Oncologist-Reported Barriers and Facilitators to Enrolling Patients in Optimization Trials That Test Less Intense Cancer Treatment

摘要

QUESTION ASKED: What are community and academic physician barriers, facilitators, and recommendations for enrolling patients in optimization clinical trials that test less intense treatment approaches? SUMMARY ANSWER: Optimization clinical trials are generally accepted to be beneficial by oncologists, but barriers to enrollment related to specific patient and cancer characteristics, biomarker and treatment selection, oncologist personal preferences, and system level issues exist. Scientifically robust design and education to overcome barriers will be needed to support future enrollment on optimization clinical trials to achieve true personalization of treatment. WHAT WE DID: We conducted a qualitative study with semistructured interviews of medical oncologists from different academic and community practices to assess their perspectives on optimization trials. Interviews were audio-recorded and transcribed. Three independent coders used a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted. WHAT WE FOUND: All physicians reported that they would enroll patients in optimization clinical trials, and they highlighted specific reasons to consider optimization trials including quality-of-life improvement by reducing toxicity, reduction in financial toxicity, fertility preservation, ability to avoid chemotherapy, minimization of overtreatment in patients with comorbid conditions, personalized treatment, opportunities to test novel therapies, and leveraging the availability of targeted therapies. Oncologists also identified accrual barriers, such as tumor-specific biology, individual (host) factors, prognostic markers of risk, access to therapies, provider experience, and system constraints. They voiced recommendations regarding preliminary data, trial design, and tools to support enrollment in optimization trials.