Shortage of trials is biggest barrier for patients

Call for ‘physician champions’

A study by the Medical Oncology Department at the Mater Hospital, Dublin, in association with Cancer Trials Ireland, has found that the biggest barrier to patients participating in cancer trials is the availability of suitable cancer trials.

The study found that there was no cancer trial option available for the majority of patients (71%) studied because the trials that were open did not meet their specific cancer type, the stage of their disease and their line of treatment.

The study involved a retrospective anonymised review of the files of 140 patients with cancer who attended the Mater Hospital, Dublin.

At the time of the study 19 cancer trials were available for patients to take part in, covering 10 different cancer types at different stages and involving a variety of different treatments.

One of the authors of the study Dr Cathy Kelly, Consultant Medical Oncologist at the Mater Hospital, said that this problem is not unique to Ireland.

“In the United States, studies show that between 60% and 77% of patients do not have a cancer trial option available to them.

“Over the past 10 years the number of patients participating in cancer trials in Ireland has doubled and the number of trials opened has tripled thanks to the trials infrastructure developed by Cancer Trials Ireland which has attracted international research groups and pharmaceutical companies to open studies in Ireland”

“While we found that 5% of patients studies enrolled on a cancer trial, which is in line with international figures, it is imperative to safeguard continued improvement in cancer outcomes that we continue to recruit more patients on more trials”, she said.

“The standard treatments for cancer that we use today were once examined in the setting of a cancer trial and the treatments of tomorrow rely upon the completion of high quality trials”, she said.

While the authors of the study suggest that the solution would be to open more trials, they highlight that the availability of funding limits the ability of research units to open new trials. In addition maintaining compliance with regulations overseeing the conduct of clinical trials, adhering to codes of good clinical practice and providing the intense patient monitoring and follow-up required by clinical trial protocols are labour intensive

The study found that a quarter of patients had an option to participate in a cancer trial but were not enrolled. In order to overcome this problem, the authors suggest that clinical research needs to be embedded into the culture of hospitals. Regular unit meetings with the research team and designating “physician champions” for specific trials help to educate and raise awareness of the clinical trials available at the site among all team members.

The study also points out that six patients who were eligible to take part in a cancer trial declined the option and it is important to establish the reasons why patients decline participation. This information might offer insight into how we can improve recruitment in the future.