Apr 04, 2022
3 minutes reading
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disclosures:
Abrahão does not report any relevant financial disclosures.
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Clinical trials play an important role in the development and evaluation of potential new cancer therapies.
However, enrollment of certain populations, such as adolescents and young adults (AYAs) ages 15 to 39, has been a persistent challenge.
“In 2006, the National Cancer Institute Progress Review Group, in conjunction with the Livestrong Foundation, identified several areas of research with the potential to improve survival disparities in this population, and that includes expanding access to clinical trials and enrollment in clinical trials.” , researcher Renata AbrahamMD, MSc, PhD† QSCERT-PC fellow at UC Davis Comprehensive Cancer Center, said in an interview with Healio. “A previous report from our team showed that only 14% of AYAs enrolled in clinical trials, compared with 40% to 60% of children diagnosed with cancer, with no significant improvements in enrollment over time.”
Renata Abraham
To better understand the barriers to AYA enrollment in cancer clinical trials, Abrahão and colleagues conducted semi-structured interviews with 17 oncologists and 26 AYA cancer survivors who were offered and/or participated in clinical trials at California cancer centers and Utah.
Abrahão discussed the findings of the qualitative study, published in Pediatric Blood Cancer, and how they can be used to increase AYA participation.
healio: What prompted you to conduct this research?†
Abraham† Our main motivation was to better understand the barriers to AYA enrollment in clinical trials, as well as potential facilitators and areas for improvement, by providing relevant information on a limited area of research.
We wanted to identify an achievable and adaptable set of factors that influence enrollment in AYA studies. We asked oncologists about their experiences treating AYAs with cancer, the key challenges they face in enrolling these patients in clinical trials, what factors would motivate AYAs to participate in trials, and potential ways to improve enrollment. . For AYAs, we asked about their experiences during their cancer treatment, how they became aware of the opportunity to participate in a clinical trial, and their experience in making the decision whether or not to participate. We also wanted to know their fears, key barriers to participation, or potential motivators and areas for improvement in the build.
healio: What barriers did each group report?
AbrahamaO† Overall, oncologists and AYAs had similar perceptions of barriers to clinical trial participation. Both groups reported financial barriers as one of the main obstacles, especially when the trial takes place in a hospital far away from the patient’s place of residence. This factor is exacerbated when AYAs are caregivers and have to work while treating their disease. Also, AYAs have a poor understanding of what a clinical trial is, the benefits it can provide, and the severity or urgency of their disease. In addition, when transitioning from childhood to adulthood, these patients may not be equipped to make good decisions about or adhere to their cancer treatment. Oncologists continued to report significant barriers: lack of open trials and strict admissions to enrollment, lack of knowledge of clinical trial availability, and late (or no) referral by primary care physicians or oncologists working in community hospitals.
Healio: Both pediatric and adult oncologists mentioned lack of awareness about clinical trials and poor communication between the two groups† How could this problem be addressed?
AbrahamaO† It is critical that clinicians caring for AYAs be aware of the importance and availability of clinical trials to improve treatment protocols and, ultimately, the survival and quality of life of these young cancer patients. Increased awareness and communication between pediatric and adult oncologists could be facilitated, for example through regular emails (monthly or bimonthly) listing open clinical trials and their specific eligibility criteria. Joint tumor boards with pediatric and adult oncologists are also recommended, and this can be done virtually once a week. At this time, all available clinical studies are presented and eligibility criteria are discussed. Another suggestion is to facilitate the acquisition of membership of the Pediatric Oncology Group for adult oncologists. For AYAs, education sessions delivered by research nurses and clinical research coordinators can complement the information provided by clinicians about clinical trials.
Healio: How can your findings in general be used to improve enrollment? from AYA patients in cancer clinical trials†
AbrahamaO† By characterizing key factors associated with low clinical trial participation in cancer AYAs, we provided additional information and also strengthened the findings of some of our colleagues that may guide policy interventions. For example, a multidisciplinary approach is needed to improve the participation of AYAs in cancer clinical trials. This includes psychological support for AYAs and improving clinical trial education with the help of research nurses, patient navigators, psychologists and social workers. We also identified financial burdens as a major barrier to clinical trial enrollment and suggested that a financial assistance program to assist AYAs with shelter, meals and transportation could improve their participation in trials.
References:
AbrahamR, et al. Blood cancer pediatrician. 2021; doi: 10.1002/pbc.29479.
Parsons HM, et op. J Clin Oncol. 2011;doi:10.1200/JCO.2011.36.2954.
For more information:
Renata AbrahamaO† MD, MSc, PhD† can be reached at the UC Davis Comprehensive Cancer Center, 2315 Stockton Blvd., Sacramento, CA 95817; email: rabrahao@ucdavis.edu.
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