Patients and Survivors of Cancer Show Strong Willingness to Enroll in Clinical Trials

Remote technology and decentralization tools in cancer clinical trials may be linked to an increase in patient consent rate, according to findings from a cross-sectional study.

Cancer clinical trials using remote technology and decentralization tools to reduce patient time and the travel burden associated with participation may be linked to an increase in patient consent rate, according to findings from a cross-sectional study.1

Of the 1183 patients who participated, 77% (n = 909) of participants answered that they would join a cancer clinical trial if it were at least as easy as their regular care in terms of distance and frequency of visits, and 47% (n = 557) said they would participate even if it required additional effort in terms of travel distance or frequency of visits. Thirty percent of respondents (n = 353) also reported that they would be willing to travel up to 90 minutes or more from their regular care to join a clinical trial.

Participants in the study, consisting of those with cancer as well as survivors of cancer, were included from the American Cancer Society Cancer Action Network’s Survivor Views panel and augmented with commercially available web survey panels.

To be included, panelists must have been aged 18 years or older with a cancer diagnosis or who had been treated for cancer within the past 7 years, and who were residents of the United States. A series of questions were designed and asked to those enrolled regarding telehealth, remote care technologies, and willingness to participate in cancer clinical trials

The mean age of the survey respondents included was 58.2 years and each individual self-reported their gender, race and ethnicity, cancer type, and treatment status. Among the

1183 respondents, 72% were female (n = 848), 25% were male (n = 296), 1% were other/nonbinary (n = 8), and 3% declined to answer (n = 31). Regarding race, 70% were White (n = 825), 20% were Black or African American (n = 234), 3% of the respondents were American Indian or Alaska Native (n = 28), 2% were Asian (n = 25), and 2% were Native Hawaiian or Other Pacific Islander (n =20). Fifty-one patients declined to answer (4%).

Further, 10% of the respondents were Hispanic Latino/Latina, or of Spanish origin (n = 115), and 86% were not (n = 1017). A total of 4% declined to answer (n = 51). Regarding cancer type and treatment status, 41% of respondents either previously had or had survived breast cancer (n = 483) and 28% were being treated for cancer during the survey period(n = 325).

Of those included in the survey, 18% (n = 217) had previously participated in a cancer clinical trial, and 6% (n = 73) had looked for a trial themselves but did not find one. Only 7% (n = 88) respondents declined to participate in a trial they were qualified for, and 46% (n = 543) had never previously discussed trial participation with their health care practitioner.

Results further showed that participants who were older than 55 years of age were more likely to say that they would only participate in trials no farther from their home than their regular care health care practitioner vs younger respondents (26% vs 16%, respectively; P =.02). Those who earned a higher income were significantly more likely than lower-income earners to say they would participate in trials requiring additional effort (62% vs 41%, respectively; P=.03).

Those included in the survey reported a patient disposition toward enrollment in cancer clinical trials increased for modifications using remote technology and other decentralization tools. A majority of the respondents (60%-85%) reported to be more likely to enroll in the trial if the participation-related time and travel burden decreased as a result of these practices.

Results of the cross-sectional survey study concluded that most patients with cancer and survivors of cancer would be willing to participate in a cancer clinical trial if recommended by their health care practitioner, even if participating means additional effort is required, including the frequency of visits, travel to a more distant location, etc.

Still, the willingness to participate in such trials which call for additional effort by participants varies with one's income and age. Participants characterized as lower-income earners and those considered to be older respondents are less likely to travel farther or attend more frequent visits.

Previous research has also shown there to be a higher travel burden experienced by patients living in low-income areas and enrolled in trialsand a positive correlation between patient income and their likelihood to participate in a trial.

Due to the COVID-19 pandemic and subsequent regulatory guidance on the conduct of clinical trials, there has been an increased adoption of decentralized clinical trials. However, many of the regulatory flexibilities permitted during the pandemic are set to expire at the conclusion of the public health emergency.

By being able to decentralize trials through remote technology and other tools, travel burden associated with trial participation can be alleviated for participants by separating where a patient is evaluated and/or treated in respect to a trial and where a trial is hosted. This has the potential to allow for a larger and more diverse cohort of trial participants.

Overall, these data show that patients with cancer as well as survivors of cancer are receptive to newer technologies and tools and their use in the context of trials. This is associated with an increase in self-reported likelihood to consent if the technology or tool decreases the need to travel to a trial site. However, the degree to which respondents would be more likely to join a trial varied by approach, and the ability to have the option for in-person visits at a trial site when desired remained important.

Overall, greater adoption of remote technology and decentralization tools may allow for patient barriers to be alleviated potentially increase patient consent rates in clinical trials.

Reference:
  1. Adams DV, Long S, Fleury, ME. Association of remote technology use and other decentralization tools with patient likelihood to enroll in cancer clinical trials. JAMA Netw Open. 2022;5(7):e2220053. doi:10.1001/jamanetworkopen.2022.20053