Enrolment of older adults with cancer in early phase clinical trials-an observational study on the experience in the north west of England

Amplifying the Patient's Voice in Oncology Early-Phase Clinical Trials: Solutions to Burdens and Barriers

Dose-finding oncology trials (DFOTs) provide early access to novel compounds of potential therapeutic benefit in addition to providing critical safety and dosing information. While access to trials for which a patient is eligible remains the largest barrier to enrollment on clinical trials, additional direct and indirect barriers unique to enrollment on DFOTs are often overlooked but worthy of consideration. Direct barriers including financial costs of care, travel and time investments, and logical challenges including correlative study designs are important to bear in mind when developing strategies to facilitate the patient experience on DFOTs. Indirect barriers such as strict eligibility criteria, washout periods, and concomitant medication restrictions should be accounted for during DFOT design to maintain the fidelity of the trial without being overly exclusionary. Involving patients and advocates and incorporating patient-reported outcomes (PROs) throughout the process, from initial DFOT design, through patient recruitment and participation, is critical to informing strategies to minimize identified barriers to offer the benefit of DFOTs to all patients.

Exploring the barriers to, and importance of, participant diversity in early-phase clinical trials: an interview-based qualitative study of professionals and patient and public representatives

OBJECTIVES

To explore the importance of, and barriers to achieving, diversity in early-phase clinical trials.

DESIGN

Qualitative interviews analysed using thematic analysis.

SETTING AND PARTICIPANTS

Five professionals (clinical researchers and methodologists) and three patient and public representatives (those with experience of early-phase clinical trials and/or those from ethnic minority backgrounds) were interviewed between June and August 2022. Participants were identified via their institutional web page, existing contacts or social media (eg, X, formerly known as Twitter).

RESULTS

Professionals viewed that diversity is not currently considered in all early-phase clinical trials but felt that it should always be taken into account. Such trials are primarily undertaken at a small number of centres, thus limiting the populations they can access. Referrals from clinicians based in the community may increase diversity; however, those referred are often not from underserved groups. Referrals may be hindered by the extra resources required to approach and recruit underserved groups and participants often having to undertake 'self-driven' referrals. Patient and public representatives stated that diversity is important in research staff and that potential participants should be informed of the need for diversity. Those from underserved groups may require clarification regarding the potential harms of a treatment, even if these are unknown. Education may improve awareness and perception of early-phase clinical trials. We provide 14 recommendations to improve diversity in early-phase clinical trials.

CONCLUSIONS

Diversity should be considered in all early-phase trials. Consideration is required regarding the extent of diversity and how it is addressed. The increased resources needed to recruit those from underserved groups may warrant funders to increase the funds to support the recruitment of such participants. The potential harms and societal benefits of the research should be presented to potential participants in a balanced but accurate way to increase transparency.

A bibliometric study of the top 100 most cited papers on aging and cancer

Cancer has been the major and increasing cause of premature death and years of life lost. Various studies suggested the correlation between the aging process and cancer genesis. To evaluate the performance of the articles and to identify and compare the top-cited articles on aging and cancer, a cross-sectional bibliometric analysis was performed. Top-cited articles that were indexed in the Core databases in Web of Science were utilized to identify articles published from inception to September 3, 2022. The top 100 most-cited articles on aging and cancer were evaluated for their specific characteristics. Both Microsoft Office Excel and Visual Basic for Applications were used to analyze the number of publications and scientific cooperations among authors over time. The query identified the top 100 most-cited articles from the 368,504 articles. The top cited articles accumulated 308,106 citations. The citations per article ranged from 39,141 to 1040. Thirty journals published these 100 articles, with the Ca-A Cancer Journal for Clinicians publishing the largest number. Most articles have focused on the trend analysis of incidence, survival outcomes, and prognosis of cancer from different origins. Co-authorship analysis revealed intense collaborative activity between United States authoritative academic institutions and scholars. The present study is the first to analyze most cited papers in "aging and cancer." The historical trends, current status, and future direction in the field of older patients with cancer are systematically summarized. The occurrence and development of cancer is correlated with aging.