To Refer or Not to Refer: Factors that Affect Primary Care Provider Referral of Patients with Cancer to Clinical Treatment Trials

Abstract

Findings support allocating funds to provide CCTT education to PCPs to increase numbers of patients willing to participate in CCTTs.

Provider roles in the recruitment of underrepresented populations to cancer clinical trials

“…3), whereas 3 studies found provider attitudes to be a promoter of patient accrual. 18,20,26 The studies also reported that provider attitudes toward patient age, 11,12,16,17 comorbidities, 12,16,17 and disease stage, 16 physician perception of patient mistrust of researchers, 14,25 and lack of physician awareness about trials 14,23,25 were factors that prevented providers from enrolling their patients into clinical trials.…”

“…Of the 18 studies eligible for review, 3 were published before 1993, 10-12 2 were published between 1993 and 1999, 13,14 and 13 were published in 2000 or later (Table 1). [15][16][17][18][19][20][21][22][23][24][25][26][27] The study designs included a randomized controlled trial (n ¼ 1), concurrent controlled trial (n ¼ 1), casecontrol (n ¼ 1), and descriptive (n ¼ 15), with 4 of the studies also using qualitative techniques to facilitate in-depth assessments of physician attitudes and perceptions. Fourteen studies reported recruitment into treatment trials only [10][11][12][13][15][16][17][18][19][20][21][22]24,26 ; 3 studies reported recruitment into both prevention and treatment trials 14,25,27 ; and 1 study reported recruitment to a prevention trial (Table 1).…”

“…Five studies targeted either racial or ethnic minorities, 14,15,23,25,27 3 studies targeted the elderly, [16][17][18] and 1 study targeted rural populations 24 as the primary goal. Nine studies did not target an underrepresented population as a primary objective; however, data were presented on advanced age, [11][12][13]19,21,26 minority status, 20,22,26 and social class (non-US study) 13 to warrant their inclusion in this article.…”

Influencing Referral of Adolescents and Young Adults With Cancer to Sites With Higher Rates of Trial Enrollment

“…20 This engagement of primary care providers in CT marketing appears to be underused; an NCI survey of primary care providers revealed that 98% did not discuss CTs with their patients and 37% were unaware that CTs might be an option. 21,22 Unpublished data from the Gordon et al study asked the primary care provider respondents about their awareness of and comfort with CTs. Seventy-eight percent thought the upper age limit for inclusion in NCIsponsored pediatric oncology trials was #21 years; only 14% felt more than moderately confident introducing CTs, and 65% felt it was not within their job scope (L.M.…”

Can the Referring Surgeon Enhance Accrual of Breast Cancer Patients to Medical and Radiation Oncology Trials? The Enhance Study

“…Surgeons often have several contacts with patients, and frequently discuss possible treatments before the patient's first visit to a medical or radiation oncologist. Because trust in a physician, particularly when the physician recommends a clinical trial, has been noted to be highly associated with trial recruitment [10][11][12][13][14][15] , we decided to undertake a prospective exploratory pilot study to evaluate whether specific referring surgeon-initiated interventions aimed at reducing physician and patient barriers could enhance clinical trial accrual in breast cancer patients. Accrual to clinical trials is a multidimensional problem that requires multidimensional interventions to effect improvement, and the potential influence of the referring surgeon is one dimension emphasized in the present study.…”