Factors associated with enrolment in clinical trials among women with early-stage breast cancer

Background

Clinical trials allow development of innovative treatments and ameliorate the quality of clinical care in oncology. Data show that only a minority of patients are enrolled in clinical trials. We assessed enrolment in clinical trials and its correlates among women with early breast cancer.

Methods

We included 9516 patients with stage I-III breast cancer from the multicenter, prospective CANTO study (NCT01993498), followed-up until year 4 (Y4) post-diagnosis. We assessed factors associated with enrolment using multivariable logistic regression. In exploratory, propensity score matched analyses, we used multiple linear regression to evaluate the relationship of enrolment in clinical trials with the European Organisation for Research and Treatment of Cancer Quality Of Life (QoL) questionnaire (EORTC QLQ-C30) Summary Score and described clinical outcomes (distant disease event, invasive disease event, and death by any cause) according to enrolment.

Results

Overall, 1716 patients (18%) were enrolled in a clinical trial until Y4 post-diagnosis of breast cancer. Socioeconomic factors were not associated with enrolment. Centres of intermediate volume were most likely to enrol patients in clinical trials [versus low volume, odds ratio 1.45 (95% confidence interval (CI) 1.08-1.95), P = 0.0124]. Among 2118 propensity score matched patients, enrolment was associated with better QoL at Y4 (adjusted mean difference versus not enrolled 1.37, 95% CI 0.03-2.71, P = 0.0458), and clinical outcomes (enrolled versus not enrolled, distant disease event 7.3% versus 10.1%, P = 0.0206; invasive disease event 8.2% versus 10.5%, P = 0.0732; death by any cause 2.8% versus 3.7%, P = 0.2707).

Conclusions

In this large study, one in five patients enrolled on a clinical trial until Y4 after diagnosis of early breast cancer. Geographical and centre-related factors were significantly associated with enrolment in clinical trials. Inclusion in clinical trials seemed associated with improved QoL and clinical outcomes. Access to innovation for early-stage breast cancer patients should be encouraged and facilitated by overcoming organizational and geographical barriers to recruitment.

•

The proportion of patients who access innovation through participation in clinical trials is generally limited.

•

Rate of enrolment in clinical trials among women with early breast cancer exceeded what previously found in other settings.

•

Clinical and geographical factors were associated to access to innovation in clinical trials.

•

Enrolment in clinical trials is associated with better quality of life and clinical outcomes.

An art therapy group intervention for cancer patients to counter distress before chemotherapy

Background: The aim of this study was to investigate the feasibility and effectiveness of a single group session based on art therapy (AT) for adult cancer patients to reduce anxiety and distress before anticancer treatment. Methods: A non-randomized pre-post study design was adopted. Sixty-two patients took part in one of twenty-seven "one-off" sessions held over a four-month period. Sixty-six patients, who simply received routine medical treatment, served as the control group (CG). Results: The intervention was appropriate to patients' needs and feasible in the context of their routine medical care. In contrast to the CG, the intervention group(IG) participants demonstrated a decrease in symptoms of anxiety, drowsiness and tiredness. Conclusions: The intervention proved suitable to the medical routine of patients' care. The clinical implications of the AT protocol and future research aimed at testing it vs. a different type of psychosocial intervention in a randomized controlled study are discussed.

Terapias artísticas y creativas en la mejora del malestar psicológico en mujeres con cáncer de mama. Revisión sistemática

Objetivo: Conocer el estado actual de la eficacia de las terapias artísticas y creativas (TAC) en las variables de malestar psicológico de mujeres con cáncer de mama y delimitarla en función del tipo de TAC y momento terapéutico del paciente. Método: La búsqueda se realizó mediante las bases de datos Pubmed, Web of Science, Psychinfo y Google Academic para el periodo 2010-2016. Resultados: Se obtienen 9 estudios RTC y cuasi-experimentales controlados (2 de Danza movimiento terapia, 1 de Arte Terapia, 1 de Musicoterapia y 5 de Escucha musical) que incluyen 680 participantes. Se discute la calidad metodológica, el riesgo de sesgo y las medidas de eficacia terapéutica. Conclusiones: Las TAC parecen ser una ayuda complementaria a corto plazo durante la fase de tratamiento en cáncer de mama. Sin embargo, son necesarios más ensayos para aclarar los mecanismos subyacentes a la mejora, así como delimitar la eficacia de cada modalidad.