Hershey, Pa. -- Patient enrollment in clinical trials as the first course of treatment after cancer diagnosis is low, despite the fact that enrollment may increase life expectancy, according to researchers at Penn State. They also found that white males with private health insurance and metastatic cancers treated at academic medical centers are more likely than other groups to enroll in clinical trials.
Dr. Nicholas G. Zaorsky, an assistant professor of radiation oncology, Penn State College of Medicine, led a team of Penn State Cancer Institute researchers who analyzed data from more than 12 million patients with 46 different types of cancer between 2004 and 2015 in the National Cancer Database. They found that only 11,576 (0.1%) of those patients were enrolled in clinical trials as their first course of therapy following diagnosis.
According to Dr. Niraj J. Gusani, professor of surgery, Penn State College of Medicine, and senior author of the study, which published in the Journal of the National Comprehensive Cancer Network in November 2019, the low enrollment is troubling because clinical trials may be beneficial for patients.
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"Major advances in cancer treatment have been supported by clinical trials," Gusani said. "By volunteering to participate in a trial, patients may help further the field of research and gain access to new treatments."
Zaorsky, Gusani and their team found that patients with cancer treated in clinical trials, when matched and compared to similar patients not treated on trials, lived longer. They report that patients with cancer in clinical trials at the first course of therapy had a median survival of seven and half months more than those not enrolled in a trial.
According to Zaorsky, previous evaluations of whether clinical trials improved survival compared patients who were enrolled in trials against those not enrolled in trials -- but didn't account for factors like age, race, gender and cancer type.
The researchers performed a stratified analysis in which they matched each patient who participated in a clinical trial with another patient who was not enrolled in a trial that had ten similar characteristics -- including cancer type, age, race, insurance type, disease stage, and whether or not surgery or chemotherapy were part of the treatment plan.
"If you're going to evaluate whether clinical trial enrollment is beneficial for patients, you have to try and match each patient to someone who has a similar cancer and sociodemographic profile," Zaorsky said. "Otherwise, it is like comparing apples to oranges."