Addressing the Barriers to Clinical Trials Accrual in Community Cancer Centres Using a National Clinical Trials Navigator:A Cross-Sectional Analysis

Abstract

Introduction Clinical trials, although academically accepted as the most effective treatment available for cancer patients, poor accrual to clinical trials remains a significant problem. A clinical trials navigator (CTN) program was piloted where patients and/or their healthcare professionals could request a search and provide a list of potential cancer clinical trials in which a patient may be eligible based on their current status and disease. Objectives This study examined the outcomes of a pilot program to try to improve clinical trials accrual with a focus on patients at medium to small sized cancer programs. Outcomes examined included patient disposition (referral to and accrual to interventional trials), patient survival, sites of referral to the CTN program. Methods One 0.5 FTE navigator was retained. Stakeholders referred to the CTN through the Canadian Cancer Clinical Trials Network. Demographic and outcomes data were recorded. Results Between March 2019 and February 2020, 118 patients from across Canada used the program. Seven per cent of patients referred were enrolled onto treatment clinical trials. No available trial excluded 39% patients, and 28% had a decline in their health and died before they could be referred or enrolled onto a clinical trial. The median time from referral to death was 109 days in those that passed. Conclusion This novel navigator pilot has the potential to increase patient accrual to clinical trials. The CTN program services the gap in the clinical trials system, helping patients in medium and small sized cancer centres identify potential clinical trials at larger centres.

Barriers to Clinical Trial Implementation Among Community Care Centers

“…The Clinical Trials Navigator developed by the Canadian Cancer Clinical Trials Network was designed to study mitigating such barriers. This pilot program sought to enable health care professionals to search for existing clinical trials more efficiently and ultimately demonstrated a reduction in referral time from nearly 7 days to 1 day . Implementing navigation platforms demonstrably improves physicians’ ability to discuss existing clinical trials with their patients.…”

“…This pilot program sought to enable health care professionals to search for existing clinical trials more efficiently and ultimately demonstrated a reduction in referral time from nearly 7 days to 1 day. 20 Once a clinical trial is identified for an eligible patient, the patient must then decide whether to participate. Common reasons that patients decline participation in a clinical trial include fear of adverse effects, negative attitude due to hearsay or personal experience, cultural appropriateness, lack of communication between physician and patient, and financial and/or logistical difficulties.…”

Identifying and addressing a new barrier to community-based patients accessing cancer clinical trials

“…Participation in clinical trials is recommended as part of the clinical care for cancer patients in most guidelines, yet patient accrual is poor [ 1 ]. Lack of awareness, understanding and accessibility of trials are commonly reported barriers [ 2 , 3 ]. Furthermore, participant enrollment is notoriously low in community-based hospitals compared to academic centres [ 4 ].…”

“…A major challenge in community hospitals is the lack of availability of clinical trials at their home centre. In Ontario, non-academic cancer centres run between 1 and 15 clinical trials at any one time, as compared to 100–350 trials in the larger, academic centres [ 2 ]. This adds a unique challenge to the community-based oncologist who needs to look outside of their cancer centre to increase access for clinical trials for their patients.…”

“…The , funded by Canadian Cancer Clinical Trials Network, is designed to serve Canadian cancer patients by identifying clinical trials anywhere in North America for which they may be eligible. In its first year, more than 120 patients subscribed to this program, with 80 % residing in Windsor-Essex [ 2 ].…”