Cancer patients missing out on trials

There is no clinical trial available to two out of three cancer patients, it has emerged.

A study just published argues for a greater volume of trials and for “champion physicians” to increase participation.

It found there was no cancer trial option for 71% of patients because the trials that were open did not meet their particular cancer type; the stage of their disease; and line of treatment.

The authors said that low recruitment to cancer clinical trials is hampering continued progress in cancer care.

It is also important to establish why eligible patients turned down an opportunity to participate in a trial and to overcome this problem, clinical research needed to be embedded into the culture of hospitals.

The study by the Mater Hospital in Dublin, together with Cancer Trials Ireland, found one quarter of patients had an option to cancer trial but did not enrol.

The study, published in the Irish Medical Journal, involved a retrospective anonymised reviews of the files of 140 patients with cancer who attend the Mater.

There were 19 cancer trials available to patients when the four-month review began in November last year. The range of treatments covered 10 different cancer types at different stages.

The treating doctor considered the cancer clinical trial option in most cases (63.4%) but only discussed the possibility of participation in just over half (54%) of them.

Among the reasons given for failing to consider the trial option included physician’s discretion and patient ineligibility. Another reason was that patients had declined a previous trial option.

Consultant medical oncologist at the hospital, Dr Cathy Kelly, said the availability of trials was not unique to Ireland: “In the United States, studies show that between 60% and 77% of patients do not have a cancer trial option available to them.”

Over the past 10 years, the number of patients participating in cancer trials in Ireland has doubled, and there has been a trebling of the number of trials that have opened.

Dr Kelly said the infrastructure developed by Cancer Trials Ireland has attracted international research groups and pharmaceutical companies to open trials in Ireland.

“While we found that 5% of patients enrolled in a cancer trial, which is in line with international figures, it is imperative to safeguard continued improvement in cancer outcomes that continue to recruit more patients on more trials,” she said.

“The standard treatments for cancer that we use today were once examined in the setting of a cancer trial and the treatments of tomorrow rely upon the completion of high-quality trials.”

A solution would be to open more trials, but the authors point out that the availability of funding is crucial. Cancer Trials Ireland, previously known as the All Ireland Co-operative Clinical Research Group, co-ordinates cancer clinical trials in Ireland. The study stressed that ongoing governmental and philanthropic support is needed to continue to increase the number of trials with a target recruitment rate of 10%.

The number of patients joining a Cancer Trials Ireland trial increased from 409 in 2006 to 1,897 last year. There were 68 trials in 2008 and 155 in 2015.


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