Feb. 11, 2011 -- Just an estimated 2% to 4% of adults who are newly diagnosed with cancer participate in clinical trials even though there are more than 8,000 such trials that are actively recruiting. One reason is that they may not know about these trials because their doctors may not tell them, suggests a new study in the Journal of the National Cancer Institute.
Of 1,522 doctors responding to a survey who treat colorectal and lung cancer, 56.7% said they had referred or enrolled at least one person in a clinical trial during the past year. Those doctors who saw more patients and who spent more time with new patients were among the most likely to refer their patients to clinical trials.
The survey was conducted by the Cancer Care Outcomes Research and Surveillance Consortium.
Medical oncologists and radiation oncologists were more likely to refer patients to clinical trials than surgeons. In addition, doctors who taught medical students or residents, and who were affiliated with a Community Clinical Oncology Program -- a network for community-based physicians to partner with academic investigators -- or a National Cancer Institute-designated cancer center were also more likely to refer patients to clinical trials.
“Low and slow accrual to cancer clinical trials limits the availability of state-of-the art therapies in routine clinical practice,” conclude study researchers led by Carrie N. Klabunde, PhD, of the National Cancer Institute. “Closer examination of nonparticipating physicians in these settings might identify interventions that could be used to increase their willingness to participate in clinical trials.”
The new study puts a number on something that the medical community has been aware of for a long time, says Leonard Saltz, MD, a medical oncologist specializing in colorectal cancer at Memorial Sloan-Kettering Cancer Center in New York City.
“The minor problem is that patients are declining the study, but the major problem is that patients are not being offered the studies,” he says.
There are many reasons that doctors may fail to mention available clinical trials, Saltz says.
“It may be that a doctor doesn’t have access to trials, and the patient would have to leave their practice to participate or have to travel,” he says. “It may be that the doctor is simply unaware of what clinical trials are out there, and it takes a lot of time to find out, and that is not time that anyone reimburses them for.”
Some patients may be unwilling to participate in clinical trials, but if they are unaware of these trials, they may not be able to make the most informed decision about their treatment.
“When a patient is diagnosed with any disease, especially one as terrifying as cancer, and hears that there is an established standard treatment, there is a tendency to tune out any limitations,” Saltz says. “Doctors, wanting to be optimists, may not offer a whole lot of information on these limitations unless asked.”
“There is also the tendency to think about trials only after all else has failed, but by this time many people are no longer candidates or are too sick to participate,” he says.