The Urgent Need to Boost Cancer Patient Enrollment in Clinical Trials

In a recent video interview with Applied Clinical Trials, Matt Robinson, PhD, senior director, oncology research program, National Comprehensive Cancer Network (NCCN), discussed the current state and challenges of cancer patient participation in clinical trials. Barriers to participation can include lack of understanding, economic burdens, and implicit biases. Robinson highlighted solutions such as increased education, legislation like the Clinical Trials Modernization Act, and engaging patients early in trial design. He also touched on the use of technology, such as biomarker testing and wearable devices, which can also enhance recruitment and reduce burdens.

ACT: Could you elaborate on the current state of cancer patient participation in clinical trials and why it's a pressing issue for the clinical research industry?

Robinson: I just want to also start by saying thank you for the opportunity to discuss this really important topic. When you think about the current state of clinical trials, historically, if you go into the literature, it's been thought that participation has been very low, less than 5% of the patients actually participate in clinical trials, but a recent paper by Unger et al. in the Journal of Clinical Oncology, where they looked at data from a five year period spanning 2013 through 2017, suggests slightly higher, albeit not that much higher levels. For therapeutic trials, about 7% of patients overall participated, but it depends on the setting that you're in, so patients in an NCI-Designated Comprehensive Cancer Center, slightly over 20% of those patients participated, but when you're in the community, only 4% of patients participate, and that's for therapeutic trials. There's also different types of trials that maybe you don't necessarily think of initially. For those things like diagnostic trials or quality of life studies, 2.5-3% of patients participate, and where we're seeing reasonable participation, in my mind, are for biosample repository studies, where patients are willing to donate their tissues for future research, and there almost a third of the patients will actually donate their tissues. I think there's room for improvement, particularly when you realize that the types of advances that we have seen in cancer care over the last decade or so, they stem from data that were generated in clinical trials, so having as many patients participate with as diverse patient population as possible is really important. As a side note, NCCN, the organization that I belong to, supports that idea. All the guidelines that they develop have a box on the front, stressing the importance of clinical trials where appropriate and applicable for an individual patient.