Barriers to study enrollment in patients with advanced cancer referred to a phase I clinical trials unit

Abstract

We conducted this retrospective study to identify reasons that patients referred to a phase I clinical trial failed to enroll or delayed enrollment onto the trial.

Materials and methods: Outcome analyses were conducted independently on data collected from electronic medical records of two sets of consecutive patients referred to a phase I clinical trial facility at MD Anderson Cancer Center. Data from the first set of 300 patients were used to determine relevant variables affecting enrollment; data from the second set of 957 patients were then analyzed for these variables.

Results: Results from the two sets of patients were similar. Approximately 55% of patients were enrolled in a phase I trial. Patients referred from within MD Anderson were more likely to be enrolled than patients seen originally outside the institution (p = .006); black patients were more likely than white patients to enroll (69% vs. 43%; p = .04). The median interval from the initial visit to initiation of treatments was 19 days. Major reasons for failure to enroll included failure to return to the clinic (36%), opting for treatment in another clinic (17%), hospice referral (11%), early death (10%), and lack of financial clearance (5%). Treatment was delayed for three weeks or more in 250 patients; in 85 patients (34%), the delay was caused by financial and insurance issues.

Conclusion: Failure to return to the clinic, pursuit of other therapy, and rapid deterioration were the major reasons for failure to enroll; lengthy financial clearance was the most common reason for delayed enrollment onto a phase I trial.

Keywords: Barrier; Consults; Enrollment; New patients; Patient referral; Phase I trial.

Figure 1.

Pie chart shows percentages of patients with cancer who were first seen in the phase I clinical trials facility at MD Anderson Cancer Center from August 1, 2011, to February 29, 2012, according to reason for failure to enroll onto a phase I clinical trial. A total of 430 of 957 patients failed to enroll.

Figure 2.

Pie chart shows percentages of patients with cancer who were first seen in the phase I clinical trials facility at MD Anderson Cancer Center from August 1, 2011, to February 29, 2012, classified by reasons for delay in enrollment for ≥3 weeks (from first visit to first dose on trial). A total of 250 of 957 patients had delays of ≥3 weeks.