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Strategies for increasing accrual in cancer clinical trials: What is the evidence?
Margo Michaels1, Elisa S Weiss2, Maria Sae-Hau2
1Health Access and Action Consulting, Newton, Massachusetts, USA.
Introduction:
Despite the importance of clinical trial participation among cancer patients, few participate-and even fewer patients from ethnic and racial minoritized groups. It is unclear whether suggested approaches to increase accrual are successful. We conducted a scoping review to identify evidence-based approaches to increase participation in cancer treatment clinical trials that demonstrated clear increases in accrual. Notably, more stringent than other published reviews, only those studies with comparison data to measure a difference in accrual rates were included.
Methods:
We searched PubMed/MEDLINE, Embase, CINAHL, and Web of Science for English-language articles published from January 1, 2012, to August 8, 2022. Studies were included if they were conducted in the United States, described single or multicomponent interventions, and provided data to measure accrual relative to baseline levels or that compared accrual rates with other interventions.
Results:
Sixteen articles were included: six with interventions addressing patient barriers, two addressing provider barriers, seven describing institutional change, and one describing policy change. Key themes emerged, such as a focus on patient education, cultural competency, and building the capacity of clinics. Few studies provide comparative accrual data, making it difficult to identify with certainty any effective, evidence-based approaches for increasing accrual. Some patient- and system-level interventions studies showed modest increases in accrual primarily through pre-post measurement.
Conclusion:
Despite an extensive body of literature about the barriers that impede cancer treatment trial accrual, along with numerous recommendations for how to overcome these barriers, results reveal surprisingly little evidence published in the last 10 years on interventions that increase accrual relative to baseline levels or compared with other interventions. As clinical trials are a primary vehicle through which we improve cancer care, it is critical that evidence-based approaches are used to inform all efforts to increase accrual. Strategies for increasing participation in cancer clinical trials must be developed and rigorously evaluated so that these strategies can be disseminated, participation in trials can increase and become more equitable, and trial results can become more generalizable.
Insights
Few studies show evidence-based approaches to increase cancer clinical trial participation, especially for minoritized groups. More research is needed to identify effective strategies for equitable accrual.
Area of Science:
- Oncology
- Clinical Trials
- Health Equity
Background:
- Cancer clinical trial participation is crucial for advancing care but remains low, particularly among ethnic and racial minoritized groups.
- Existing literature offers numerous recommendations to overcome participation barriers, yet robust evidence for effective interventions is scarce.
Purpose of the Study:
- To conduct a scoping review identifying evidence-based approaches that demonstrably increase accrual in cancer treatment clinical trials.
- To specifically include studies with comparative data to rigorously assess intervention effectiveness.
Main Methods:
- Searched major databases (PubMed/MEDLINE, Embase, CINAHL, Web of Science) for English-language articles from 2012-2022.
- Included studies conducted in the US describing single or multicomponent interventions with data on accrual rates relative to baseline or other interventions.
Main Results:
- Sixteen articles were included, focusing on patient barriers (6), provider barriers (2), institutional change (7), and policy change (1).
- Key themes included patient education, cultural competency, and clinic capacity building.
- Few studies provided comparative accrual data; some patient- and system-level interventions showed modest pre-post increases.
Conclusions:
- Despite extensive literature on barriers, there is limited published evidence over the last decade on interventions that significantly increase cancer clinical trial accrual.
- Developing and rigorously evaluating evidence-based strategies is critical for increasing equitable participation and improving generalizability of trial results.
- This highlights the need for robust research into effective accrual enhancement strategies to advance cancer care.
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