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Popa M, Young B, Rousseau N, Cherry MG, Jenkins I, Cloke J, Pettitt A, Jenkinson MD, Ahmed S, Pemberton AR, Sherratt FC. Consultations about randomised controlled trials are shorter and less in-depth for socioeconomically disadvantaged patients compared to socioeconomically advantaged patients: qualitative analysis across three trials. Trials 2024; 25:382. [PMID: 38872208 DOI: 10.1186/s13063-024-08216-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Patients from socioeconomically disadvantaged backgrounds are underserved in randomised controlled trials, yet they experience a much greater burden of disease compared with patients from socioeconomically advantaged areas. It is crucial to make trials more inclusive to ensure that treatments and interventions are safe and effective in real-world contexts. Improving how information about trials is verbally communicated is an unexplored strategy to make trials more inclusive. This study examined how trials are communicated verbally, comparing consultations involving patients from the most and least socioeconomically disadvantaged areas. METHODS Secondary qualitative analysis of 55 trial consultation transcripts from 41 patients, sampled from 3 qualitative studies embedded in their respective UK multi-site, cancer-related randomised controlled trials. Patients living in the most and least socioeconomically disadvantaged areas, defined using English Indices of Multiple Deprivation decile scores, were purposively sampled. Analysis was largely thematic and drew on the constant comparison method. RESULTS Recruiters communicated clinical uncertainty in a similar way for patients living in different socioeconomic areas. Consultations with disadvantaged patients were, on average, half the duration of those with advantaged patients, and tended to involve recruiters providing less in-depth explanations of trial concepts, used phrasing that softened trial arm risks, and described trial processes (e.g. randomisation) using informal or metaphorical phrasing. Disadvantaged and advantaged patients differed in the concerns they expressed; disadvantaged patients voiced fewer concerns and asked fewer questions but were also less likely to be invited to do so by recruiters. CONCLUSION Interactions about trials unfolded in different ways between patients living in different socioeconomic areas, likely due to both patient- and recruiter-related factors. We present considerations for recruiters when discussing trials with patients from socioeconomically disadvantaged backgrounds, aimed at enhancing trial communication. Future research should examine disadvantaged patients' and recruiters' experiences of verbal trial communication to inform guidance that addresses the needs and preferences of underserved groups.
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Affiliation(s)
- Mariana Popa
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Nikki Rousseau
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mary G Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Isobel Jenkins
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Jane Cloke
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Andrew Pettitt
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Saiqa Ahmed
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Allan R Pemberton
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Frances C Sherratt
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
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2
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Durbin SM, Lundquist DM, Pelletier A, Jimenez R, Petrillo L, Kim J, Lynch K, Healy M, Johnson A, Ollila N, Yalala V, Malowitz B, Kehlmann A, Chevalier N, Turbini V, Bame V, Heldreth H, Silva J, McIntyre C, Juric D, Nipp RD. Time Toxicity Experienced by Early-Phase Cancer Clinical Trial Participants. JCO Oncol Pract 2024:OP2300811. [PMID: 38857457 DOI: 10.1200/op.23.00811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/12/2024] [Accepted: 04/24/2024] [Indexed: 06/12/2024] Open
Abstract
PURPOSE Early-phase clinical trials (EP-CTs) are designed to determine optimal dosing, tolerability, and preliminary activity of novel cancer therapeutics. Little is known about the time that patients spend interacting with the health care system (eg, time toxicity) while participating in these studies. METHODS We retrospectively reviewed the electronic health records of consecutive patients enrolled in EP-CTs from 2017 to 2019 to obtain baseline characteristics and number of health care-associated days, defined as all inpatient and outpatient visits while on trial. We used univariable and multivariable analyses to identify predictors of increased time toxicity, defined as the proportion of health care-associated days among total days on trial. For ease of interpretation, we created a dichotomous variable, with high time toxicity defined as ≥20% health care-associated days during time on trial and used regression models to evaluate relationships between time toxicity and clinical outcomes. RESULTS Among 408 EP-CT participants (mean age, 60.5 years [standard deviation, SD, 12.6]; 56.5% female; 88.2% White; 96.0% non-Hispanic), patients had an average of 22.5% health care-associated days while on trial (SD, 13.8%). Those with GI (B = 0.07; P = .002), head/neck (B = 0.09; P = .004), and breast (B = 0.06; P = .015) cancers and those with worse performance status (B = 0.04; P = .017) and those receiving targeted therapies (B = 0.04; P = .014) experienced higher time toxicity. High time toxicity was associated with decreased disease response rates (odds ratio, 0.07; P < .001), progression-free survival (hazard ratio [HR], 2.10; P < .001), and overall survival (HR, 2.16; P < .001). CONCLUSION In this cohort of EP-CT participants, patients spent more than one-fifth of days on trial with health care contact. We identified characteristics associated with higher time toxicity and found that high toxicity correlated with worse clinical outcomes. These data could help inform patient-clinician discussions about EP-CTs, guide future trial design, and identify at-risk patients.
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Affiliation(s)
- Sienna M Durbin
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA
| | - Debra M Lundquist
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | | | - Rachel Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Laura Petrillo
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice Kim
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA
| | - Kaitlyn Lynch
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Megan Healy
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Andrew Johnson
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Nicholas Ollila
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Vaishnavi Yalala
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Benjamin Malowitz
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Allison Kehlmann
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Nicholas Chevalier
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Victoria Turbini
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | - Viola Bame
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Hope Heldreth
- Statistician, Brigham and Women's Hospital, Boston, MA
| | - Jenipher Silva
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Casandra McIntyre
- Department of Nursing & Patient Care Services, Massachusetts General Hospital, Boston, MA
| | - Dejan Juric
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA
| | - Ryan D Nipp
- University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK
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3
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Ignatiadis M, Poulakaki F, Spanic T, Brain E, Lacombe D, Sonke GS, Vincent-Salomon A, Van Duijnhoven F, Meattini I, Kaidar-Person O, Aftimos P, Lecouvet F, Cardoso F, Retèl VP, Cameron D. EBCC-14 manifesto: Addressing disparities in access to innovation for patients with metastatic breast cancer across Europe. Eur J Cancer 2024; 207:114156. [PMID: 38861756 DOI: 10.1016/j.ejca.2024.114156] [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: 04/11/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
The European Breast Cancer Council (EBCC) traditionally identifies controversies or major deficiencies in the management of patients with breast cancer and selects a multidisciplinary expert team to collaborate in setting crucial principles and recommendations to improve breast cancer care. The 2024 EBCC manifesto focuses on disparities in the care of patients with metastatic breast cancer. There are several reasons for existing disparities both between and within countries. Our recommendations aim to address the stigma of metastatic disease, which has led to significant disparities in access to innovative care regardless of the gross national income of a country. These recommendations are for different stakeholders to promote the care of patients with metastatic breast cancer across Europe and worldwide.
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Affiliation(s)
- Michail Ignatiadis
- Department of Medical Oncology, Institut Bordet, Hôpital Universitaire de Bruxelles, Brussels, Belgium.
| | - Fiorita Poulakaki
- Breast Surgery Department, Athens Medical Center, Athens, Greece; Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Tanja Spanic
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy; Europa Donna Slovenia, Ljubljana, Slovenia
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Gabe S Sonke
- University of Amsterdam, Amsterdam, the Netherlands
| | - Anne Vincent-Salomon
- Department of Diagnostic and Theragnostic Medicine, Institut Curie Hospital Group, Paris, France
| | - Frederieke Van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology & Breast Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Orit Kaidar-Person
- Department of Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel; Tel Aviv School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Philippe Aftimos
- Department of Medical Oncology, Institut Bordet, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Frederic Lecouvet
- Institut du Cancer Roi Albert II (IRA2), Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium; Department of Medical Imaging, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Valesca P Retèl
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam (ESHPM), Rotterdam, the Netherlands
| | - David Cameron
- Edinburgh University Cancer Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
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4
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Liadi Y, Campbell T, Dike P, Harlemon M, Elliott B, Odero-Marah V. Prostate cancer metastasis and health disparities: a systematic review. Prostate Cancer Prostatic Dis 2024; 27:183-191. [PMID: 37046071 DOI: 10.1038/s41391-023-00667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Prostate cancer (PCa), one of the most prevalent malignancies affecting men, significantly contributes to increased mortality rates worldwide. While the causative death is due to advanced metastatic disease, this occurrence disproportionately impacts men of African descent compared to men of European descent. In this review, we describe potential mechanisms underlying PCa metastases disparities and current treatments for metastatic disease among these populations, differences in treatment outcomes, and survival rates, in hopes of highlighting a need to address disparities in PCa metastases. METHODS We reviewed existing literature using databases such as PubMed, Google Scholar, and Science Direct using the following keywords: "prostate cancer metastases", "metastatic prostate cancer disparity", "metastatic prostate cancer diagnosis and treatment", "prostate cancer genetic differences and mechanisms", "genetic differences and prostate tumor microenvironment", and "men of African descent and access to clinical treatments". The inclusion criteria for literature usage were original research articles and review articles. RESULTS Studies indicate unique genetic signatures and molecular mechanisms such as Epithelial-Mesenchymal Transition (EMT), inflammation, and growth hormone signaling involved in metastatic PCa disparities. Clinical studies also demonstrate differences in treatment outcomes that are race-specific, for example, patients of African descent have a better response to enzalutamide and immunotherapy yet have less access to these drugs as compared to patients of European descent. CONCLUSIONS Growing evidence suggests a connection between a patient's genetic profile, the prostate tumor microenvironment, and social determinants of health that contribute to the aggressiveness of metastatic disease and treatment outcomes. With several potential pathways highlighted, the limitations in current diagnostic and therapeutic applications that target disparity in PCa metastases warrant rigorous research attention.
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Affiliation(s)
- Yusuf Liadi
- Department of Biology, Morgan State University, Baltimore, MD, 21251, USA
| | - Taaliah Campbell
- Department of Biology, Morgan State University, Baltimore, MD, 21251, USA
- Center for Cancer Research and Therapeutic Development, Department of Biological Sciences, Clark Atlanta University, Atlanta, GA, 30314, USA
| | - Precious Dike
- Department of Biology, Morgan State University, Baltimore, MD, 21251, USA
| | - Maxine Harlemon
- Department of Biology, Morgan State University, Baltimore, MD, 21251, USA
- Center for Cancer Research and Therapeutic Development, Department of Biological Sciences, Clark Atlanta University, Atlanta, GA, 30314, USA
| | - Bethtrice Elliott
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, 21251, USA
| | - Valerie Odero-Marah
- Department of Biology, Morgan State University, Baltimore, MD, 21251, USA.
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, 21251, USA.
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5
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Stalsberg R, Darvik MD. Social Representativeness and Intervention Adherence-A Systematic Review of Clinical Physical Activity Trials in Breast Cancer Patients. Int J Public Health 2024; 69:1607002. [PMID: 38784387 PMCID: PMC11111874 DOI: 10.3389/ijph.2024.1607002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives Representativeness in physical activity randomised controlled trials (RCT) in breast cancer patients is essential to analyses of feasibility and validity considering privileged- social groups. A step-by-step exclusion of less privileged groups through the trial process could reinforce health inequality. This study aimed at examining representativeness in breast cancer (BC) physical activity trials, investigate associations between socio-economic status (SES) and intervention adherence, and explore associations between representativeness and the relationship between SES and intervention adherence. Methods Systematic, computerised searches were performed in PubMed, CINAHL, AMED, EMBASE and PsycINFO. Additional citation-based searches retrieved 37 articles. Distributions of education level, ethnicity, and marital status in study samples were compared to national populations data to estimate representativeness in less privileged groups. Results A preponderance of studies favoured educated, married and white patients. Only six studies reported SES-adherence associations, hampering conclusions on this relationship and possible associations between representativeness and an SES-adherence relationship. Conclusion Less educated, unmarried and non-white individuals may be underrepresented in BC physical activity RCTs, while SES-adherence associations in such trials are inconclusive. Unintentional social misrepresentations may indicate that disguised inequity warrants revived attention.
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Affiliation(s)
- Ragna Stalsberg
- Department of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | - Monica Dahle Darvik
- Department of Neuromedicine and Movement Science, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
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6
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Hong Y, Lee N, Kirkpatrick CE, Hu S, Lee S, Hinnant A. "Trust Me, I'm a Doctor." How TikTok Videos from Different Sources Influence Clinical Trial Participation. HEALTH COMMUNICATION 2024:1-12. [PMID: 38699819 DOI: 10.1080/10410236.2024.2346680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
This study experiments with TikTok videos to promote clinical trial participation. More specifically, it examines how short-form video sources (doctors vs. prior volunteers for clinical trials) influence perceived source credibility, self-efficacy, and behavioral intention to participate in clinical trials. Findings from this online experiment (N = 396) showed that doctor sources led to greater behavioral intention through enhancing source credibility compared to prior volunteer sources. Alternatively, prior volunteer sources increased behavioral intention via enhanced self-efficacy for participants with low trust in doctors. These findings contribute to the understanding of how short-form video sources act as heuristic cues, leading to persuasion outcomes. Overall, we recommend featuring doctors when using video-based messages to promote clinical trial participation. Also, this study emphasizes the need for health communication practitioners to consider prior volunteers as spokespersons when targeting populations with low baseline trust in doctors.
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Affiliation(s)
- Yoorim Hong
- Strategic Communication, School of Journalism, University of Missouri
| | - Namyeon Lee
- Department of Mass Communication, University of North Carolina at Pembroke
| | - Ciera E Kirkpatrick
- Advertising & Public Relations, College of Journalism & Mass Communications, University of Nebraska-Lincoln
| | - Sisi Hu
- Advertising, School of Journalism and Strategic Media, University of Arkansas
| | - Sungkyoung Lee
- Strategic Communication, School of Journalism, University of Missouri
| | - Amanda Hinnant
- Journalism Studies, School of Journalism, University of Missouri
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7
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Fegan G, Tod D, Downing A, Elmusharaf N, Pepper C, Fegan C. Social deprivation independently impacts clinical outcomes in patients with chronic lymphocytic leukemia. Haematologica 2024; 109:1566-1569. [PMID: 38268485 PMCID: PMC11063865 DOI: 10.3324/haematol.2023.283527] [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: 05/19/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
Not available.
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Affiliation(s)
- Gregory Fegan
- Swansea Trial Unit, Swansea University Medical School, Singleton Park, Swansea, United Kingdom SA2 8PP
| | - Daniel Tod
- Swansea Trial Unit, Swansea University Medical School, Singleton Park, Swansea, United Kingdom SA2 8PP
| | - Abigail Downing
- Department of Haematology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom, CF14 4XW
| | - Nagah Elmusharaf
- Department of Haematology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom, CF14 4XW
| | - Christopher Pepper
- Brighton and Sussex Medical School, University of Sussex. Brighton, United Kingdom, BN1 9PX
| | - Christopher Fegan
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales, United Kingdom CF144XN.
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8
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Lee H, Bates AS, Callier S, Chan M, Chambwe N, Marshall A, Terry MB, Winkfield K, Janowitz T. Analysis and Optimization of Equitable US Cancer Clinical Trial Center Access by Travel Time. JAMA Oncol 2024; 10:652-657. [PMID: 38512297 PMCID: PMC10958387 DOI: 10.1001/jamaoncol.2023.7314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/03/2023] [Indexed: 03/22/2024]
Abstract
Importance Racially minoritized and socioeconomically disadvantaged populations are currently underrepresented in clinical trials. Data-driven, quantitative analyses and strategies are required to help address this inequity. Objective To systematically analyze the geographical distribution of self-identified racial and socioeconomic demographics within commuting distance to cancer clinical trial centers and other hospitals in the US. Design, Setting, and Participants This longitudinal quantitative study used data from the US Census 2020 Decennial and American community survey (which collects data from all US residents), OpenStreetMap, National Cancer Institute-designated Cancer Centers list, Nature Index of Cancer Research Health Institutions, National Trial registry, and National Homeland Infrastructure Foundation-Level Data. Statistical analyses were performed on data collected between 2006 and 2020. Main Outcomes and Measures Population distributions of socioeconomic deprivation indices and self-identified race within 30-, 60-, and 120-minute 1-way driving commute times from US cancer trial sites. Map overlay of high deprivation index and high diversity areas with existing hospitals, existing major cancer trial centers, and commuting distance to the closest cancer trial center. Results The 78 major US cancer trial centers that are involved in 94% of all US cancer trials and included in this study were found to be located in areas with socioeconomically more affluent populations with higher proportions of self-identified White individuals (+10.1% unpaired mean difference; 95% CI, +6.8% to +13.7%) compared with the national average. The top 10th percentile of all US hospitals has catchment populations with a range of absolute sum difference from 2.4% to 35% from one-third each of Asian/multiracial/other (Asian alone, American Indian or Alaska Native alone, Native Hawaiian or Other Pacific Islander alone, some other race alone, population of 2 or more races), Black or African American, and White populations. Currently available data are sufficient to identify diverse census tracks within preset commuting times (30, 60, or 120 minutes) from all hospitals in the US (N = 7623). Maps are presented for each US city above 500 000 inhabitants, which display all prospective hospitals and major cancer trial sites within commutable distance to racially diverse and socioeconomically disadvantaged populations. Conclusion and Relevance This study identified biases in the sociodemographics of populations living within commuting distance to US-based cancer trial sites and enables the determination of more equitably commutable prospective satellite hospital sites that could be mobilized for enhanced racial and socioeconomic representation in clinical trials. The maps generated in this work may inform the design of future clinical trials or investigations in enrollment and retention strategies for clinical trials; however, other recruitment barriers still need to be addressed to ensure racial and socioeconomic demographics within the geographical vicinity of a clinical site can translate to equitable trial participant representation.
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Affiliation(s)
- Hassal Lee
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York
| | - Alexander Shakeel Bates
- Department of Neurobiology and Howard Hughes Medical Institute, Harvard Medical School, Boston, Massachusetts
| | - Shawneequa Callier
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael Chan
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York
| | - Nyasha Chambwe
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Mary Beth Terry
- Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Karen Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tobias Janowitz
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee
- Northwell Health Cancer Institute, Manhasset, New York
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9
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Cardenas-Rojas A, Pacheco-Barrios K, Castelo-Branco L, Gonzalez-Mego P, Marduy A, Vásquez-Ávila K, Caumo W, Fregni F. Factors influencing clinical trial participation of women with fibromyalgia across the United States: a cross-sectional survey. Women Health 2024; 64:369-379. [PMID: 38804121 PMCID: PMC11133875 DOI: 10.1080/03630242.2024.2334700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/20/2024] [Indexed: 05/29/2024]
Abstract
Although fibromyalgia is a widespread chronic pain condition where 90 percent of patients are women, they are underrepresented in Randomized Clinical Trials (RCTs). We aim to describe the willingness to participate, assess different factors, and explore the impact of sociodemographic and clinical characteristics on perceived barriers to trial participation. This is a cross-sectional survey targeting women with fibromyalgia. Univariate and multivariate logistic regression were performed. Of the 436 women with fibromyalgia, 56 percent were very likely to participate in RCTs. Minorities expressed less interest than non-minorities, while higher pain scores, previous participation, and younger patients reported a higher interest. Barriers significantly associated with a reduced willingness were: the participant's perception (side effects, distance, potential negative impact), the center (reputation), the trial protocol (number of visits, placebo), and trial awareness by their physician. In a multivariate analysis, older age, low education, lower income, and higher pain scores were associated with perceived barriers to RCT participation. Despite the high interest to participate, factors such as side effects, the center's distance, number of visits, placebo treatments, and the institution's reputation must be considered in clinical trials for women with fibromyalgia.
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Affiliation(s)
- A Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - K Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - L Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - P Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - A Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - K Vásquez-Ávila
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - W Caumo
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - F Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
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10
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Wei JX, Shastri A, Sica RA, Mantzaris I, Kornblum N, Shah U, Janakiram M, Gritsman K, Verma A, Goldfinger M, Cooper D, Shah N. Impact of race and ethnicity on early mortality in multiple myeloma: a SEER analysis. Haematologica 2024; 109:1480-1486. [PMID: 37881838 PMCID: PMC11063841 DOI: 10.3324/haematol.2023.283304] [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: 04/12/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Abstract
Over the past two decades, there have been significant advances in the treatment of multiple myeloma which has led to an improvement in overall survival.1,2 However, a notable proportion of patients continue to experience early mortality (EM), defined as 2 years from the time of diagnosis. This raises the possibility that improvements in myeloma survival have not extended equally to all groups. Using the latest data drawn from the Surveillance Epidemiology and End Results database of patients in the United States spanning 2000-2019, we study impact of important sociodemographic factors on EM. Through regression modeling, we demonstrate that patients diagnosed from 2000-2005, of older age, male sex, and of certain racial minority status (non-Hispanic Black and Hispanic) have higher odds of EM. Of these factors, minority status contributed to worse 2-year overall survival as well. We evaluate whether income, as a surrogate to access to care, could potentially explain this finding, but find that race has a distinct relationship with EM that is not modified by income. This is further reinforced by subgroup analysis. After characterizing groups vulnerable to EM, we examine reasons for these disparities and potential avenues to address them.
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Affiliation(s)
- John X Wei
- Department of Medicine, Montefiore/Albert Einstein College of Medicine, New York
| | - Aditi Shastri
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York
| | - R Alejandro Sica
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York
| | - Ioannis Mantzaris
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York
| | - Noah Kornblum
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Murali Janakiram
- Division of Hematologic Malignancies, City of Hope National Medical Center, Duarte, CA
| | - Kira Gritsman
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York
| | - Amit Verma
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York
| | - Mendel Goldfinger
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York
| | - Dennis Cooper
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York
| | - Nishi Shah
- Division of Hematologic Malignancies, Department of Medical Oncology, Montefiore/Albert Einstein College of Medicine, New York.
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11
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Gu N, Elsisi Z, Suk R, Li M. Geographic disparity in the distribution of cancer clinical trials in the United States and the associated factors. J Manag Care Spec Pharm 2024; 30:376-385. [PMID: 38555628 PMCID: PMC10982574 DOI: 10.18553/jmcp.2024.30.4.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Little is known regarding the geographic disparity in the distribution of phase 1-3 clinical trials of new cancer treatments in the US and the associated factors. OBJECTIVE To examine county-level variation in the number of phase 1-3 cancer clinical trials and the associations between county characteristics and having phase 1-3 cancer clinical trials. METHODS We identified phase 1-3 cancer clinical trials started in the US between January 2008 and December 2022 from the Aggregate Analysis of ClinicalTrials.gov database. We analyzed the distribution of phase 1-3 cancer clinical trials at the county level. Using a mixed-effects regression with states as random intercepts, we estimated the associations between a county's median age, median household income, percentage of population from racial and ethnic minority groups, proportion of population aged 25 years or older with an educational attainment of bachelor's degree or higher, rurality, cancer incidence rate, and number of medical oncologists per population with having any phase 1-3 cancer clinical trial in a county. RESULTS After excluding trials that were suspended, terminated, and withdrawn, a total of 14,977 phase 1-3 cancer clinical trials started in the United States between January 2008 and December 2022 were included in the primary analysis. Only 1,333 out of 3,143 counties (42.4%) had 1 or more trial during this period. Counties that were rural, with lower median household income, a less educated population, fewer medical oncologists per population, and lower cancer incidence rates demonstrated a significantly lower likelihood of having phase 1-3 cancer clinical trials. CONCLUSIONS Our study revealed substantial geographic disparities in the distribution of phase 1-3 cancer clinical trials. Limited trial availability in low-income, low-education, low-oncologist, and rural areas can be a significant barrier to patient participation, potentially hindering adoption and worsening outcomes in disadvantaged populations.
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Affiliation(s)
- Ningzhou Gu
- Department of Industrial Engineering and Operations Research (IEOR), Columbia University, New York City, NY
- Gu and Elsisi served as co-first authors and contributed equally to the work
| | - Zizi Elsisi
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle
- Gu and Elsisi served as co-first authors and contributed equally to the work
| | - Ryan Suk
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
| | - Meng Li
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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12
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Ikhile D, Ford E, Glass D, Gremesty G, van Marwijk H. A systematic review of risk factors associated with depression and anxiety in cancer patients. PLoS One 2024; 19:e0296892. [PMID: 38551956 PMCID: PMC10980245 DOI: 10.1371/journal.pone.0296892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/18/2023] [Indexed: 04/01/2024] Open
Abstract
Depression and anxiety are common comorbid conditions associated with cancer, however the risk factors responsible for the onset of depression and anxiety in cancer patients are not fully understood. Also, there is little clarity on how these factors may vary across the cancer phases: diagnosis, treatment and depression. We aimed to systematically understand and synthesise the risk factors associated with depression and anxiety during cancer diagnosis, treatment and survivorship. We focused our review on primary and community settings as these are likely settings where longer term cancer care is provided. We conducted a systematic search on PubMed, PsychInfo, Scopus, and EThOS following the PRISMA guidelines. We included cross-sectional and longitudinal studies which assessed the risk factors for depression and anxiety in adult cancer patients. Quality assessment was undertaken using the Newcastle-Ottawa assessment checklists. The quality of each study was further rated using the Agency for Healthcare Research and Quality Standards. Our search yielded 2645 papers, 21 of these were eligible for inclusion. Studies were heterogenous in terms of their characteristics, risk factors and outcomes measured. A total of 32 risk factors were associated with depression and anxiety. We clustered these risk factors into four domains using an expanded biopsychosocial model of health: cancer-specific, biological, psychological and social risk factors. The cancer-specific risk factors domain was associated with the diagnosis, treatment and survivorship phases. Multifactorial risk factors are associated with the onset of depression and anxiety in cancer patients. These risk factors vary across cancer journey and depend on factors such as type of cancer and individual profile of the patients. Our findings have potential applications for risk stratification in primary care and highlight the need for a personalised approach to psychological care provision, as part of cancer care.
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Affiliation(s)
- Deborah Ikhile
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Devyn Glass
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Georgie Gremesty
- National Institute for Health and Care Research Applied Research Collaboration Kent, Surrey and Sussex, Hove, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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13
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Ganesan AN, Tiver KD. Remote Monitoring of Cardiac Implantable Electronic Devices: Helping Our Patients Get Online and Stay Connected. JACC Clin Electrophysiol 2024; 10:331-333. [PMID: 38206264 DOI: 10.1016/j.jacep.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Anand N Ganesan
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia.
| | - Kathryn D Tiver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
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14
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Wilson BE, Hanna TP, Booth CM. Efficacy-effectiveness gaps in oncology: Looking beyond survival. Cancer 2024; 130:335-338. [PMID: 37916831 DOI: 10.1002/cncr.35075] [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: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
The efficacy-effectiveness (EE) gap describes the differences in survival seen in clinical trials and routine clinical practice, where patients in real-world practice often have inferior outcomes compared to trial populations. However, EE gaps may exist beyond survival outcomes, including gaps in quality of life, toxicity, cost-effectiveness, and patient time, and these EE gaps should also influence patient and clinician treatment decisions. Failure to clearly acknowledge these EE gaps may cause patients, clinicians, and health care systems to have unrealistic expectations of the benefits of therapy across a range of important clinical and economic domains. In this commentary, the authors review the evidence supporting the existence of EE gaps in quality of life, time toxicity, cost and toxicities, and urge for further research into this important topic.
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Affiliation(s)
- Brooke E Wilson
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Timothy P Hanna
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
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15
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Lewis A, Young MJ, Rohaut B, Jox RJ, Claassen J, Creutzfeldt CJ, Illes J, Kirschen M, Trevick S, Fins JJ. Ethics Along the Continuum of Research Involving Persons with Disorders of Consciousness. Neurocrit Care 2023; 39:565-577. [PMID: 36977963 PMCID: PMC11023737 DOI: 10.1007/s12028-023-01708-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/23/2023] [Indexed: 03/30/2023]
Abstract
Interest in disorders of consciousness (DoC) has grown substantially over the past decade and has illuminated the importance of improving understanding of DoC biology; care needs (use of monitoring, performance of interventions, and provision of emotional support); treatment options to promote recovery; and outcome prediction. Exploration of these topics requires awareness of numerous ethics considerations related to rights and resources. The Curing Coma Campaign Ethics Working Group used its expertise in neurocritical care, neuropalliative care, neuroethics, neuroscience, philosophy, and research to formulate an informal review of ethics considerations along the continuum of research involving persons with DoC related to the following: (1) study design; (2) comparison of risks versus benefits; (3) selection of inclusion and exclusion criteria; (4) screening, recruitment, and enrollment; (5) consent; (6) data protection; (7) disclosure of results to surrogates and/or legally authorized representatives; (8) translation of research into practice; (9) identification and management of conflicts of interest; (10) equity and resource availability; and (11) inclusion of minors with DoC in research. Awareness of these ethics considerations when planning and performing research involving persons with DoC will ensure that the participant rights are respected while maximizing the impact and meaningfulness of the research, interpretation of outcomes, and communication of results.
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Affiliation(s)
- Ariane Lewis
- NYU Langone Medical Center, 530 First Avenue, Skirball-7R, New York, NY, 10016, USA.
| | - Michael J Young
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin Rohaut
- Inserm, CNRS, APHP - Hôpital de la Pitié Salpêtrière, Paris Brain Institute - ICM, DMU Neuroscience, Sorbonne University, Paris, France
| | - Ralf J Jox
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jan Claassen
- New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Claire J Creutzfeldt
- Harborview Medical Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, Seattle, WA, USA
| | - Judy Illes
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Joseph J Fins
- Weill Cornell Medical College, New York, NY, USA
- Yale Law School, New Haven, CT, USA
- Rockefeller University, New York, NY, USA
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16
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Miller YM, Bakhtary S, Chou ST, Hailu B, Reik RA, Richard RH, Spencer BR, Witherspoon R, Delaney M. Involvement of Diverse Populations in Transfusion Medicine Research. Transfus Med Rev 2023; 37:150766. [PMID: 37993382 PMCID: PMC11032214 DOI: 10.1016/j.tmrv.2023.150766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 11/24/2023]
Abstract
Communities of color and diverse communities (eg, race, socioeconomic status, language, sexual orientation etc.) have not been recruited and enrolled equitably to participate in research studies in transfusion medicine. The exclusion of diverse communities in transfusion research can lead to health disparities lack of access to approved therapeutics and unequal allocation of interventions, resulting in missed opportunities to optimize health for individuals and communities. Involvement of diverse populations in research goes beyond inclusion as research subjects. Strategies should include specific studies on health conditions of importance to diverse communities with stable funding sources and specific funding announcements to develop projects led by diverse researchers, mentorship of diverse researchers, and openness to various ways of communicating research plans. Qualitative approaches and interdisciplinary collaboration should be supported to enhance inclusivity.
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Affiliation(s)
| | - Sara Bakhtary
- Transfusion Medicine, Department of Laboratory Medicine, University of California San Francisco, USA
| | - Stella T Chou
- Division of Transfusion Medicine, The Children's Hospital of Philadelphia University of Pennsylvania School of Medicine, USA
| | | | | | - Raven Hardy Richard
- National Institutes of Health (NIH) National Human Genome Research Institute (NHGRI), USA
| | | | | | - Meghan Delaney
- Division of Pathology & Laboratory Medicine Children's National Hospital, The George Washington University, USA
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17
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Chaix E, Mongin D, Gabay C, Iudici M. Reporting and Representativeness of Race, Ethnicity, and Socioeconomic Status in Systemic Sclerosis Randomized Trials: An Observational Study. Arthritis Care Res (Hoboken) 2023; 75:1698-1705. [PMID: 36358027 DOI: 10.1002/acr.25059] [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: 06/29/2022] [Revised: 10/07/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess how and to what extent socioeconomic status and ethnicity/race of participants are reported in randomized controlled trials (RCTs) on systemic sclerosis (SSc), and to estimate the representativeness of different ethnic/racial groups in SSc RCTs. METHODS We searched all published RCTs on SSc indexed in PubMed. We retrieved information on main features of RCTs published from 2000 onward and recorded for each study whether race/ethnicity was reported; how ethnicity/race was defined and assigned; and the number of patients included for each racial/ethnic group. Multivariable logistic regression was used to identify factors associated with race/ethnicity reporting. Proportion of races/ethnicities included in US-based RCTs on SSc was examined and compared with US demographic data. RESULTS We included 106 studies, mostly conducted in Europe (42%) or North America (25%), published after 2010 (74%), and enrolling a total of 6,693 patients. About one-third of studies provided information about race/ethnicity, with no improved reporting over time. Only 2 papers reported patient's socioeconomic status. Study location (US or intercontinental) was the only significant factor associated with a better reporting of race/ethnicity in multivariable analysis. In studies where race/ethnicity was reported, White patients were mostly represented (79%), followed by Asian (7%), and African American (6%). In the sensitivity analysis limited to studies from the US, underrepresentation of African American patients was observed in the 2000-2010 time period, but not later. CONCLUSION Documentation of race/ethnicity and socioeconomic status is poor in RCTs on SSc. More effort should be made to document race/ethnicity and socioeconomic status and to promote diversity in SSc RCTs.
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Affiliation(s)
- Edouard Chaix
- Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Denis Mongin
- Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cem Gabay
- Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Michele Iudici
- Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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18
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Charton E, Baldini C, Fayet Y, Schultz E, Auroy L, Vallier E, Italiano A, Robert M, Coquan E, Isambert N, Moreau P, Touzeau C, Le Tourneau C, Ghrieb Z, Kiladjian JJ, Delord JP, Gomez Roca C, Vey N, Barlesi F, Lesimple T, Penel N, Soria JC, Massard C, Besle S. Inequality factors in access to early-phase clinical trials in oncology in France: results of the EGALICAN-2 study. ESMO Open 2023; 8:101610. [PMID: 37536254 PMCID: PMC10415590 DOI: 10.1016/j.esmoop.2023.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Investigation of the disparities in the access to experimental treatment in early-phase clinical trials is lacking. The objective of the EGALICAN-2 study was to identify the factors underpinning such inequalities. METHODS A national prospective survey was conducted in 11 early-phase clinical trial centers (CLIP2) certified by the French National Cancer Institute. Sociodemographic, socioeconomic and medical data were collected. Univariate logistic regression models were carried out to estimate odds ratios and 90% confidence intervals associated with the effect of each study variable. A multivariate logistic regression model was built to explore the independent factors associated with the administration of the experimental treatment (C1D1). A post hoc analysis was carried out excluding female cancer patients. RESULTS Between 2015 and 2016, 1355 patients referred from 11 CLIP2 centers in France were included in the study. Eight hundred and forty-eight patients received C1D1 (73%) and 320 patients (27%) were screening failure. Median age was 58 years (range 17-97 years) and 667 patients (54%) were female. Most patients had a metastatic disease (n = 751, 87%). In the multivariate logistic regression analysis, the significant independent factors associated with C1D1 were male sex, initial care received in a hospital with an early-phase unit and living in wealthy metropolitan areas (P values <0.05). In the post hoc analysis, the sex factor was no longer significant [odds ratio = 1.21 (95% confidence interval 0.86-1.70), P value = 0.271]. CONCLUSIONS This study investigated the factors producing social inequalities in the context of early-phase clinical trials in oncology. Our research highlights factors of sex, care pathway and geographic location. Gynecological cancer was found to impact C1D1 significantly, unlike breast cancer. The results of this study should contribute to improve patient access to early-phase clinical trials.
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Affiliation(s)
- E Charton
- Human and Social Sciences Department, Centre Léon Bérard, Lyon.
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - Y Fayet
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon
| | - E Schultz
- CEPED (UMR 196), University of Paris, IRD, Paris; SESSTIM, CANBIOS Team, Aix-Marseille University, INSERM, IRD, Marseille
| | - L Auroy
- University of Grenoble Alpes, CNRS, Sciences Po Grenoble, Grenoble
| | - E Vallier
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | | | - M Robert
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Saint-Herblain
| | - E Coquan
- Medical Oncology Department, Centre François Baclesse, Caen
| | - N Isambert
- Medical Oncology Department, University Hospital of Poitiers, Poitiers
| | - P Moreau
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon
| | - C Touzeau
- Department of Hematology, University Hospital of Nantes, Nantes
| | - C Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris
| | - Z Ghrieb
- Service de Pharmacologie et Investigations Cliniques, Hôpital Saint-Louis, AP-HP, Paris
| | - J-J Kiladjian
- Service de Pharmacologie et Investigations Cliniques, Hôpital Saint-Louis, AP-HP, Paris
| | - J-P Delord
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - C Gomez Roca
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - N Vey
- Department of Hematology, Institut Paoli-Calmettes, Marseille
| | - F Barlesi
- CRCM, INSERM, CNRS, APHM, Aix-Marseille University, Marseille; Gustave Roussy, Villejuif
| | - T Lesimple
- Department of Oncology, Eugene Marquis Center, Rennes
| | - N Penel
- Centre Oscar Lambret, Lille University, Lille
| | - J-C Soria
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - C Massard
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - S Besle
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif; Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon, Institut Convergence PLAsCAN, Lyon, France
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19
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Mahoney ME, Sridhar SS. Clinical trial reform in the post-COVID era. Ther Adv Med Oncol 2023; 15:17588359231183676. [PMID: 37431430 PMCID: PMC10331111 DOI: 10.1177/17588359231183676] [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: 01/20/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023] Open
Abstract
The COVID-19 pandemic precipitated the acute and efficient rollout of telehealth and virtual health care around the world. This review article focuses on the adoption of virtual care in the management of oncology patients, and discusses how virtual care offers the potential for large-scale, positive impacts on access to clinical trials. Virtual care during and following the peak of the pandemic has been found to be both safe and efficacious for oncology patients. Features, such as wearable health technologies, remote monitoring, home visits, and investigations being done closer to home, represent just some of the strengths of the virtual assessment rollout that were successfully utilized. One of the primary criticisms of oncological clinical trials is that clinical trial participants are not always representative of the patient populations treated in routine practice. This is in part due to stringent inclusion criteria and more broadly pertains to a lack of access to clinical trials, many of which are geographic as most trials are conducted in an urban, academic, or 'centralized' center. This paper seeks to discuss the barriers to clinical trial participation and to propose that the virtual care transformation that occurred during the pandemic has equipped oncological clinicians and researchers with the tools to better address these obstacles. A review of the literature on the impact of the virtual care rollout during and after the peak of the COVID-19 pandemic both locally and abroad was conducted. It is proposed that improving patient access through the decentralization of clinical trials has the potential to enhance evidence-based, real-world data, and to produce generalizable trial results that ultimately improve patient outcomes.
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Affiliation(s)
- Meghan E. Mahoney
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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20
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Mitchell C, Fryer K, Guess N, Aminu H, Jackson B, Gordon A, Reynolds J, Huang Q, Jayasooriya S, Mawson R, Lawy T, Linton E, Brown J. Underserved 'Deep End' populations: a critical analysis addressing the power imbalance in research. Br J Gen Pract 2023; 73:326-329. [PMID: 37385767 PMCID: PMC10325604 DOI: 10.3399/bjgp23x733461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Affiliation(s)
- Caroline Mitchell
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Kate Fryer
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Nicola Guess
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford
| | - Habiba Aminu
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Ben Jackson
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Anna Gordon
- Elizabeth Blackwell Institute, University of Bristol, Bristol
| | - Josephine Reynolds
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Qizhi Huang
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Shamanthi Jayasooriya
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Rebecca Mawson
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Tom Lawy
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Emma Linton
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Janet Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield
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21
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Rodriguez DK, Hewage SA, Periyakoil VS. Factors affecting the recruitment of Hispanic/Latinx American older adults in clinical trials in the United States: A scoping review. J Am Geriatr Soc 2023; 71:1974-1991. [PMID: 37013348 PMCID: PMC10258132 DOI: 10.1111/jgs.18264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Participation of Hispanic/Latinx American older adults (HLAOA) in clinical trials is fundamental to health equity in aging research. However, information on strategies for the successful recruitment of this population in clinical trials is limited. DESIGN This scoping review aims to identify hindering and facilitating factors that impact the recruitment of HLAOA in clinical trials in the United States. METHODS Two databases (PubMed, EMBASE) were searched for original research articles from inception until March 2022 reporting on factors that engaged HLAoa (≥65) in clinical trials. One thousand and thirteen studies were scrutinized to identify 31 eligible articles. RESULTS Most articles were from cancer clinical trials (14 studies). Hindering factors that impacted the recruitment of HLAoa in clinical trials were related to (i) study design and logistics challenges, (ii) challenges imposed by social determinants of health, (iii) communication barriers, and (iv) patients' mistrust, and (v) family issues. Facilitating factors include (i) effective modes of outreach, (ii) strategic clinical trial design, (iii) incorporating culturally-respectful approaches that are tailored to the participants' sociocultural background, and (iv) bridging language barriers. CONCLUSIONS Successful recruitment of HLAOA into clinical trials requires identifying the study question, co-designing the trial design, implementation, and evaluation in respectful collaboration with the Hispanic/Latinx community with careful attention to their needs and minimizing the study burden on this vulnerable population. Factors identified here may guide researchers to better understand the needs of HLAOA and successfully recruit them into clinical trials, leading to more equitable research that increases their representation in clinical research.
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Affiliation(s)
- Dulce K Rodriguez
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Sumali A Hewage
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Vyjeyanthi S Periyakoil
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
- Veterans Affairs Palo Alto Health Care Center, Palo Alto, California, USA
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22
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Martín AG, Fernández Rodríguez EJ, Sánchez Gómez C, Galve MIR. Multifactorial Study on the Impact of Educational Level, Employment Status, and the Need for Extraordinary Care on the Economic Impact of Cancer Patients. Healthcare (Basel) 2023; 11:healthcare11091306. [PMID: 37174847 PMCID: PMC10178604 DOI: 10.3390/healthcare11091306] [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: 03/09/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Cancer is one of the major socio-health problems in the world. The level of education, the profession and/or employment status of the patient and the family can influence the amount of household income, the additional expenditure, and the possible socio-economic impact of the disease. The main objective of the study is to analyse and evaluate the influence of the level of education, the employment status of the patient, and the need for care and how these factors influence the additional expenditure and the possible socio-economic impact. METHODS descriptive cross-sectional randomised observational epidemiological study without replacement at the Hospital Universitario de Salamanca (CAUSA). RESULTS total sample (n = 365) comprised 53.2% of patients with no education or primary education, 25.8% with secondary education and 21.1% with higher education. Overall, 36.4% of patients were employed, 10.1% were self-employed, 53.0% were not employed, and 38.9% were experiencing other conditions. Significant statistics were found for educational level, employment status of the patient and main caregivers in terms of financial expenditure. CONCLUSIONS Oncology patients with more education spend more on home help and/or accompanying the patient and transfers to the hospital for treatment. Higher incomes are not synonymous with higher expenditure in the sample. The patient's main caregivers are a fundamental pillar of the patient's household income and additional spending on orthopaedic material.
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Affiliation(s)
- Alberto García Martín
- Department of Labour Law and Social Work, University of Salamanca, 37007 Salamanca, Spain
| | - Eduardo J Fernández Rodríguez
- Department of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Celia Sánchez Gómez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Department of Developmental and Educational Psychology, University of Salamanca, 37007 Salamanca, Spain
| | - M Isabel Rihuete Galve
- Department of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Medical Oncology Unit, University Hospital of Salamanca, 37007 Salamanca, Spain
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Reynolds SA, O'Connor L, McGee A, Kilcoyne AQ, Connolly A, Mockler D, Guinan E, O'Neill L. Recruitment rates and strategies in exercise trials in cancer survivorship: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01363-8. [PMID: 37022641 DOI: 10.1007/s11764-023-01363-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Despite clear evidence-based supporting a benefit to exercise on physical and psychological metrics in patients with cancer, recruitment to exercise trials amongst cancer survivors is suboptimal. We explore current recruitment rates, strategies, and common barriers to participation in exercise oncology trials in cancer survivorship. METHODS A systematic review was conducted using a pre-defined search strategy in EMBASE, CINAHL, Medline, Cochrane Library, and Web of Science. The search was performed up to 28/02/2022. Screening of titles and abstracts, full-text review, and data extraction was completed in duplicate. RESULTS Of the 3204 identified studies, 87 papers corresponding to 86 trials were included. Recruitment rates were highly variable with a median rate of 38% (range 0.52-100%). Trials recruiting prostate cancer patients only had the highest median recruitment rate (45.9%) vs trials recruiting colorectal cancer patients only which had the lowest (31.25%). Active recruitment strategies such as direct recruitment via a healthcare professional were associated with higher recruitment rates (rho = 0.201, p = 0.064). Common reasons for non-participation included lack of interest (46.51%, n (number of studies) = 40); distance and transport (45.3%, n = 39); and failure to contact (44.2%, n = 38). CONCLUSIONS Recruitment of cancer survivors to exercise interventions is suboptimal with barriers being predominantly patient-oriented. This paper provides the benchmark for current recruitment rates to exercise oncology trials, providing data for trialists planning future trial design and implementation, optimise future recruitment strategies, and evaluate their own recruitment success against current practice. IMPLICATIONS FOR CANCER SURVIVORS Enhanced recruitment to cancer survivorship exercise trials is necessary in facilitating the publication of definitive exercise guidelines, generalisable to varying cancer cohorts. PROSPERO REGISTRATION NUMBER CRD42020185968.
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Affiliation(s)
- Sophie A Reynolds
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Louise O'Connor
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Anna McGee
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Anna Quinn Kilcoyne
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Archie Connolly
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - David Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Linda O'Neill
- Trinity St James's Cancer Institute, Dublin, Ireland.
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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24
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Steyaert S, Pizurica M, Nagaraj D, Khandelwal P, Hernandez-Boussard T, Gentles AJ, Gevaert O. Multimodal data fusion for cancer biomarker discovery with deep learning. NAT MACH INTELL 2023; 5:351-362. [PMID: 37693852 PMCID: PMC10484010 DOI: 10.1038/s42256-023-00633-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/17/2023] [Indexed: 09/12/2023]
Abstract
Technological advances now make it possible to study a patient from multiple angles with high-dimensional, high-throughput multi-scale biomedical data. In oncology, massive amounts of data are being generated ranging from molecular, histopathology, radiology to clinical records. The introduction of deep learning has significantly advanced the analysis of biomedical data. However, most approaches focus on single data modalities leading to slow progress in methods to integrate complementary data types. Development of effective multimodal fusion approaches is becoming increasingly important as a single modality might not be consistent and sufficient to capture the heterogeneity of complex diseases to tailor medical care and improve personalised medicine. Many initiatives now focus on integrating these disparate modalities to unravel the biological processes involved in multifactorial diseases such as cancer. However, many obstacles remain, including lack of usable data as well as methods for clinical validation and interpretation. Here, we cover these current challenges and reflect on opportunities through deep learning to tackle data sparsity and scarcity, multimodal interpretability, and standardisation of datasets.
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Affiliation(s)
- Sandra Steyaert
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University
| | - Marija Pizurica
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University
| | | | | | - Tina Hernandez-Boussard
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University
- Department of Biomedical Data Science, Stanford University
| | - Andrew J Gentles
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University
- Department of Biomedical Data Science, Stanford University
| | - Olivier Gevaert
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University
- Department of Biomedical Data Science, Stanford University
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25
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Nathan PC. Vulnerable populations in childhood cancer research and clinical care. Cancer 2023; 129:1476-1478. [PMID: 36813752 DOI: 10.1002/cncr.34702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Paul C Nathan
- The Hospital for Sick Children, Division of Hematology/Oncology, The University of Toronto, Toronto, Ontario, Canada
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26
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Nathan AS, Reddy KP, Yang L, Eberly LA, Dayoub EJ, Khatana SAM, Julien HM, Desai ND, Szeto WY, Herrmann HC, Kobayashi TJ, Fiorilli P, Batchelor WB, Mehran R, Alkhouli MA, Giri J, Groeneveld PW, Fanaroff AC. Characteristics of Clinical Trial Sites for Novel Transcatheter Mitral and Tricuspid Valvular Therapies. JAMA Cardiol 2023; 8:120-128. [PMID: 36477493 PMCID: PMC9856899 DOI: 10.1001/jamacardio.2022.4457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Racial and ethnic minority and socioeconomically disadvantaged patients have been underrepresented in randomized clinical trials. Efforts have focused on enhancing inclusion of minority groups at sites participating at clinical trials; however, there may be differences in the patient populations of the sites that participate in clinical trials. Objective To identify any differences in the racial, ethnic, and socioeconomic composition of patient populations among candidate sites in the US that did vs did not participate in trials for novel transcatheter therapies. Design, Setting, and Participants This cross-sectional analysis used Medicare Provider Claims from 2019 for patients admitted to hospitals in the US. All clinical trials for transcatheter mitral and tricuspid valve therapies and the hospitals participating in each of the trials were identified using ClinicalTrials.gov. Hospitals with active cardiac surgical programs that did not participate in the trials were also identified. Data analysis was performed between July 2021 and July 2022. Exposures Multivariable linear regression models were used to identify differences in racial, ethnic, and socioeconomic characteristics among patients undergoing cardiac surgery or transcatheter aortic valve replacement at trial vs nontrial hospitals. Main Outcome and Measures The main outcome of the study was participation in a clinical trial for novel transcatheter mitral or tricuspid valve therapies. Results A total of 1050 hospitals with cardiac surgery programs were identified, of which 121 (11.5%) participated in trials for transcatheter mitral or tricuspid therapies. Patients treated in trial hospitals had a higher median zip code-based household income (difference of $5261; 95% CI, $2986-$7537), a lower Distressed Communities Index score (difference of 5.37; 95% CI, 2.59-8.15), and no significant difference in the proportion of patients dual eligible for Medicaid (difference of 0.86; 95% CI, -2.38 to 0.66). After adjusting for each of the socioeconomic indicators separately, there was less than 1% difference in the proportion of Black and Hispanic patients cared for at hospitals participating vs not participating in clinical trials. Conclusions and Relevance In this cohort study among candidate hospitals for clinical trials for transcatheter mitral or tricuspid valve therapies, trial hospitals took care of a more socioeconomically advantaged population than nontrial hospitals, with a similar proportion of Black and Hispanic patients. These data suggest that site selection efforts may improve enrollment of socioeconomically disadvantaged patients but may not improve the enrollment of Black and Hispanic patients.
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Affiliation(s)
- Ashwin S Nathan
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Kriyana P Reddy
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
| | - Lin Yang
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Lauren A Eberly
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Elias J Dayoub
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sameed A M Khatana
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Howard M Julien
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Nimesh D Desai
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Division of Cardiac Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Wilson Y Szeto
- Division of Cardiac Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Howard C Herrmann
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Taisei J Kobayashi
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Paul Fiorilli
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jay Giri
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alexander C Fanaroff
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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27
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Shi JJ, Lei X, Chen YS, Chavez-MacGregor M, Bloom E, Schlembach P, Shaitelman SF, Buchholz TA, Kaiser K, Ku K, Smith BD, Smith GL. Socioeconomic Barriers to Randomized Clinical Trial Retention in Patients Treated With Adjuvant Radiation for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 116:122-131. [PMID: 36724858 DOI: 10.1016/j.ijrobp.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE Socioeconomic barriers contribute to breast cancer clinical trial enrollment disparities. We sought to identify whether socioeconomic disadvantage also is associated with decreased trial retention. METHODS AND MATERIALS We performed a secondary analysis of 253 (of 287) patients enrolled in a randomized phase 3 trial of conventionally fractionated versus hypofractionated whole-breast irradiation. The outcome of trial retention versus dropout was defined primarily based on whether the patient completed breast cosmesis outcomes assessment at 3-year follow-up, and secondarily, at 5-year follow-up. Associations of retention with severity of socioeconomic disadvantage, quantified by patients' home neighborhood area deprivation index (ADI) rank (1 [least] to 100 [most deprivation]), were tested using the Kruskal-Wallis test and multivariate logistic regression. Associations of retention with patients' use of social resource assistance were analyzed using the χ2 test. RESULTS In total, 21.7% (n = 55) of patients dropped out by 3 years and 36.7% (n = 92) by 5 years. Median ADI was 36.5 (interquartile range, 22-57) for retained and 46.0 (interquartile range, 29-60) for dropout patients. Dropout was associated with more severe socioeconomic deprivation (ADI ≥45 vs <45) at 3 years (odds ratio, 3.63; 95% confidence interval, 1.62-8.15; P = .002) and 5 years (odds ratio, 2.55; 95% confidence interval, 1.37-4.76; P = .003). While on study, patients who ultimately dropped out were more likely to require resource assistance for practical (transportation, housing, financial) than psychological needs (distress, grief) or advance care planning (P = .03). CONCLUSIONS In this study, ADI was associated with disparities in clinical trial retention of patients with breast cancer receiving adjuvant radiation treatment. Results suggest that developing multidimensional interventions that extend beyond routine social determinants needs screening are needed, not only to enhance initial clinical trial access and enrollment but also to enable robust long-term retention of socioeconomically disadvantaged patients and improve the validity and generalizability of reported long-term trial clinical and patient-reported outcomes.
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Affiliation(s)
- Julia J Shi
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Elizabeth Bloom
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Kelsey Kaiser
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberly Ku
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Grace L Smith
- University of Texas MD Anderson Cancer Center, Houston, Texas.
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28
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Chadow D, Audisio K, Perezgrovas-Olaria R, Cancelli G, Robinson NB, Rahouma M, Soletti G, Angiolillo DJ, Metkus TS, Gaudino MFL. Differences Among Clinical Trials and Registries on Surgical and Percutaneous Coronary Interventions. Ann Thorac Surg 2023; 115:79-86. [PMID: 35643330 DOI: 10.1016/j.athoracsur.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/19/2022] [Accepted: 05/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND A need exists for systematic evaluation of the differences in baseline characteristics and early outcomes between patients enrolled in randomized controlled trials (RCTs) and clinical practice for coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). METHODS Systematic searches were conducted to identify RCTs comparing CABG vs PCI and CABG or PCI registries. Sixteen predefined baseline characteristics and 30-day mortality were extracted from the included studies. Pooled proportion and mean with 95% CI were calculated for binary and continuous outcomes, respectively, by using the random effects model. RESULTS Fourteen RCTs and 10 registries including more than 2 million patients were included. Registry patients who underwent CABG had a higher prevalence of hypertension, smoking, reduced left ventricular ejection fraction, and prior myocardial infarction, but a lower prevalence of single-vessel disease when compared with CABG-treated patients included in RCTs. Regarding PCI, hypertension, hyperlipidemia, left main coronary artery disease, triple-vessel coronary disease, and NYHA functional class <IV were significantly more prevalent among patients in RCTs, whereas age, reduced left ventricular ejection fraction, and smoking were more represented among PCI registry patients. Thirty-day mortality was higher in registries for both PCI-treated and CABG-treated patients. CONCLUSIONS There were significant differences in baseline characteristics and 30-day mortality between patients enrolled in RCTs comparing CABG vs PCI and CABG and PCI registries. However, results were mixed, and the discrepancy was less than seen in other fields.
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Affiliation(s)
- David Chadow
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | | | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Thomas S Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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29
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Wheeler AJ, Garg H, Kaushik D, Mansour A, Pruthi D, Liss MA. Predictors of participants' retention-socioeconomic factors or nonadherence: insights from a urological clinical prospective study. Trials 2022; 23:970. [PMID: 36461104 PMCID: PMC9716754 DOI: 10.1186/s13063-022-06901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To investigate various patient-level variables, specifically socioeconomic status, as risk factors for withdrawal in a recently completed clinical study. We specifically investigated a non-interventional prospective study assessing the role of novel imaging as a biomarker for cancer upgradation in prostate cancer for this objective. METHODS In this retrospective analysis, we assessed the association between various patient-level factors including clinic-demographic factors, socioeconomic status, and the number of non-adherences with the participants' retention or withdrawal from the study. For socioeconomic status (SES), we used the zip code-based Economic Innovation Group Distressed Community Index (DCI) which classifies into five even distress tiers: prosperous, comfortable, mid-tier, at-risk, or distressed. Low SES was defined as those with a DCI Distress tier of at-risk or distressed. We compared values between the two retention and withdrawal groups using t-test, chi-square test, and logistic regression analysis. RESULTS Of 273 men screened, 123 men were enrolled. Among them, 86.2% (106/123) retained through the study whereas 13.8% (17/123) withdrew from the study. The mean (SD) age was 64 (6.4) years. Overall, 31.7% (39/123) were Hispanics and 24.3% (30/123) were African Americans. The median (IQR) DCI score was 34 (10.3, 68.1) and 30.8% (38/123) of patients belonged to low SES. The median DCI score in participants who retained in the study was statistically similar to those who withdrew from the study (p=0.4). Neither the DCI tiers (p=0.7) nor the low SES (p=0.9) were associated with participants' retention or withdrawal of the study. In terms of non-adherence, all participants in the withdrawn group had at least one non-adherent event compared to 48.1% in the retained group (p<0.001). Repetitive non-adherence was significantly higher in participants who withdrew from the study vs those who retained in the study [88.2% vs 16.9%, p <0.001]. On multivariate logistic regression analysis, the number of non-adherences (OR=12.5, p<0.001) and not DCI (OR=0.99, p=0.7) appeared to be an independent predictor for participants' retention or withdrawal from the study. CONCLUSIONS Expanding diverse inclusion and limiting withdrawal with real-time non-adherence monitoring will lead to more efficient clinical research and greater generalizability of results.
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Affiliation(s)
- Allison J Wheeler
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Harshit Garg
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Ahmed Mansour
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Deepak Pruthi
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Michael A Liss
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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30
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Grant M, Hockings H, Lapuente M, Adeniran P, Saud RA, Sivajothi A, Amin J, Crusz SM, Rashid S, Szabados B, Wells P, Boleti E, Powles TB. Learning from Crisis: a Multicentre Study of Oncology Telemedicine Clinics Introduced During COVID-19. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1861-1869. [PMID: 34213751 PMCID: PMC8249430 DOI: 10.1007/s13187-021-02053-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has necessitated adaptation of cancer patient care. Oncology patients who contract COVID-19 have poor outcomes. Telemedicine clinics (teleclinics) have been introduced for cancer patients to reduce the risk of horizontal transmission at St. Bartholomew's Hospital and The Royal Free Hospital in London. Teleclinics have become routine in many specialities; however, inclusion in oncology care was not standard prior to the pandemic. A mixed-methods survey was designed and delivered to cancer patients (n = 106) at St. Bartholomew's Hospital and The Royal Free Hospital who had transitioned to teleclinics in March 2020. The survey explored patients' perceptions of this format. In total, 96 (90.5%) patients consented to take part, across a range of tumour types. Overall, respondents reacted favourably to the format of the teleclinics, with 90.6% of respondents (87/96) stating they would utilise teleclinics beyond the pandemic. Additionally, a survey was distributed to clinicians delivering these teleclinics (n = 16) to explore previous training in, perceptions of, and lessons learned from the introduction of telemedicine. Results suggest patients are accepting of teleclinic use for most clinical purposes. Teleclinic implementation affords benefits to cancer patient care both during and after COVID-19, but there is an urgent need for telemedicine education in oncology specialty training.
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Affiliation(s)
- Michael Grant
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
- Specialist Kidney Cancer Unit, Royal Free Hospital, Royal Free NHS Foundation Trust, London, UK
| | - Helen Hockings
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Maria Lapuente
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Philip Adeniran
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Rabiah Abbas Saud
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Anjali Sivajothi
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Jubel Amin
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Shanthini M. Crusz
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Sukaina Rashid
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Bernadette Szabados
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Paula Wells
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Ekaterini Boleti
- Specialist Kidney Cancer Unit, Royal Free Hospital, Royal Free NHS Foundation Trust, London, UK
| | - Thomas B. Powles
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
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The reporting and representation of sex and gender in head and neck cancer clinical trials. Oral Oncol 2022; 135:106217. [DOI: 10.1016/j.oraloncology.2022.106217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/06/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022]
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Caston NE, Lalor F, Wall J, Sussell J, Patel S, Williams CP, Azuero A, Arend R, Liang MI, Rocque GB. Ineligible, Unaware, or Uninterested? Associations Between Underrepresented Patient Populations and Retention in the Pathway to Cancer Clinical Trial Enrollment. JCO Oncol Pract 2022; 18:e1854-e1865. [PMID: 36178922 PMCID: PMC9653198 DOI: 10.1200/op.22.00359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/07/2022] [Accepted: 08/15/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Cancer clinical trials can benefit current and future patients; however, Black patients, rural residents, and patients living in disadvantaged areas are often underrepresented. Using an adapted version of Unger and colleagues' model of the process of clinical trial enrollment, we evaluated the relationship between underrepresented patient populations and trial end points. METHODS This retrospective study included 512 patients with breast or ovarian cancer who were prescribed a therapeutic drug at the University of Alabama at Birmingham from January 2017 to February 2020. Patient eligibility was assessed using open clinical trials. We estimated odds ratios and 95% CIs using logistic regression models to examine the relationship between underrepresented patient populations and trial enrollment end points: eligibility, interest, offer, enrollment, and declining enrollment. RESULTS Of the patients in our sample, 27% were Black, 18% were rural residents, and 19% lived in higher disadvantaged neighborhoods. In adjusted models, each comparison group had similar odds of being eligible for a clinical trial. Black versus White patients had 0.40 times the odds of interest in clinical trials and 0.56 times the odds of enrollment. Patients living in areas of higher versus lower disadvantage had 0.46 times the odds of enrolling and 3.40 times the odds of declining enrollment when offered. CONCLUSION Eligibility did not drive clinical trial enrollment disparities in our sample; however, retention in the clinical trial enrollment process appears to vary by group. Additional work is needed to understand how interventions can be tailored to each population's specific needs.
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Affiliation(s)
- Nicole E. Caston
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Fallon Lalor
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jaclyn Wall
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Courtney P. Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Rebecca Arend
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Margaret I. Liang
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gabrielle B. Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
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Caston NE, Williams CP, Wan C, Ye S, Pywell C, Ingram SA, Azuero A, Sussell J, Patel S, Arend R, Rocque GB. Associations between geography, decision‐making style, and interest in cancer clinical trial participation. Cancer 2022; 128:3977-3984. [DOI: 10.1002/cncr.34455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Nicole E. Caston
- Department of Medicine, Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
| | - Courtney P. Williams
- Department of Medicine, Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
| | - Clara Wan
- Department of Medicine, Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
| | - Star Ye
- Department of Medicine, Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
| | - Cameron Pywell
- Department of Medicine, Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
| | - Stacey A. Ingram
- Department of Medicine, Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
| | - Andres Azuero
- Department of Family, Community, and Health Systems University of Alabama at Birmingham School of Nursing Birmingham Alabama USA
| | | | | | - Rebecca Arend
- Department of Medicine, Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
| | - Gabrielle B. Rocque
- Department of Medicine, Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
- O'Neal Comprehensive Cancer Center Birmingham Alabama USA
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Mekinda MA, Chaudhary S, Vanderford NL, White KB, Kennedy LS, Marriott LK. Approaches for Measuring Inclusive Demographics Across Youth Enjoy Science Cancer Research Training Programs. JOURNAL OF STEM OUTREACH 2022; 5:10.15695/jstem/v5i2.12. [PMID: 37840910 PMCID: PMC10575593 DOI: 10.15695/jstem/v5i2.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
The National Cancer Institute's (NCI) Youth Enjoy Science Program (YES) funds initiatives to support the cancer research training and career ambitions of middle school through undergraduate students from populations underrepresented in the biomedical sciences. The program has funded 16 institutions nationally as of January 2022. Given the program's focus on increasing diversity within the cancer research workforce, demographic characteristics of YES trainees provide essential information about the populations being served and program effectiveness. Six programs formed an interest group focused on trainee demographics and surveyed all YES grantees about their demographic data practices. Fifteen programs (94%) completed the survey. Survey data were analyzed through descriptive statistics and thematic coding. Findings revealed considerable variability in programs' approach to demographic data, including which demographics were measured, how they were operationalized, and when and how the data were collected. Half of YES programs (53%) could report underrepresented populations in biomedical research among trainees using consistent definitions. Most programs described efforts to improve their demographic data practices; however, challenges remained for the vast majority. In consideration of these findings, we offer recommendations for inclusive demographic data practices to better define and retain underrepresented populations in biomedical sciences.
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Affiliation(s)
- Megan A. Mekinda
- University of Chicago Medicine Comprehensive Cancer Center, Chicago, IL
| | - Sunita Chaudhary
- Rutgers Cancer Institute of New Jersey, Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nathan L. Vanderford
- Markey Cancer Center and the Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY
| | | | | | - Lisa K. Marriott
- OHSU-PSU School of Public Health; Oregon Health and Science University; Portland, OR
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Abravan A, Price G, Banfill K, Marchant T, Craddock M, Wood J, Aznar MC, McWilliam A, van Herk M, Faivre-Finn C. Role of Real-World Data in Assessing Cardiac Toxicity After Lung Cancer Radiotherapy. Front Oncol 2022; 12:934369. [PMID: 35928875 PMCID: PMC9344971 DOI: 10.3389/fonc.2022.934369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Radiation-induced heart disease (RIHD) is a recent concern in patients with lung cancer after being treated with radiotherapy. Most of information we have in the field of cardiac toxicity comes from studies utilizing real-world data (RWD) as randomized controlled trials (RCTs) are generally not practical in this field. This article is a narrative review of the literature using RWD to study RIHD in patients with lung cancer following radiotherapy, summarizing heart dosimetric factors associated with outcome, strength, and limitations of the RWD studies, and how RWD can be used to assess a change to cardiac dose constraints.
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Affiliation(s)
- Azadeh Abravan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Gareth Price
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Kathryn Banfill
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tom Marchant
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Matthew Craddock
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Joe Wood
- Christie Medical Physics and Engineering, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Marianne C. Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Alan McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Marcel van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
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Morton ME, Sandage MJ. Sex and Race Reporting and Representation in Noncancerous Voice Clinical Trials: A Meta-Analysis of National Institutes of Health-Registered Research Between 1988 and 2021. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2594-2607. [PMID: 35858261 DOI: 10.1044/2022_jslhr-22-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this meta-analysis was to assess the frequency of sex, race, and ethnicity reporting and proportional representation in funded, noncancerous voice clinical trials to determine the state of compliance with National Institutes of Health (NIH) guidelines for inclusivity in clinical research. METHOD Clinical trials registered with the NIH/U.S. National Library of Medicine between January 1988 and September 2021 were analyzed. Primary reports of the trials were obtained from clinicaltrials.gov and PubMed. Outcomes included the proportion of trials reporting sex, race, and ethnicity and the proportion of participants by sex, race, and ethnicity in the trials. Descriptive statistics and chi-square tests were used to analyze the data with 95% confidence intervals (CIs) reported. RESULTS The search yielded 46 research studies. After inclusion and exclusion criteria were applied and attempts to locate studies were conducted, 11 total articles were ultimately evaluated. Descriptively, there were more female subjects, yet overall, no significant difference in sex distribution (χ2 = 0.07, p = .75, 95% CI [-0.25, -0.19]). Race and ethnicity were only reported in two clinical trials. Black participants were underrepresented in one clinical trial (χ2 = 4.93, p = .02, 95% CI [-0.11, -0.02]), whereas Hispanic participants were underrepresented in a second trial (χ2 = 11.27, p < .00, 95% CI [-0.20, - 0.13]). CONCLUSIONS This preliminary analysis highlights the disparities in race and ethnicity recruitment and reporting in noncancerous voice clinical trials. There is a need for strategic recruitment strategies and improved reporting practices to adhere to the NIH inclusivity directives.
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Affiliation(s)
| | - Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
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Smith-Lickess SK, Stefanic N, Shaw J, Shepherd H, Naehrig D, Turner RM, Cabrera-Aguas M, Meiser B, Halkett GK, Jackson M, Saade G, Bucci J, Milross C, Dhillon HM. What is the effect of a low literacy talking book on patient knowledge, anxiety and communication before radiation therapy starts? A pilot study. J Med Radiat Sci 2022; 69:463-472. [PMID: 35839313 DOI: 10.1002/jmrs.606] [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: 09/03/2021] [Accepted: 06/29/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Radiation therapy is a common cancer treatment, requiring timely information to help patients prepare for treatment. We pilot tested a low literacy, psycho-educational talking book (written booklet, with accompanying audio recording) to examine (i) the effect of the tool on knowledge, anxiety and communication; (ii) acceptability, and (iii) how it was used in appointments. METHODS A pre-post design was employed. Patients scheduled to receive radiation therapy for any cancer were recruited from two hospitals in Sydney, Australia. Participants were sent the talking book before treatment planning and completed baseline and follow-up surveys, before and after the intervention. RESULTS Forty participants were recruited, and 39 completed all study assessments. Overall, knowledge increased after receiving the talking book by 3.8 points from 13.9 to 17.7/20 (95% confidence interval (CI) 2.7, 4.8, P < 0.001). Anxiety and concerns were significantly lower after receiving the talking book (P = 0.015 and P = 0.004, respectively). Nearly half of participants (s = 17, 48%) reported using the book during appointments. Most reported finding it easier to communicate (n = 31, 89%) and to ask more questions (n = 21, 62%). CONCLUSION The talking book shows promise in improving knowledge, reducing anxiety and enhancing communication. Strategies to support the implementation of the talking book are required. Further studies to translate the book into different languages are also planned.
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Affiliation(s)
- Sian K Smith-Lickess
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Psychology, University of Bath, Bath, UK
| | - Natalie Stefanic
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Heather Shepherd
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Diana Naehrig
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Radiation Oncology and Medical Services, Sydney, NSW, Australia
| | - Robin M Turner
- Dunedin School of Medicine, Otago University, Wellington, New Zealand
| | - Maria Cabrera-Aguas
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Georgia Kb Halkett
- Faculty of Health Sciences, Curtin School of Nursing, Curtin University, Perth, WA, Australia
| | - Michael Jackson
- UNSW Sydney, Prince of Wales Clinical School, Randwick, Sydney, NSW, Australia.,Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - George Saade
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Joseph Bucci
- St George Hospital Cancer Care, Radiation Oncology Unit, Sydney, NSW, Australia
| | - Christopher Milross
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Radiation Oncology and Medical Services, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Predicting access to postoperative treatment after glioblastoma resection: an analysis of neighborhood-level disadvantage using the Area Deprivation Index (ADI). J Neurooncol 2022; 158:349-357. [PMID: 35503190 DOI: 10.1007/s11060-022-04020-9] [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: 02/03/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Social determinants of health (SDoH)-socioeconomic and environmental factors-impact outcomes. The Area Deprivation Index (ADI), a composite of seventeen SDoH factors, has been correlated with poorer outcomes. We aimed to compare outcomes and treatment access for glioblastoma, a universally fatal malignant brain tumor, in patients more (ADI 34-100%) versus less disadvantaged (ADI 0-33%). METHODS A 5-year retrospective study of Rhode Island Hospital and Mayo Clinic databases was conducted from 2012 to 2017 for patients ≥ 18 years with glioblastoma. Patient addresses were matched to ADI percentiles and grouped into more (top 66% ADI) and less disadvantaged. Adjusted multivariable regressions were used to compare outcomes between groups. RESULTS A total of 434 patients met inclusion; 92.9% were insured, 56.2% were more disadvantaged (n = 244), and the more disadvantaged cohort was younger on average (62 years). After adjustment, the more disadvantaged group had decreased odds of receiving gross total resection (adjusted odds ratio (aOR) 0.43, 95% CI [0.27-0.68]; p < 0.001). This cohort also had decreased odds of undergoing chemotherapy (aOR 0.51[0.26-0.98]), radiation (aOR 0.39[0.20-0.77]), chemoradiation (aOR 0.42[0.23-0.77]), tumor-treating fields (aOR 0.39[0.16-0.93]), and clinical trial participation (aOR 0.47[0.25-0.91]). No differences in length of survival or postoperative Karnofsky Performance Status Scale were observed. CONCLUSION More disadvantaged glioblastoma patients had decreased odds of receiving gross total resection. They also exhibited decreased odds of receiving standard of care like chemoradiation as well as participating in a clinical trial, compared to the less disadvantaged group. More research is needed to identify modifiable SDoH barriers to post-operative treatment in disadvantaged patients with glioblastoma.
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Ousseine YM, Bouhnik AD, Mancini J. Health Literacy and Clinical Trial Participation in French Cancer Patients: A National Survey. Curr Oncol 2022; 29:3118-3129. [PMID: 35621643 PMCID: PMC9140004 DOI: 10.3390/curroncol29050253] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies have explored the relationship between health literacy (HL) and trial participation. In this context, we aimed to study this relationship in French cancer patients. We used data from the French national VIe après le CANcer (VICAN) survey. Two questionnaire items focused on previous invitations to participate in clinical trials and subsequent enrollment. The Single Item Literacy Screener was used to measure functional HL. In total, 1954 cancer patients responded to both VICAN surveys (two and five years after diagnosis). Mean age was 54.1 ± 12.7 years at diagnosis, and 37.6% were classified as having limited HL. One in ten (10.3%) respondents reported having been previously invited to participate in a clinical trial. Of these, 75.5% had enrolled. Limited HL was associated with fewer trial invitations but not with enrollment once invited. Multivariate analysis confirmed the negative effect of limited HL on clinical trial invitation (adjOR = 0.55 (0.39 to 0.77), p < 0.001) after adjustment for multiple characteristics. Patients with limited HL received fewer invitations to participate in trials but were likely to enroll when asked. Addressing HL is necessary to create a more inclusive health system and to reduce inequalities not only in access to innovative cancer care, but to health inequalities in general.
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Affiliation(s)
- Youssoufa M. Ousseine
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille University, 13009 Marseille, France; (Y.M.O.); (A.-D.B.)
- Santé Publique France, French National Public Health Agency, CEDEX, 94415 Saint-Maurice, France
| | - Anne-Déborah Bouhnik
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille University, 13009 Marseille, France; (Y.M.O.); (A.-D.B.)
| | - Julien Mancini
- APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Hop Timone, BioSTIC, Biostatistique et Technologies de l’Information et de la Communication, Aix Marseille University, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-91-22-35-02
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Allison K, Patel D, Kaur R. Assessing Multiple Factors Affecting Minority Participation in Clinical Trials: Development of the Clinical Trials Participation Barriers Survey. Cureus 2022; 14:e24424. [PMID: 35637812 PMCID: PMC9127181 DOI: 10.7759/cureus.24424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/21/2022] Open
Abstract
The purpose of this review is to analyze factors that influence individuals' decisions to participate in clinical trials focusing on racial and ethnic disparities that exist in clinical trials. These factors are then used to develop a survey that may be used in a clinical setting to further understand specific factors affecting participation. A comprehensive search of electronic databases was carried out for publications from 2010 to 2021 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After reviewing the data, the predominant factors that were encountered in the search were then commented upon and reviewed to create an evidence-based questionnaire. Using the comprehensive search, factors that affect clinical trial participation were identified. These factors were then used to create a comprehensive, evidence-based questionnaire to be implemented in a clinical setting to conduct and analyze the factors impacting participation in clinical trials. Understanding the factors that primarily impact an individual's decisions to participate or not participate in a clinical trial allow researchers to implement changes to decrease the hesitancy regarding participation.
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Gatto L, Di Nunno V, Franceschi E, Tosoni A, Bartolini S, Brandes AA. Pharmacotherapeutic Treatment of Glioblastoma: Where Are We to Date? Drugs 2022; 82:491-510. [PMID: 35397073 DOI: 10.1007/s40265-022-01702-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
The clinical management of glioblastoma (GBM) is still bereft of treatments able to significantly improve the poor prognosis of the disease. Despite the extreme clinical need for novel therapeutic drugs, only a small percentage of patients with GBM benefit from inclusion in a clinical trial. Moreover, often clinical studies do not lead to final interpretable conclusions. From the mistakes and negative results obtained in the last years, we are now able to plan a novel generation of clinical studies for patients with GBM, allowing the testing of multiple anticancer agents at the same time. This assumes critical importance, considering that, thanks to improved knowledge of altered molecular mechanisms related to the disease, we are now able to propose several potential effective compounds in patients with both newly diagnosed and recurrent GBM. Among the novel compounds assessed, the initially great enthusiasm toward trials employing immune checkpoint inhibitors (ICIs) was disappointing due to the negative results that emerged in three randomized phase III trials. However, novel biological insights into the disease suggest that immunotherapy can be a convincing and effective treatment in GBM even if ICIs failed to prolong the survival of these patients. In this regard, the most promising approach consists of engineered immune cells such as chimeric antigen receptor (CAR) T, CAR M, and CAR NK alone or in combination with other treatments. In this review, we discuss several issues related to systemic treatments in GBM patients. First, we assess critical issues toward the planning of clinical trials and the strategies employed to overcome these obstacles. We then move on to the most relevant interventional studies carried out on patients with previously untreated (newly diagnosed) GBM and those with recurrent and pretreated disease. Finally, we investigate novel immunotherapeutic approaches with special emphasis on preclinical and clinical data related to the administration of engineered immune cells in GBM.
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Affiliation(s)
- Lidia Gatto
- Department of Oncology, AUSL Bologna, Bologna, Italy
| | | | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy.
| | - Alicia Tosoni
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
| | - Stefania Bartolini
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
| | - Alba Ariela Brandes
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
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Special Considerations in Patients with Early-Stage Breast Cancer and Survivors. Obstet Gynecol Clin North Am 2022; 49:195-208. [DOI: 10.1016/j.ogc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Do Breast Cancer Patients Manage to Participate in an Outdoor, Tailored, Physical Activity Program during Adjuvant Breast Cancer Treatment, Independent of Health and Socio-Demographic Characteristics? J Clin Med 2022; 11:jcm11030843. [PMID: 35160292 PMCID: PMC8836448 DOI: 10.3390/jcm11030843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Abstract
Exercise could reduce the side-effects of adjuvant breast cancer treatment; however, socio-demographic, health, and intervention conditions may affect patients’ adherence to interventions. This study aimed to examine adherence to a 12-month outdoor post-surgery exercise program among newly diagnosed breast cancer patients during adjuvant treatment, and to identify socio-demographic and health-related predictors. In total, 47 women with invasive breast cancer stage I–II or ductal/lobular carcinoma grade 3 were included pre-surgery and randomized two weeks post-surgery to exercise (2 × 60 min/week). Patient characteristics (body-mass index (BMI), socioeconomic status, comorbidity, physical activity, and maximal oxygen uptake (VO2max)) were recorded pre-surgery. Correlations between adherence and patient characteristics and statistics for between-group differences were performed. The mean age was 54.2 years, mean BMI 27.8 kg/m2, and 54.2% received chemotherapy. Completers had a mean adherence of 81%, independent of season. Withdrawals (23%) occurred after a mean of 6.5 weeks (0–24 weeks), they were suggestively older, had lower socioeconomic status and pre-surgery VO2max, and higher BMI. Household income was significantly lower among withdrawals. There were insignificant correlations between adherence and health conditions. High adherence is achievable in a Nordic outdoor physical exercise program in breast cancer patients during adjuvant treatment, including chemotherapy. Additional studies are needed to clarify follow-up needs in some groups.
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The cost of cancer care: how far would you go for a trial? Ir J Med Sci 2022; 191:2487-2491. [PMID: 35038110 PMCID: PMC8761872 DOI: 10.1007/s11845-021-02915-6] [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: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinical trials are often considered the gold standard in cancer care. However, patients face barriers in trial participation including distances to cancer centres and personal costs including changing employment status, cost of medications, inpatient admissions, and parking tariffs. AIM Our aim was to compare the distances patients travelled for clinical trials compared to those receiving standard systemic anticancer therapy (SACT). We also investigated the additional costs associated with this. METHODS This was a retrospective review of electronic patient medical records. The distance from the patients' home address to Beaumont was calculated as a one-way journey in kilometres. Patients attending for clinical trials were compared to those receiving standard of care SACT. RESULTS A total of 271 patients receiving standard SACT over a 5-day period and 111 patients enrolled on 24 clinical trials were included. The median one-way distance travelled by patients enrolled in clinical trials was 41.4 km, compared to 14 km in those patients' receiving standard of care SACT. The median estimated cost was €13 vs €4.20 for those enrolled on clinical trials compared to those receiving standard of care treatment, respectively. CONCLUSION Patients enrolled on clinical trials often travel more than twice as far to receive their anti-cancer treatment compared to those receiving standard of care SACT and incur an increased cost of travel expenses.
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Management of cardiovascular disease using an mHealth tool: a randomized clinical trial. NPJ Digit Med 2021; 4:165. [PMID: 34862449 PMCID: PMC8642390 DOI: 10.1038/s41746-021-00535-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/26/2021] [Indexed: 01/02/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death and morbidity worldwide. This randomized controlled, single-center, open-label trial tested the impact of a mobile health (mHealth) service tool optimized for ASCVD patient care. Patients with clinical ASCVD were enrolled and randomly assigned to the intervention or control group. Participants in the intervention group were provided with a smartphone application named HEART4U, while a dedicated interface integrated into the electronic healthcare record system was provided to the treating physicians. A total of 666 patients with ASCVD were enrolled, with 333 patients in each group. The estimated baseline 10-year risk of cardiovascular disease was 9.5% and 10.8% in the intervention and control groups, respectively, as assessed by the pooled cohort risk equations. The primary study endpoint was the change in the estimated risk at six months. The estimated risk increased by 1.3% and 1.1%, respectively, which did not differ significantly (P = 0.821). None of the secondary study endpoints showed significant differences between the groups. A post-hoc subgroup analysis showed the benefit was greater if a participant in the intervention group accessed the application more frequently. The present study demonstrated no significant benefits associated with the use of the mHealth tool in terms of the predefined study endpoints in stable patients with ASCVD. However, it also suggested that motivating patients to use the mHealth tool more frequently may lead to greater clinical benefit. Better design with a positive user experience needs to be considered for developing future mHealth tools for ASCVD patient care.Trial Registration: ClinicalTrials.gov NCT03392259.
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Fox L, Wylie H, Haire A, Green S, Kibaru J, Van Hemelrijck M. "Something Good Has to Come Out of the Horror": A Qualitative Examination of Cancer Survivors' Attitudes Towards Participation in Research During the First Year of the COVID-19 Pandemic. Front Public Health 2021; 9:741188. [PMID: 34778175 PMCID: PMC8585927 DOI: 10.3389/fpubh.2021.741188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The first year of the COVID-19 pandemic has been highly disruptive for people with cancer. Furthermore, it has been shown that accrual to cancer trials dropped substantially in 2020. Building on findings from a previous pilot survey, the present study used qualitative methods to gain insights into attitudes towards participation in research studies amongst people who have experienced cancer, in the context of the first year of the COVID-19 pandemic. Materials and Methods: We interviewed 13 participants from the UK, who were purposively sampled, including a broad sample of cancer types, and a mixture of individuals who have and have not taken part in research previously. Participants underwent semi-structured interviews (median interview duration: 47 min) and were asked open-ended questions about their attitude towards and experiences with COVID-19, and their attitude towards research participation. In addition to this, prompts were used to ask participants about concerns that were highlighted by our previous quantitative work on this topic, such as concerns about being older or having to travel to participate. Interview transcripts were analysed using a framework analysis approach. Results: Our findings suggest that cancer patient decision-making about research participation during an infectious disease pandemic may be a function of a basic cost-benefit analysis, which considers the benefit of taking part, either personally to themselves or to wider society. The benefit may then be weighed by the patient against the risk of being infected, which may be influenced by trust in the relevant clinicians/researchers; familiarity with the study location; provision of detailed information on safety protocols for infectious disease; and, in particular, the availability of safe transport to and from the study location. Discussion: Some cancer patients say that they would be less likely to participate in a research study in the middle of an infectious disease pandemic due to an increased risk to themselves. Patients' perceived risk to themselves from participating may be ameliorated via the provision of certain practical solutions that can be considered at the study protocol design stage, such as safe travel, information, and the use of staff and study sites familiar to the patient.
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Affiliation(s)
- Louis Fox
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
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Lerman MH, Holmes B, St Hilaire D, Tran M, Rioth M, Subramanian V, Winzeler AM, Brown T. Validation of a Mortality Composite Score in the Real-World Setting: Overcoming Source-Specific Disparities and Biases. JCO Clin Cancer Inform 2021; 5:401-413. [PMID: 33830788 PMCID: PMC8140809 DOI: 10.1200/cci.20.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study tested whether a composite mortality score could overcome gaps and potential biases in individual real-world mortality data sources. Complete and accurate mortality data are necessary to calculate important outcomes in oncology, including overall survival. However, in the United States, there is not a single complete and broadly applicable mortality data source. It is further likely that available data sources are biased in their coverage of sex, race, age, and socioeconomic status (SES).
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Di Nunno V, Franceschi E, Tosoni A, Gatto L, Lodi R, Bartolini S, Brandes AA. Glioblastoma: Emerging Treatments and Novel Trial Designs. Cancers (Basel) 2021; 13:cancers13153750. [PMID: 34359651 PMCID: PMC8345198 DOI: 10.3390/cancers13153750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Nowadays, very few systemic agents have shown clinical activity in patients with glioblastoma, making the research of novel therapeutic approaches a critical issue. Fortunately, the availability of novel compounds is increasing thanks to better biological knowledge of the disease. In this review we want to investigate more promising ongoing clinical trials in both primary and recurrent GBM. Furthermore, a great interest of the present work is focused on novel trial design strategies. Abstract Management of glioblastoma is a clinical challenge since very few systemic treatments have shown clinical efficacy in recurrent disease. Thanks to an increased knowledge of the biological and molecular mechanisms related to disease progression and growth, promising novel treatment strategies are emerging. The expanding availability of innovative compounds requires the design of a new generation of clinical trials, testing experimental compounds in a short time and tailoring the sample cohort based on molecular and clinical behaviors. In this review, we focused our attention on the assessment of promising novel treatment approaches, discussing novel trial design and possible future fields of development in this setting.
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Affiliation(s)
- Vincenzo Di Nunno
- Department of Oncology, AUSL Bologna, Via Altura 3, 40139 Bologna, Italy; (E.F.); (A.T.); (L.G.); (S.B.); (A.A.B.)
- Correspondence: ; Tel.: +39-0516225697
| | - Enrico Franceschi
- Department of Oncology, AUSL Bologna, Via Altura 3, 40139 Bologna, Italy; (E.F.); (A.T.); (L.G.); (S.B.); (A.A.B.)
| | - Alicia Tosoni
- Department of Oncology, AUSL Bologna, Via Altura 3, 40139 Bologna, Italy; (E.F.); (A.T.); (L.G.); (S.B.); (A.A.B.)
| | - Lidia Gatto
- Department of Oncology, AUSL Bologna, Via Altura 3, 40139 Bologna, Italy; (E.F.); (A.T.); (L.G.); (S.B.); (A.A.B.)
| | - Raffaele Lodi
- Istituto delle Scienze Neurologiche di Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 40139 Bologna, Italy;
| | - Stefania Bartolini
- Department of Oncology, AUSL Bologna, Via Altura 3, 40139 Bologna, Italy; (E.F.); (A.T.); (L.G.); (S.B.); (A.A.B.)
| | - Alba Ariela Brandes
- Department of Oncology, AUSL Bologna, Via Altura 3, 40139 Bologna, Italy; (E.F.); (A.T.); (L.G.); (S.B.); (A.A.B.)
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Spielman DB, Schlosser RJ, Liebowitz A, Sharma R, Overdevest J, Mattos J, Gudis DA. Do Federal Regulations Affect Gender, Racial, and Ethnic Disparities in Chronic Rhinosinusitis Research? Otolaryngol Head Neck Surg 2021; 166:1211-1218. [PMID: 34126802 DOI: 10.1177/01945998211021011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Food and Drug Administration and the National Institutes of Health (NIH) have asserted that diverse demographic representation in clinical trials is essential. In light of these federal guidelines, the objective of this study is to assess the racial, ethnic, and gender demographics of patients enrolled in clinical trials registered with the NIH that evaluate chronic rhinosinusitis with nasal polyposis (CRSwNP) relative to the demographics of the US population. STUDY DESIGN Cross-sectional study. SETTING Not applicable. METHODS ClinicalTrials.gov was queried to identify all prospective clinical trials for CRSwNP. Individual study and pooled data were compared with national US census data. RESULTS Eighteen studies were included comprising 4125 patients and evaluating dupilumab, mepolizumab, omalizumab, fluticasone/OptiNose, MediHoney, mometasone, and SINUVA. Women constituted 42.7% of clinical trial participants. Of the 4125 participants, 69.6% identified as White, 6.6% as Black, 20.8% as Asian, 0.1% as Pacific Islander, 0.4% as American Indian, 8.0% as Hispanic, and 2.4% as other. The racial, ethnic, and gender composition of the pooled study population differs significantly from national US census data, with underrepresentation of Black, Hispanic, Pacific Island, and American Indian individuals, as well as females (P < .05). CONCLUSION The racial, ethnic, and gender demographics of patients enrolled in CRSwNP clinical trials registered with the NIH differ significantly from the demographics of the US population, despite federal guidelines advising demographically representative participation. Proactive efforts to enroll participants that better represent anticipated treatment populations should be emphasized by researchers, institutions, and editorial boards.
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Affiliation(s)
- Daniel B Spielman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andi Liebowitz
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rahul Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jose Mattos
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Ferguson JE, Vetos D, Ho BV, Aziz M, Lee WM, Mohyuddin GR, Prouty M. Trends in diversity of participants in dermatology clinical trials over time: A systematic review. J Am Acad Dermatol 2021; 86:1403-1405. [PMID: 34090958 DOI: 10.1016/j.jaad.2021.05.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jessica E Ferguson
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas; School of Medicine, University of Kansas, Kansas City, Kansas
| | - Develyn Vetos
- Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Bao Vincent Ho
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas; School of Medicine, University of Kansas, Kansas City, Kansas
| | - Muhammad Aziz
- Department of Medicine, University of Toledo, Toledo, Ohio
| | - Wade M Lee
- Department of Medicine, University of Toledo, Toledo, Ohio
| | - Ghulam Rehman Mohyuddin
- Department of Internal Medicine, The University of Kansas Health Center, Kansas City, Kansas
| | - Megan Prouty
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas.
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