Barriers to clinical trial enrollment of older adults with cancer: A qualitative study of the perceptions of community and academic oncologists
Barriers to clinical trial enrollment of older adults with cancer: A qualitative study of the perceptions of community and academic oncologists
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DOI：
10.1016/j.jgo.2019.07.017
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发表时间：
2020-03-01
影响因子：
3
通讯作者：
Dale, William
中科院分区：
文献类型：
--
作者：
Sedrak, Mina S.;Mohile, Supriya G.;Dale, William
目的：肿瘤学家可能是老年人参与研究的主要障碍之一。多项研究描述了学术临床医生对不让老年人参加试验的担忧。尽管大多数老年人在社区接受癌症治疗，但很少有研究考察社区肿瘤学家面临的独特挑战以及它们与肿瘤学家相关的学术障碍有何不同。方法：从2018年3月至6月，在希望之城通过电话或面对面的方式对44名内科肿瘤学家进行了半结构化访谈(其中24名来自学术界，20名来自社区)。采访探索了肿瘤学家对老年癌症患者临床试验登记障碍的看法。结果：在44名受试者中，36%为女性，68%为执业10年。在整个样本中，严格的资格标准(n=20)和肿瘤学家对治疗毒性的担忧(n=15)是最常被引用的障碍。与学术肿瘤学家相比，社区肿瘤学家更多地提到患者的态度、信念和理解(n=9比n=2)和照顾者负担(n=6比n=0)。相比之下，与社区肿瘤学家相比，学术肿瘤学家更多地提到肿瘤学家的偏见(n=10比n=3)和时间/支持不足(n=4比n=1)。结论：学术肿瘤学家和社区肿瘤学家对试验的认知差异表明障碍是多方面的、复杂的，并因实践环境而异。增加癌症老年患者试验收益的干预措施可能受益于针对不同实践环境的独特障碍而量身定做。(C)2019爱思唯尔有限公司。保留所有权利。
Objectives: Oncologists can be one of the major barriers to older adult's participation in research. Multiple studies have described academic clinicians' concerns for not enrolling older adults onto trials. Although the majority of older adults receive their cancer care in the community, few studies have examined the unique challenges that community oncologists face and how they differ from oncologist-related barriers in academia.Methods: Semi-structured interviews were conducted by telephone or face-to-face with 44 medical oncologists (24 academic-based and 20 community-based) at City of Hope from March to June 2018. Interviews explored oncologists' perceptions of barriers to clinical trial enrollment of older adults with cancer. Data were analyzed using qualitative content analysis.Results: Of the 44 participants, 36% were women and 68% were in practice for >10 years. Among the entire sample, stringent eligibility criteria (n = 20) and oncologist concerns for treatment toxicities (n = 15) were the most commonly cited barriers. Compared to academic oncologists, community oncologists more often cited patient attitudes, beliefs, and understanding (n = 9 vs. n = 2) and caregiver burden (n = 6 vs. n = 0). In contrast, compared to community oncologists, academic oncologists more often cited oncologist bias (n = 10 vs. n = 3) and insufficient time/support (n = 4 vs. n = 1).Conclusions: Differences in perceptions among academic and community oncologists about trials suggest that barriers are multifaceted, complex, and vary by practice setting. Interventions to increase trial accrual among older adults with cancer may benefit from being tailored to address the unique barriers of different practice settings. (C) 2019 Elsevier Ltd. All rights reserved.