Improving accrual into cancer clinical trials

It is thought by some that there are inadequate patient entries on high priority national cancer treatment protocols, resulting in intolerable delays in addressing crucial research issues. The North Central Cancer Treatment Group in Rochester, Minnesota generated a questionnaire with possible impediments to patient treatment entry as well as suggested measures for approving accrual. Of 334 questionnaires, 63% were completed and returned by medical oncologists, radiation therapists, surgeons and nurse/data managers. The most frequently listed impediments included patients' advanced age or fragility, inadequate health insurance, and excess travel distance. Protocol concerns included too many tests that were too complex and too costly. Practice concerns included physicians too busy and inadequate help. Suggestions toward improving patient accrual included subsidizing drugs, subsidizing nonessential tests for patient care, and increasing funding for support personnel. Popular suggestions for education efforts included teaching the importance of clinical trials, emphasizing personal benefit to the patient and recognition of physicians and institutions participating. It was felt that protocols should be simplified, be more consistent with practice, and be more flexible. These considerations are relevant not only in the interests of more effective clinical research but also in the interests of appropriate education of residents and oncology fellows involved in clinical trials.