• Kenneth L Kehl, Neeraj K Arora, Deborah Schrag, John Z Ayanian, Steven B Clauser, Carrie N Klabunde, Katherine L Kahn, Robert H Fletcher, and Nancy L Keating.
• Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
• J. Natl. Cancer Inst. 2014 Oct 1; 106 (10).

BackgroundClinical trials are essential to establish the effectiveness of new cancer therapies, but less than 5% of adults with cancer enroll in trials. In addition to ineligibility or lack of available trials, barriers to enrollment may include limited patient awareness about the option of participation.MethodsWe surveyed a multiregional cohort of patients with lung or colorectal cancer (or their surrogates) three to six months after diagnosis. We assessed whether respondents reported learning that clinical trial participation might be an option, and, if so, with whom they discussed trials. We used logistic regression to assess the association of patient characteristics with discussing trial participation and enrolling in trials. All statistical tests were two-sided.ResultsOf 7887 respondents, 1114 (14.1%) reported discussing the possibility of clinical trial participation; most learned about trials from their physicians, and 287 patients (3.6% of all patients, 25.8% of trial discussants) enrolled. Among 2173 patients who received chemotherapy for advanced (stage III/IV lung or stage IV colorectal) cancer, 25.7% discussed trials, and 7.6% (29.5% of trial discussants) enrolled. Discussions were less frequent among older patients, African American or Asian vs white patients, and those with lower incomes and more comorbidity. Enrollment was higher among patients reporting shared vs physician-driven decisions (all P < .05).ConclusionsIn this population-based cohort, only 14% of patients discussed participation in clinical trials. Discussions were more frequent among advanced cancer patients but were still reported by a minority of patients. Strategies to expand access to trials and facilitate patient-provider communication about participation may accelerate development of better cancer therapeutics.© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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