Using OncoDoc as a computer-based eligibility screening system to improve accrual onto breast cancer clinical trials

While clinical trials offer cancer patients the optimum treatment, historical accrual of such patients has not been very successful. OncoDoc is a decision support system designed to provide best therapeutic recommendations for breast cancer patients. Developed as a browsing tool of a knowledge base structured as a decision tree, OncoDoc allows physicians to control the contextual instantiation of patient characteristics to build the best formal equivalent of an actual patient. Used as a computer-based eligibility screening system, depending on whether instantiated patient parameters are matched against guideline knowledge or available clinical trial protocols, it provides either evidence-based therapeutic options or relevant patient-specific clinical trials. Implemented at the Gustave Roussy Institute and routinely used at the point of care during a 4-month period, it significantly improved physician compliance with guideline recommendations and enhanced physician awareness of open trials while increasing patient enrollment to clinical trials by 50%. But, when analyzing reasons of non-accrual of potentially eligible patients, it appeared that physicians' psychological reluctance to refer patients to clinical trials, measured during the experiment at 25%, may not be resolved by the simple dissemination of clinical trial information at the point of care.