This MedPageToday.com article reports some disappointing news:
Doctors Don’t Enroll Patients in Clinical Trials
By Kristina Fiore, Staff Writer, MedPage Today
Published: February 12, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California
Physicians may be part of the reason why patient participation in clinical trials for cancer is low, researchers said.
Only 56.7% of surveyed physicians reported referring at least one patient to such a trial within the preceding year, Carrie Klabunde, PhD, of the National Cancer Institute, and colleagues reported in the Journal of the National Cancer Institute.
To get data on physician referrals, the researchers surveyed 1,533 physicians who participated in the Cancer Care Outcomes Research and Surveillance Consortium, who were caring for lung and colorectal cancer patients. The response rate for the survey — done between 2005 and 2006 — was 61%.
The lack of referrals was even more dramatic when separated by specialty — 87.8% of medical oncologists, 66.1% of radiation oncologists, and 35% of surgeons reported referring or enrolling patients in clinical trials during the preceding 12 months.
The mean number of patients referred by medical oncologists was 17.2, compared with 9.5 for radiation oncologists and 12.2 for surgeons.
The researchers found several other factors, aside from specialty, were associated with trial referral, including involvement in teaching and being in a hospital-based practice rather than an office-based one (P=0.018)
Affiliation with either a Community Clinical Oncology Program (CCOP) or a National Cancer Institute (NCI)-designated cancer center also predicted greater likelihood of referral (P<0.05 for all).
Still, only two-thirds of physicians with a CCOP- or NCI-designated cancer center affiliation reported involvement in clinical trials, the researchers pointed out.
They also found that nonsurgical specialists who reported income increases as a result of referring patients to trials enrolled significantly more patients than did those who didn’t have income increases (CR 1.20, 95% CI 1.12 to 1.30, P=0.001).
However, only a small portion of all survey participants reported income arrangements to begin with, the researchers said.
Although the study was limited in its generalizability and by self-reported data, Klabunde and colleagues called for more strategies to improve participation.
For instance, they suggested, physicians should “foster a culture of research and encourage a professional responsibility to support clinical research within the medical and professional schools that train clinicians.”
In an accompanying editorial, Lori Minasian, PhD, and Ann O’Mara, PhD, of the National Cancer Institute, echoed their colleagues’ call to enhance physician engagement in enrolling patients in trials, overcoming barriers such as lack of compensation for the additional work that is required to manage these patients.
They agreed that this should include introducing medical students to the basic principles of clinical and translational research.
“Not every physician should be expected to actively accrue patients onto clinical trials, but all physicians should understand the value of clinical trials and know how to refer patients,” they wrote. “If we want research to inform practice, we need a work force of physicians who value the research and understand how to incorporate research results into their practice.”
We, as patients, need to strongly consider participating in clinical trials–and we all need to encourage our doctors to help promote clinical trials, too. That’s the only way new cancer therapies will be developed.
Feel good and keep smiling! Pat & Pattie