Knowledge, attitudes, and factors influencing clinical trial participation among breast cancer patients in Brazil: The LACOG 1123 (ASTRAL) study.

Abstract

e23209 Background: Despite Brazil’s growing participation in clinical cancer research, data on knowledge, attitudes, and factors influencing clinical trial participation remain limited. The LACOG 1123 (ASTRAL) study evaluated these aspects among Brazilian patients with breast cancer (BC). Methods: Patients ≥18 years diagnosed with stage I-IV BC within the previous five years and receiving active treatment or having completed treatment within two years were invited by their treating physicians to complete an electronic survey. The questionnaire included sociodemographic and clinical characteristics, as well as questions related to clinical research adapted from previously published surveys. Results: A total of 350 responses were received from all regions of Brazil. Most physicians worked both in private and public setting (52%). Median age was 49.0 years (IQR 42-60), 54.6% were white, and 85.3% had private health insurance. The majority had initial disease (32.5%) and 89.1% were receiving active treatment. Regarding previous knowledge on clinical research, 63.1% reported having heard about clinical trials, most of them learned through some kind of media (68%); however, 65.5% were unaware of the existence of research centers at their treatment sites. Only 13.1% had ever been invited to participate in a clinical trial. The main motivation to participate was contributing to science (38.8%), followed by contributing to the hospital and care team (25.1%). Physicians’ opinions were reported to play a central role in decision-making by 76.2% of participants, and 74.5% reported that refusing participation would not compromise the quality of care. Regarding perceptions of clinical research, 79.1% agreed that clinical trials benefit patients and society, 67.2% reported willingness to participate if invited, and 61.6% would encourage relatives or friends to participate. Regarding concerns to participation, 18% reported fear of being treated as a “guinea pig,” whereas 39.4% reported no fear of participating. Conclusions: Brazilian BC patients demonstrate strong altruistic and pro-science attitudes, with high willingness to participate in and encourage clinical trial enrollment. Although overall awareness levels were relatively high, access to clinical trials remains substantially lower than that reported in high-income settings. Moreover, the study population was skewed toward higher socioeconomic status, despite balanced representation of physicians from private and public institutions, likely overestimating levels of research awareness. Persistently low invitation rates likely reflect not only limited physician engagement, but also restricted trial availability and insufficient awareness of ongoing studies among care teams, highlighting key opportunities to expand equitable access and strengthen patient confidence in clinical research.