The great mismatch: Assessing cancer clinical trial accrual rates.

Abstract

e23151 Background: Efforts to increase cancer clinical trial accruals have been disappointing. Much focus has been placed on patient and some system barriers. Yet, pinpointing the causes of low accrual rates is needed to more effectively increase accruals. We undertook this study to identify the sites and breadth of low accrual rates to cancer clinical trials. Methods: At 3 participating Cancer Centers, we identified breast, liver and lung cancer patients at treatment decision points, when clinical trials would likely be more relevant. We included all open medical treatment trials for these cancers at these sites. Regular Expressions and Python algorithms identified patients with upcoming appointments to determine those at treatment decision points. Both trials and patients were classified by cancer type, stage, receptor and biomarker status. We then matched patients and trials and informed oncologists and patients about the match lists. Results: Of 63,255 patients with breast, liver or lung cancer and an appointment in the upcoming week, 11,502 were found to be at a treatment decision point (e.g., new, recurrent or progressing cancer) via SQL and 1552 via additional Python/RegEx algorithms. Of these,523 were consented and 326 matched to trials at a high level (e.g., type, stage, receptors). Subsequent manual review found 147 to be potentially eligible for an open trial. Of these, 39 enrolled in a CT. Among patients, 67% of breast, 11% of liver and 18% of lung, were early stage. Open trials for early-stage cancers across the 3 sites included: 50% of breast; 26% of liver and 26% of lung. Overall 51% of cancer patients had early stage while 28% of trials targeted early-stage cancer. Conclusions: There is a significant mismatch between the stages of cancer with which patients present, and the stages of cancer targeted for clinical trials. Clinical trial information: NCT05146297 .