To address the low enrollment rates of adults in clinical trials, particularly in oncology, and identify strategies to enhance participation.
Approach:
Data Analysis: Utilized the Flatiron dataset to analyze clinical trial participation among 205,743 adults with advanced or metastatic cancer across 1,664 physicians and 107 oncology practices in the US.
Multilevel Analysis: Examined patient, clinician, and practice-level characteristics affecting clinical trial enrollment from 2011 to 2024.
Key Findings:
Only 5.2% of patients received a clinical study drug, with participation increasing from 3.9% in 2011 to 6.8% in 2024.
A small percentage of physicians (23.4%) and practices (19.6%) accounted for the majority of trial enrollments.
Structural barriers, such as the absence of available trials, prevent 60% of treated patients from participating, while clinical factors account for another 20%.
Interpretation:
The study highlights the need for targeted interventions to improve clinical trial access.
Limitations:
The analysis primarily focuses on practices with existing clinical trial infrastructure, which may limit the generalizability of the findings.
The contribution of patient-level variables to trial participation has declined over time.
Conclusion:
Enhancing clinical trial participation requires addressing barriers at multiple levels.
