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Observational Study
. 2018 Oct 15;124(20):4064-4071.
doi: 10.1002/cncr.31727. Epub 2018 Oct 6.

A prospective comparison of cancer clinical trial availability and enrollment among adolescents/young adults treated at an adult cancer hospital or affiliated children's hospital

Stefanie M Thomas  1   2 , Jemily Malvar  1 , Hanh Henry Tran  3 , Jared T Shows  4 , David R Freyer  1   2   5
Affiliations
Observational Study

A prospective comparison of cancer clinical trial availability and enrollment among adolescents/young adults treated at an adult cancer hospital or affiliated children's hospital

Stefanie M Thomas et al. Cancer. .

Abstract

Background: Low cancer clinical trial (CCT) enrollment may contribute to survival disparities affecting adolescents and young adults (AYAs) (ages 15-39 years). The objective of this study was to evaluate whether differences in CCT availability related to treatment site could explain the low CCT enrollment.

Methods: This prospective, observational cohort study was conducted at an academic children's hospital and its affiliated but geographically separated adult cancer hospital within a National Cancer Institute-designated Comprehensive Cancer Center. For consecutive, newly diagnosed AYA patients, it was determined whether an appropriate CCT existed nationally, was available at the treatment site, and was used for enrollment. Proportions of AYAs in these categories were compared between sites using the chi-square test.

Results: One hundred fifty-two consecutive AYA patients were included from the children's hospital (n = 68; ages 15-20 years) and the adult cancer hospital (n = 84; ages 18-39 years). Although there was no difference in CCT existence for individual AYA patients by site (children's hospital [36 of 68 patients; 52.9%] vs adult cancer hospital [45 of 84 patients; 53.6%]; P = .938), CCT availability was significantly lower at the adult cancer hospital (14 of 84 patients [16.7%] vs 30 of 68 [44.1%] at the children's hospital; P < .001). The proportion of AYAs enrolled was low at both sites (8 of 68 patients [11.8%] vs 6 of 84 patients [7.1%], respectively; P = .327). Fewer existing CCTs were available at the adult cancer hospital (4 of 27 patients [14.8%] vs 8 of 14 patients [57.1%], respectively), and those were directed toward solid tumors and new agents.

Conclusions: Efforts to improve low CCT enrollment among AYAs should be differentiated by treatment site. In the adult setting, these efforts should be aimed at improving CCT availability by overcoming site-level barriers to opening existing CCTs.

Keywords: adolescent; adolescents and young adults (AYAs); clinical oncology; clinical trial as topic; multicenter studies as topic; pediatric oncology; young adult.

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Conflict of interest statement

Conflicts: The authors have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
CONSORT diagram of the current study comparing cancer clinical trial availability for adolescent and young adult (AYA) patients treated at Children’s Hospital Los Angeles (CHLA) or the adult-focused Norris Cancer Hospital (NCH).
Figure 2:
Figure 2:
Comparison of cancer clinical trial existence, availability, and enrollment of adolescents and young adults at Children’s Hospital Los Angeles (CHLA, n=68) and the Norris Cancer Hospital (NCH, n=84). See Methods for operational definitions of cancer clinical trial existence, availability and enrollment.
See this image and copyright information in PMC

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