The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68807

Shawna V. Hudson, PhD, The Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, 732-235-9591, hudsonsh@umdnj.edu

Nationally, participation rates for cancer clinical trials among adult patients who are eligible are low, ranging from 3 to 5%. New Jersey enrollment rates for eligible patients are comparable, ranging from 2 to 4% for cancer clinical trials. While increased enrollment is a priority, increasing access to members of the medically underserved is also critical.

Multiple barriers to successful cancer clinical trial patient recruitment and accrual — cultural, structural, and psychological — have been documented. Much of the literature focuses on patient rather than physician barriers. Research suggests that physician referral is one of the most effective means of recruiting patients onto cancer clinical trials. Yet, factors that affect whether a physician chooses to discuss a trial with a patient as a possible course of treatment, especially a racial and/or ethnic minority patient, remain largely under-explored phenomena in the research literature.

This paper presents results from a pilot study that examines physician attitudes toward and knowledge about cancer clinical trial research. In addition, the study collects self-reported data about physician referral patterns for cancer clinical trials. A stratified sample of 97 community physicians including oncologists, family practice doctors, internal medicine doctors, obstetricians/gynecologists, surgeons, and urologists were surveyed. Physicians in the study were recruited from hospitals affiliated with The Cancer Institute of New Jersey, the state’s only NCI designated Comprehensive Cancer Center. Half of the physicians were recruited from five hospitals that have significant numbers of diagnosed racial and/or ethnic minority cancer patients as defined by the NJ State Cancer Registry. The other half practice at hospitals with low numbers of diagnosed racial and/or ethnic minority cancer patients. Data collection for this study is ongoing.

This paper discusses barriers to access. Preliminary analyses indicate that insufficient resources and patient concerns are primary barriers to recruitment of ethnic and racial minorities into clinical trials. Physicians cite structural issues such as lack of infrastructure and time as the primary barriers to clinical trial referral. For their African American and Latino patients, physicians also cite patient concern about being treated like a “guinea pig” as a primary deterrent to successful recruitment of minorities.

The paper also suggests “next steps” for implementing an action plan to address key barriers. Almost nine out of ten physicians suggest that improvement of outreach to community physicians would help facilities conducting cancer clinical trials to increase enrollment of minority patients. This paper explores a model for implementing an effective intervention strategy.

Learning Objectives:

• List primary physician barriers to cancer clinical trial accrual.
• Articulate barriers that physicians describe as more or less salient for minority patients.
• Describe the components of an evidence-based intervention model.

Keywords: Barriers to Care, Psychosocial Issues of Cancer

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.