Factors influencing clinical trial enrollment in glioblastoma patients: A retrospective study at the University of Vermont Medical Center.

Abstract

2054 Background: The standard of care for patients with glioblastoma (GBM) is a combination therapy of radiation and temozolomide. NCCN guidelines recommend clinical trials should be offered to glioblastoma patients when appropriate. This study aims to investigate the number of patients enrolled in clinical trials at the University of Vermont Medical Center (UVMMC) and/or referred to larger academic centers for trials. This study sought to identify and analyze characteristics of patients enrolled in trials at UVMMC and other outside academic centers. Methods: A retrospective review was undertaken of the electronic health records of ninety patients with GBM from 2021 to 2023 who were followed at UVMMC. Patient age, gender, and educational and employment status were collected. We assessed all comers who were offered a clinical trial, patients who proceeded to enroll in a clinical trial, and factors that influenced enrollment. We also assessed location where the trial was conducted (UVMMC vs Outside Center) and the trial interventions provided at the various centers. Results: We assessed 90 patients diagnosed with GBM at UVMMC from 2021-2023. 87% of all patients were offered the opportunity to enroll in a clinical trial. 17% of patients who were offered a trial successfully enrolled. Amongst enrolled patients, 62% completed their clinical trial at UVMMC while 38% were referred and treated at nearby academic centers in the New England Area including Mass General Hospital and Dana-Faber Cancer Institute (DFCI). Intrinsic barriers to enrollment included poor Karnofsky performance scale (KPS) scores, MGMT negative status, presence of leptomeningeal disease, and deep tumor locations precluding resection. Extrinsic factors included distance to academic centers, trial closure to accrual, and socioeconomic status. There was a correlation between socioeconomic status and trial enrollment. Of the thirty-eight patients identified with higher educational attainment (college or higher), 87% were offered a clinical trial and 18% eventually enrolled. Among the non-college educated group of thirty-six, 92% were offered a trial. However, only 14% enrolled. Further analysis on age, gender, and clinical trial intervention will be reported in future publications. Conclusions: Expanding access to clinical trials is critical to optimizing care for GBM patients. Our findings highlight access to academic centers is crucial to clinical trial enrollment. Further studies analyzing modifiable barriers to clinical trial accrual are needed.