DURHAM, NC — While clinical trials are essential for advancing treatment options in oncology and making certain patients receive innovative care, too few cancer patients are referred to them, according to a new study.
The report in Military Medicine described how system-, provider- and patient-level barriers to clinical trial participation have been described but have not been studied in the VHA. “Although the VHA has engaged in several initiatives to improve veteran’s access to clinical trials, including the National Cancer Institute and VA Interagency Group to Accelerate Trials Enrollment program and VHA work on the White House Cancer Moonshot, further research is needed to understand the multifaceted challenges underlying limited enrollment for Veterans who receive care in the VHA system,” wrote the authors led by The Behavouralist, a consultancy in the UK, and including the Durham, NC, VA Healthcare System, the Georgia E. Wahlen VAMC in Salt Lake City and other academic institutions.
The goal of the research was to evaluate VHA oncology providers’ attitudes toward and experiences with referral and enrollment of veterans with cancer into clinical trials. The authors also sought to advise on actions that could be taken to enhance veterans’ access to clinical trials, as well as VHA contributions to clinical research.
To do that, the study team administered an electronic 34-item survey to VHA oncology care providers and performed semistructured interviews with them between May 2022 and August 2023. The survey sought to ascertain care providers’ perceptions of and experiences with referral and enrollment to clinical trials. The semistructured interviews explored providers’ perceived barriers to clinical trial participation and recruitment bias, as well as potentially modifiable factors for improving clinical trial enrollment at the VHA. Among those were providers’ concerns, motivations for and facilitators of enrollment of patients into clinical trials and the manner in which they communicate about clinical trials with their patients.
Overall, 38 oncology care providers completed the survey, and 8 completed the semistructured interview, including 5 staff physicians, 1 fellow, 1 nurse practitioner and 1 physician assistant. Most, 34, survey respondents identified their specialty as medical oncology; 1 respondent identified the specialty as radiation oncology; and 3 identified the specialty as hematology.
Of those, 19 were women and 14 men, with the remainder not providing their gender. Most of the respondents were white, 17, with 11 Asians, 3 Black and 3 Hispanic or Latino.
Among the various barriers to clinical trial referral and enrollment at multiple levels were:
- lack of appropriate trials,
- strict patient eligibility criteria,
- difficulties in understanding and managing the referral process for trials outside the VHA system and
- challenges with obtaining information and identifying available clinical trials.
The veteran patients also presented barriers, including:
- financial and logistical concerns,
- lack of trust in the medical establishment,
- lack of adequate social support and
- psychological and physical comorbidities.
The respondents highlighted opportunities for system-level change that can overcome some of these barriers, including academic affiliations, patient support from internal and external nurse navigators and dedicated research coordinators.
“The insights gleaned from this research can guide VHA in its efforts to optimize access to clinical trials for veterans,” the authors wrote.
- Monreal I, Chappell H, Kiss R, Friedman DR, Akesson J, Sae-Hau M, Szumita L, Halwani A, Weiss ES. Understanding the Barriers to Clinical Trial Referral and Enrollment Among Oncology Providers Within the Veterans Health Administration. Mil Med. 2024 Sep 14:usae441. doi: 10.1093/milmed/usae441. Epub ahead of print. PMID: 39276316.