Disentangling the reasons why older adults do not readily participate in cancer trials: a socio-epidemiological mixed methods approach

• Published in: Age and ageing Vol. 53; no. 2
• Main Authors: Hagège, Meoïn, Bringuier, Michaël, Martinez-Tapia, Claudia, Chouaïd, Christos, Helissey, Carole, Brain, Etienne, Lempdes, Godelieve Rochette, Dubot, Coraline, Bello-Roufai, Diana, Geiss, Romain, Kempf, Emmanuelle, Gourden, Audrey, Elgharbi, Hanane, Garrigou, Sonia, Gregoire, Laetitia, Derbez, Benjamin, Canouï-Poitrine, Florence
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-02-2024; Oxford Publishing Limited (England); Oxford University Press (OUP)
• Subjects: Cancer; Clinical research; Clinical trials; Epidemiology; Geriatry and gerontology; Health care; Human health and pathology; Humanities and Social Sciences; Life Sciences; Living conditions; Medical personnel; Mixed methods research; Older people; Participation; Patients; Refusal; Relatives; Research Paper; Santé publique et épidémiologie; Social interactions; Social isolation; Sociodemographics; Sociology; participation; inclusion; older people; refusal to participate; non-invitation; cancer trial
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afae007

Abstract
Background
Few studies of the under-representation of older adults in cancer clinical trials (CTs) have encompassed the entire pathway from a trial being available in a cancer centre to the patient’s invitation to participate and then agreement or refusal to participate.
Objectives
The study’s primary objective was to evaluate CT non-invitation and refusal rates. The secondary objectives were to identify factors associated with non-invitation and refusal and to assess experiences of CT participation from the patients’ and professionals’ perspectives.
Methods
Here, we used mixed methods and a socio-epidemiological approach to analyse reasons for the non-participation of eligible older patients with a solid cancer in cancer CTs in France.
Results
We found that non-invitation and low CT participation are mainly related to the patients’ sociodemographic characteristics and living conditions (such as social isolation, being single, divorced or widowed, not having children and the absence of close family members) and the healthcare professionals’ perceptions of insufficient informal support or a high homecare requirement.
Conclusion
Our results suggest that efforts to increase fair inclusion and the participation of older adults in CTs should target the physician–patient relationship, the medical profession and hospital funding, rather than the patient alone.