITED AC 2008; 11:215-23. [PMID: 18417969 DOI: 10.1159/000116882] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To increase accrual among Hispanics to the Cancer Genetics Network national cancer genetics registry. METHODS Drawing from South Texas cancer registries, 444 Hispanic men and women were randomly assigned to one of three experimental conditions: standard direct-mailed procedures (X1), X1 plus culturally tailored materials (X2), and X2 plus interpersonal phone contact (X3). Participants were also surveyed about the effectiveness of the education materials and the phone contact. A refusal survey was provided for those who declined to join the study. RESULTS A total of 154 individuals joined the Cancer Genetics Network. The X3 condition yielded the greatest accrual (43.2%) compared to X1 (30.9%) and X2 (29.9%; p < 0.05). Tailored materials appeared to have no effect but were highly regarded. The main reasons for not participating were a lack of interest and time requirements. CONCLUSION Interpersonal communication can have a powerful effect on recruitment. However, more research is needed to determine the cost-efficacy of more labor-intensive approaches to registry accrual.
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Affiliation(s)
- Amelie G Ramirez
- Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78230, USA.
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Ford JG, Howerton MW, Lai GY, Gary TL, Bolen S, Gibbons MC, Tilburt J, Baffi C, Tanpitukpongse TP, Wilson RF, Powe NR, Bass EB. Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review. Cancer 2008; 112:228-42. [PMID: 18008363 DOI: 10.1002/cncr.23157] [Citation(s) in RCA: 708] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Racial and ethnic minorities, older adults, rural residents, and individuals of low socioeconomic status are underrepresented among participants in cancer-related trials. The authors conducted a systematic review to determine the barriers to participation of underrepresented populations in cancer-related trials. Their search included English-language publications that reported original data on the recruitment of underrepresented groups to cancer treatment or prevention trials between 1966 and December 2005 in multiple electronic databases. They also hand-searched titles in 34 journals from January 2003 to December 2005 and they examined reference lists for eligible articles. Titles and abstracts were reviewed to identify relevant studies. Data on barriers to participation were synthesized both qualitatively and based on statistically significant associations with trial enrollment. Of 5257 studies that were cited, 65 studies were eligible for inclusion in the current analysis, including 46 studies on recruitment into cancer therapeutic trials, 15 studies on recruitment into prevention trials, and 4 studies on recruitment into both prevention and treatment trials. Numerous factors were reported as barriers to participation in cancer-related trials. However, only 20 of the studies reported statistically significant associations between hypothesized barriers and enrollment. The available evidence had limitations in quality regarding representativeness, justification of study methods, the reliability and validity of data-collection methods, potential for bias, and data analysis. The results indicated that underrepresented populations face numerous barriers to participation in cancer-related trials. The current systematic review highlighting the literature on recruitment of underrepresented populations to cancer trials and may be used as the evidence base toward developing an agenda for etiologic and intervention research to reduce the disparities in participation in cancer-related trials.
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Affiliation(s)
- Jean G Ford
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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An Educational Video to Increase Clinical Trials Enrollment among Lung Cancer Patients. J Thorac Oncol 2008; 3:23-9. [DOI: 10.1097/jto.0b013e31815e8bb2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ramirez AG, Wildes K, Talavera G, Nápoles-Springer A, Gallion K, Pérez-Stable EJ. Clinical trials attitudes and practices of Latino physicians. Contemp Clin Trials 2007; 29:482-92. [PMID: 18155966 DOI: 10.1016/j.cct.2007.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 11/07/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ethnic differences in physicians' attitudes and behaviors related to clinical trials might partially account for disparities in clinical trial participation among Latino patients. Literature regarding Latino physicians' clinical trials attitudes and practices, in comparison to White physicians, was lacking. METHODS Cross-sectional data from randomly selected physicians (N=695), stratified by ethnicity, were analyzed to test associations of ethnicity with physicians' participation in and attitudes toward referral of patients to clinical trials. RESULTS Chi-square analyses showed significant (p<0.05) associations of physician race/ethnicity and clinical trials involvement, type of trial for which the physician is likely to recommend a patient, belief in scientific value, and factors that would influence recommendation for a patient to participate. Multivariate analyses resulted in several significant (p<0.05) predictors of clinical trials outcomes, including physician race/ethnicity. CONCLUSIONS Latino physicians were significantly less involved in clinical trials than White physicians and found less scientific value in them, highlighting areas for future education and intervention.
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Affiliation(s)
- Amelie G Ramirez
- Institute for Health Promotion Research, Department of Epidemiology and Biostatistics, School of Medicine, University of Texas Health Science Center at San Antonio, TX 78230, USA.
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Fayter D, McDaid C, Eastwood A. A systematic review highlights threats to validity in studies of barriers to cancer trial participation. J Clin Epidemiol 2007; 60:990-1001. [PMID: 17884592 DOI: 10.1016/j.jclinepi.2006.12.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Revised: 12/06/2006] [Accepted: 12/15/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the barriers, modifiers, and benefits involved in participating in randomized controlled trials of cancer therapies as perceived by health care providers and patients. STUDY DESIGN AND SETTING We conducted a systematic review of the literature to identify published and unpublished studies in any language using electronic databases searched from 1996 to 2004, contact with experts, and reference lists. All study designs were acceptable provided relevant data were reported. Two reviewers were involved in the selection of studies, data extraction, and quality assessment processes. Studies were combined in a narrative synthesis. RESULTS Fifty-six studies met the inclusion criteria and represented the perspective of the patient or the health care provider or both. Although a range of barriers to trial participation were identified, a number of threats to the internal and external validity of the included studies limited interpretation of the evidence. CONCLUSION The limitations within the evidence base do not permit a clear interpretation of the barriers, moderators, and benefits involved in participation in cancer trials. We recommend that trialists prospectively identify the issues relevant to a particular trial using the current research as a starting point. We report checklists to guide this process.
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Affiliation(s)
- Debra Fayter
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
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UyBico SJ, Pavel S, Gross CP. Recruiting vulnerable populations into research: a systematic review of recruitment interventions. J Gen Intern Med 2007; 22:852-63. [PMID: 17375358 PMCID: PMC2219860 DOI: 10.1007/s11606-007-0126-3] [Citation(s) in RCA: 257] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 12/12/2006] [Accepted: 12/27/2006] [Indexed: 01/13/2023]
Abstract
BACKGROUND Members of vulnerable populations are underrepresented in research studies. OBJECTIVE To evaluate and synthesize the evidence regarding interventions to enhance enrollment of vulnerable populations into health research studies. DATA SOURCES Studies were identified by searching MEDLINE, the Web of Science database, personal sources, hand searching of related journals, and article references. Studies that contained data on recruitment interventions for vulnerable populations (minority, underserved, poor, rural, urban, or inner city) and for which the parent study (study for which recruitment was taking place) was an intervention study were included. A total of 2,648 study titles were screened and 48 articles met inclusion criteria, representing 56 parent studies. Two investigators extracted data from each study. RESULTS African Americans were the most frequently targeted population (82% of the studies), while 46% targeted Hispanics/Latinos. Many studies assessed 2 or more interventions, including social marketing (82% of studies), community outreach (80%), health system recruitment (52%), and referrals (28%). The methodologic rigor varied substantially. Only 40 studies (71%) incorporated a control group and 21% used statistical analysis to compare interventions. Social marketing, health system, and referral recruitment were each found to be the most successful intervention about 35-45% of the studies in which they were attempted, while community outreach was the most successful intervention in only 2 of 16 studies (13%) in which it was employed. People contacted as a result of social marketing were no less likely to enroll than people contacted through other mechanisms. CONCLUSIONS Further work with greater methodologic rigor is needed to identify evidence-based strategies for increasing minority enrollment in research studies; community outreach, as an isolated strategy, may be less successful than other strategies.
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Affiliation(s)
- Stacy J. UyBico
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT USA
| | - Shani Pavel
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT USA
| | - Cary P. Gross
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT USA
- Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT USA
- Office for Eliminating Cancer Disparities, Yale Cancer Center, New Haven, CT USA
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