Investigating reasons patients do not join a cancer clinical trial.

Abstract

11092 Background: The perennial challenge to cancer clinical trials is accrual. To date, the focus to improve accruals rested on addressing patient knowledge, attitudes and beliefs rooted in patient reluctance to be experimented on, financial and practical barriers and issues of mistrust. We undertook this study to describe the impact of an educational intervention to democratize recruitment and improve understanding of and information about cancer clinical trials. Methods: We implemented a time series intervention (INT) identifying cancer patients at treatment decision points at 3 participating Cancer Centers, educating consented breast, liver and lung cancer patients about clinical trials in general and providing clinical trial match lists to oncologists and patients prior to treatment decision-making. We defined a treatment decision point as a new, recurrent or progressing cancer. We surveyed patients and their oncologists pre- and post-intervention about their knowledge, attitudes and beliefs (KABs) of clinical trials. We compared pre & post KABs using Chi Sq and Fisher’s Exact T tests. Results: Of 523 consented patients at treatment decision points, 514 completed pre & 368, post-INT surveys; 60% were non-white with no racial ethnic difference in response rates (70% BIPOC v 79% White; p = 0.07). Following an educational intervention, there was no significant change in positive attitude towards clinical trials (CT): 71% pre-intervention vs 77% post-intervention; p = 0.55, regardless of race-ethnicity (RE) (p = 0.5025). Black patients as compared to white patients, reported greater barriers to CT including: transportation (60% vs 37%; p < 0.001) and family responsibilities (46% vs 25%; p = 0.001). There was no RE difference in other barriers: patient report of physicians talking with them about clinical trials (89% vs 65%; p = .36), insurance (77% vs 74%; p = 0.6051); out of pocket expenses (64% vs 53%; p = 0.12); time off work (41% vs 37%; p = 0.5457). 25/28 (89%) treating oncologists of consented patients responded. Oncologists reported being less likely to offer CTs to patients who they perceived were reluctant to: get placebo (48%), be randomized (48%), have increased family responsibilities (52%), would have difficulty getting time off work (45%) or had comorbidities (40%). Conclusions: More than ¾ of patients have a positive attitude towards clinical trials with no racial-ethnic difference. Black patients reported more barriers to trial enrollment than white patients. Despite Black patients having more barriers that would reduce oncologists’ likelihood of offering CTs to patients, there was no RE in patients’ report of oncologists talking with them about CTs. Clinical trial information: NCT05146297 .