Decentralization Tools May Improve Cancer Clinical Trial Enrollment

According to a cross-sectional survey study published in JAMA, remote and decentralization tools can improve clinical trial enrollment and participation in cancer studies. 

Recently, many professionals have critiqued clinical trials, identifying a lack of diversity as a critical issue that may cause limitations. 

In fact, a recent analysis by Phesi found that despite being at the highest risk of cancer-related death, 42% of cancer clinical trials have no Black participants. This number increases to 48% for Hispanic and Latino populations.  

Using the American Cancer Society Cancer Action Network’s Survivor Views panel, adult patients in the United States who have been diagnosed with or treated for cancer within the past seven years were surveyed.  

The survey questions touched on the following aspects: telehealth, remote care technologies, and willingness to participate in cancer clinical trials.  

Understanding the composition of survey respondents is essential as researchers were looking for methods to diversify enrollment in addition to expanding it. Most of the participants were female at 75%.  

In addition to gender diversity, researchers also collected data on racial and ethnic diversity. While 4% of participants declined to specify race, approximately 70% were White, 20% were Black, 3% were American Indian or Alaska Native, 2% were Asian, and 2% were Native Hawaiian or Pacific Islander.  

Similarly, 4% of subjects declined to specify their ethnicity but a significant portion of them, 86%, stated that they were not Hispanic or Latino.  

The study found that 30% more patients were willing to participate in a clinical trial if it did not alter their frequency and distance of visits. 

Although some respondents said they were willing to travel up to 90 minutes to participate in a clinical trial, researchers determined that this answer correlated with socioeconomic status. People from higher-income households were 21% more likely to be willing to travel when compared to participants in lower-income families. 

The study also evaluated the survey respondents’ “general willingness to adopt technologies and tools related to remote care not specifically within the clinical trial context.” From this, they found that 80% of patients had a general willingness to adopt remote care tools.  

Moreover, specific clinical trial-related questions established that between 60% and 85% of participants would be inclined to participate in clinical trials. With the use of remote clinical trial methods, participants’ interest increased.  

“Decentralization of trials through remote technology and other tools can alleviate travel burden associated with trial participation by delinking where a patient is evaluated and/or treated in respect to a trial and where a trial is hosted, potentially allowing for a larger and more diverse cohort of trial participants,” stated the clinicians in the paper.  

Although the FDA issued draft guidance to encourage clinical trial diversity, more tools and incentives must be implemented to make this shift. This study provides one method of addressing the concerns, but the real-life applications have not yet been quantified.