Accrual to Clinical Trials: Let’s Look at the Physicians

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Clinical trials have long been recognized as the definitive way to identify efficacious treatments and to understand the risks and benefits of those treatments. Unfortunately, only a small fraction of cancer patients participate in clinical trials and limited information exists regarding the profile of physicians who recruit patients onto trials and the clinical practice settings in which they work. The population-based assessment of specialty physicians who recruit and refer patients to clinical trials by Klabunde et al. ( 1 ) in this issue of the Journal provides an important description of the types of physicians who are recruiting patients to cancer clinical trials in a subset of institutions that are already involved in clinical research ( 1 ).

The study by Klabunde et al. ( 1 ) included 1533 medical oncologists, radiation oncologists, and surgeons who were involved in the care of patients with colorectal or lung cancer. The investigators identified physician and infrastructure factors associated with clinical trial participation within the Cancer Care Outcomes Research and Surveillance Consortium, a partnership of academic and Veterans Administration hospitals with community outreach that are funded to do clinical research on cancer outcomes ( 2 ). Among the more telling findings: Physicians who saw a higher number of patients and who spent more time with each new patient had higher clinical trial accrual rates. Specifically, the majority of medical oncologists (59.4%) saw more than 20 colorectal or lung cancer patients per month, whereas the majority of surgeons (65%) saw fewer than five of these patients per month. The majority of medical oncologists (63.5%) and radiation oncologists (84%) spent 60 minutes or more with a new cancer patient visit, whereas the majority of surgeons (81.4%) spent less than 60 minutes. Factors that may facilitate discussion of treatment options with other physicians, such as teaching medical students or residents and attending tumor board meetings, were found to be associated with a higher likelihood of accruing or referring patients to trials. As expected, frequent participation in tumor board meetings (ie, weekly or monthly) was associated with higher rates of accrual, most likely because patients could be promptly referred to trials with specific eligibility requirements. However, participation in discussion formats is only a small part of the story, given that only 869 (56.7%) of physicians in the study had accrued or referred at least one patient to a clinical trial during the previous 12 months.