Promoting Accrual of Older Patients with Cancer to Clinical Trials: An Alliance for Clinical Trials in Oncology Member Survey (A171602)

• Published in: The oncologist (Dayton, Ohio) Vol. 23; no. 9; pp. 1016 - 1023
• Main Authors: Freedman, Rachel A., Dockter, Travis J., Lafky, Jacqueline M., Hurria, Arti, Muss, Hyman J., Cohen, Harvey J., Jatoi, Aminah, Kemeny, M. Margaret, Ruddy, Kathryn J.
• Format: Journal Article
• Language: English
• Published: England AlphaMed Press 01-09-2018
• Subjects: Accrual; Aged; Aged, 80 and over; Cancer; Clinical trials; Geriatric Oncology; Humans; Medical Oncology; Neoplasms - epidemiology; Older adults; Patient Selection; Surveys and Questionnaires; Clinical trials; Accrual; Older adults; Cancer
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2018-0033

Background
There are multiple known individual‐ and practice‐level barriers to enrollment of older patients with cancer to clinical trials, but little is known about how the clinical research workforce feels about potential higher‐level strategy changes aimed to promote increased enrollment of older patients.
Subjects, Materials, and Methods
We invited all 11,351 Alliance for Clinical Trials in Oncology (“Alliance”) members to participate in an anonymous, web‐based survey to examine awareness of current accrual patterns for older patients to clinical trials, to ascertain consensus on how to tackle enrollment challenges, and to provide the impetus for high‐level changes to improve clinical trial accrual of older patients with cancer.
Results
During the period from February 28, 2017, to June 16, 2017, 1,146 Alliance members participated (response rate = 10%), including a national diverse sample of physicians, nurses, administrative/clinical research staff, and patient advocates with representation from community, academic, and rural sites. Overall, one third felt that >50% of clinical trial enrollees should be age ≥65, and 64.9% felt the Alliance could improve upon enrollment of older patients. The four most commonly ranked strategies to improve enrollment of older patients were creating more dedicated trials for this population (36.3%), minimizing exclusion criteria focused on comorbidity (35.5%), developing independent strategies for those aged ≥65 and for those aged ≥70 (33.2%), and requiring that most/all Alliance trials have a specific expansion cohort of older patients (30.0%).
Conclusion
We anticipate that the recommendations from >1,000 Alliance members will continue to propel important strategy changes aimed to improve accrual of older patients with cancer to clinical trials.
Implications for Practice
This survey of the Alliance for Clinical Trials membership sought opinions on potential, large‐scale, national strategies to improve accrual of older adults with cancer. Consensus was found around multiple strategies, including creating more dedicated trials for older patients, developing less stringent eligibility criteria, and mandating expansion cohorts of older patients within broader Alliance trials. It is anticipated that the recommendations from >1,000 Alliance members will continue to propel important strategy changes aimed to improve accrual of older patients with cancer to clinical trials.
This article describes a web‐based survey of the Alliance for Clinical Trials in Oncology membership, including physicians, nurses, patient advocates, project managers, statisticians, leadership, and administrative staff. The goal of the survey was to identify new strategies to effect change in accrual for older patients with cancer by eliciting the opinions of a national sample of the oncology clinical research workforce and patient advocates who participate in high‐impact cancer clinical research.