Barriers to clinical trial enrollment of older adults with cancer: A qualitative study of the perceptions of community and academic oncologists

Sedrak, Mina S.; Mohile, Supriya G.; Sun, Virginia; Sun, Can‐Lan; Chen, Bihong T.; Li, Daneng; Wong, Chi-Wah; George, Kevin; Padam, Simran; Liu, Jennifer; Katheria, Vani; Dale, William

doi:10.1016/j.jgo.2019.07.017

Cited by 53 publications

(51 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although common barriers to enrollment of older patients in oncology clinical trials have been the subject of frequent inquiry, the participation of this population, particularly those aged ≥70 years and/or with poor health, has not changed substantially over time 20,32‐35 . Several studies have described the barriers as complex and multifaceted, often involving a combination of system, physician, and patient factors 31,36‐41 . Specific efforts to improve the clinical trial enrollment of older patients with cancer have included a physician‐directed educational intervention, 42 focused committees, policy statements, 43‐47 and the development of a limited number of trials dedicated to older patients 48‐53 .…”

Section: Introductionmentioning

confidence: 99%

“…20,[32][33][34][35] Several studies have described the barriers as complex and VOLUME 71 | NUMBER 1 | JANUARY/FEBRUARY 2021 multifaceted, often involving a combination of system, physician, and patient factors. 31,[36][37][38][39][40][41] Specific efforts to improve the clinical trial enrollment of older patients with cancer have included a physician-directed educational intervention, 42 focused committees, policy statements, [43][44][45][46][47] and the development of a limited number of trials dedicated to older patients. [48][49][50][51][52][53] However, few studies 54,55 have synthesized this research.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Older adult participation in cancer clinical trials: A systematic review of barriers and interventions

Sedrak

Freedman

Cohen

et al. 2020

CA A Cancer J Clinicians

Self Cite

263

200

View full text Add to dashboard Cite

Cancer is a disease of aging and, as the world's population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinical trial participation of older adults with cancer remain sparse. For this systematic review, the authors evaluated published studies regarding barriers to participation and interventions to improve participation of older adults in cancer trials. The quality of the available evidence was low and, despite a literature describing multifaceted barriers, only one intervention study aimed to increase enrollment of older adults in trials. The findings starkly amplify the paucity of evidence-based, effective strategies to improve participation of this underrepresented population in cancer trials. Within these limitations, the authors provide their opinion on how the current cancer research infrastructure must be modified to accommodate the needs of older patients. Several underused solutions are offered to expand clinical trials to include older adults with cancer. However, as currently constructed, these recommendations alone will not solve the evidence gap in geriatric oncology, and efforts are needed to meet older and frail adults where they are by expanding clinical trials designed specifically for this population and leveraging real-world data.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Older adult participation in cancer clinical trials: A systematic review of barriers and interventions

Sedrak

Freedman

Cohen

et al. 2020

CA A Cancer J Clinicians

Self Cite

263

200

View full text Add to dashboard Cite

show abstract

“…Most clinical trials were suspended during this period and are only resuming very gradually. The older cancer population already suffered from lack of access to these trials [8] , [9] ; for selected patients, delaying surgery does not impact prognosis in cases such as stage I or II breast cancer or low intermediary risk prostate cancer [10] , [11] . In other cases, however, this delay could impact the prognosis and the recurrence risk.…”

Section: Discussionmentioning

confidence: 99%

“…Most clinical trials were suspended during this period and are only resuming very gradually. The older cancer population already suffered from lack of access to these trials [8] , [9] ;…”

Section: Discussionmentioning

confidence: 99%

How did we take care of our older cancer patients during the first COVID-19 wave? The French experience

et al. 2021

View full text Add to dashboard Cite

Background The management of older cancer patients has been highly challenging for clinicians in a health-care system operating at maximum capacity during the COVID-19 pandemic. Patients and methods We analyzed data from 9 different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic for elderly cancer patients. The secondary endpoint was to assess the incidence of hospitalization and mortality due to COVID-19. All patients were older than 65 years of age. Results We analyzed data from 332 outpatients’ case files between 9th of March and 30th of April 2020. The median age was 75 years (range: 65–101) and 53% were male. Because of the COVID-19 pandemic, more than half of the outpatients received modified patient care, defined as postponement or cancellation of surgery, irradiation scheme adapted, systemic treatment or the use of telemedicine. Among patients with localized cancer, 60% had a change in management strategy due to the pandemic. Changes in management strategy were made for 53% of patients at the metastatic stage. GCSF was used , in 83% of patients, increasing considerably in the context of the pandemic. Sixty-nine percent of physicians used telemedicine. In the final analysis, only one patient was hospitalized for COVID-19 infection. No deaths due to COVID-19 were reported in elderly cancer patients during this time period. Conclusion Our study is the first to assess modification of patient care in elderly cancer outpatients during an epidemic. With this unprecedented crisis, our objective is to protect our patients from infection via protective barrier measures and social distancing, but also to guarantee the continuity of cancer care without overexposing this fragile population. Physicians were able to adapt their practice and used new forms of management, like telemedicine.

show abstract

“…Consequently, most of what is known about cancer therapeutics is based on clinical trials conducted in younger and healthier patients [8][9][10]. Furthermore, despite a plethora of literature documenting barriers to the accrual of older adults to cancer clinical trials (Figure 1), there are few evidence-based strategies to mitigate these barriers [11,12]. A recent systematic review revealed that among 8691 studies screened, only 12 relevant observational studies examined barriers hindering the participation of older adults in cancer clinical trials, and one (negative) randomized controlled trial evaluated an intervention to increase the enrollment of older adults in trials [8].…”

Section: Introductionmentioning

confidence: 99%

Strategies to Improve Participation of Older Adults in Cancer Research

Liu

Gutierrez

Tiwari

et al. 2020

JCM

Self Cite

View full text Add to dashboard Cite

Cancer is a disease associated with aging. As the US population ages, the number of older adults with cancer is projected to dramatically increase. Despite this, older adults remain vastly underrepresented in research that sets the standards for cancer treatments and, consequently, clinicians struggle with how to interpret data from clinical trials and apply them to older adults in practice. A combination of system, clinician, and patient barriers bar opportunities for trial participation for many older patients, and strategies are needed to address these barriers at multiple fronts, five of which are offered here. This review highlights the need to (1) broaden eligibility criteria, (2) measure relevant end points, (3) expand standard trial designs, (4) increase resources (e.g., institutional support, interdisciplinary care, and telehealth), and (5) develop targeted interventions (e.g., behavioral interventions to promote patient enrollment). Implementing these solutions requires a substantial investment in engaging and collaborating with community-based practices, where the majority of older patients with cancer receive their care. Multifaceted strategies are needed to ensure that older patients with cancer, across diverse healthcare settings, receive the highest-quality, evidence-based care.

show abstract

Barriers to clinical trial enrollment of older adults with cancer: A qualitative study of the perceptions of community and academic oncologists

Cited by 53 publications

References 56 publications

Older adult participation in cancer clinical trials: A systematic review of barriers and interventions

Older adult participation in cancer clinical trials: A systematic review of barriers and interventions

How did we take care of our older cancer patients during the first COVID-19 wave? The French experience

Strategies to Improve Participation of Older Adults in Cancer Research

Contact Info

Product

Resources

About