Barriers to Enrolling the Elderly in Cancer Trials

描述(申请人提供)：背景：老年患者 目前在癌症临床试验中的代表性不足。因此，新的 证据可能不能推广到携带 最大的疾病负担。获得临床试验也为患者提供了 有机会接受最新的治疗和细致的临床护理。 为了确保临床试验系统是相关的和可访问的 对于所有癌症患者来说，识别特定的障碍是很重要的 老年癌症患者的入学人数。 具体目标：1)确定人口学和临床特征 参与临床试验的老年癌症患者； 2)确定审判的体制和组织决定因素 老年癌症患者的参与；3)确定研究中心 在招收老年癌症患者方面特别成功 临床试验，并确定研究人员的态度和 这些中心的招生策略与中心的招生策略不同 在招募老年患者方面不太成功；以及4)识别 老年癌症患者对参与临床试验的态度。 研究计划：首先，我们将对障碍进行基于人口的分析 为老年癌症患者参与乳腺癌、前列腺癌、肺癌、 和结肠癌在国家癌症研究所赞助的临床试验中 研究所。SEER-Medicare数据将用于评估 人群中的突发癌症患者。我们将分析 患者和医院的特点，以及卫生系统因素，如 管理式护理市场在招募老年患者方面的渗透。 在这些发现的指导下，我们将对老年人进行定性研究 癌症患者以及临床研究人员以确定他们的态度 促进老年患者参与临床试验。 职业发展规划：我的职业目标是成为一名独立的 调查员，重点关注老年患者的护理质量 癌症-特别是关于老年患者的新癌症疗法是如何 评估和传播。为了获得必要的技能，我将 在严谨的研究和独立的项目上与我的导师密切合作 学习。此外，我还将接受公共硕士的正式培训 卫生政策和管理中的卫生计划。 意义：我们假设患者的不情愿，调查员的态度， 缺乏对直接医疗费用的保险覆盖是至关重要的 老年癌症患者参与试验的障碍。这是我们的希望 这项工作将促进有针对性和新颖性的发展 克服这些障碍的方法。

DESCRIPTION (provided by applicant): BACKGROUND: Elderly patients are currently underrepresented in cancer clinical trials. As a result, new evidence may not be generalizable to the population group that carries the greatest burden of illness. Access to clinical trials also offers patients the opportunity to receive the newest treatments and meticulous clinical care. In order to ensure that the clinical trial system is relevant and accessible to all patients with cancer, it is important to identify specific barriers to the enrollment of elderly cancer patients. SPECIFIC AIMS: 1) To identify demographic and clinical characteristics of elderly cancer patients that are associated with clinical trial participation; 2) To identify institutional and organizational determinants of trial participation for elderly cancer patients; 3) To identify research centers that are particularly successful in enrolling elderly cancer patients into clinical trials, and determine whether the investigators' attitudes and enrollment strategies at these centers are different from those at centers that are less successful at enrolling elderly patients; and 4) To identify attitudes of elderly cancer patients towards participation in clinical trials. RESEARCH PLAN: First, we will perform a population-based analysis of barriers to the participation of elderly cancer patients with breast, prostate, lung, and colon cancer in clinical trials sponsored by the National Cancer Institute. The SEER-Medicare data will be used to estimate characteristics of incident cancer patients in the population. We will analyze the impact of patient and hospital characteristics, and health system factors such as managed care market penetration on the recruitment of elderly patients. Guided by these findings, we will then perform qualitative studies of elderly cancer patients as well as clinical investigators to ascertain their attitudes toward the participation of elderly patients in clinical trials. CAREER DEVELOPMENT PLAN: My career goal is to become an independent investigator, focusing on the quality of care for elderly patient with cancer-specifically on how new cancer therapies for elderly patients are evaluated and disseminated. In order to attain the necessary skills, I will work closely with my mentors on a rigorous program of research and independent study. Additionally, I will receive formal training in the Masters of Public Health program in Health Policy and Administration. SIGNIFICANCE: We hypothesize that patient reluctance, investigator attitudes, and the lack of insurance coverage for direct medical costs are crucial barriers to trial participation for elderly cancer patients. It is our hope that this work will facilitate the development of targeted and novel approaches to overcoming these barriers.