title: National cancer clinical trials: children have equal access; adolescents do not.
abstract: OBJECTIVE
  To determine whether adolescents with cancer, who in comparison to younger patients have a higher cancer incidence and lower mortality reduction, have equal access to national cancer clinical trials.
  
  
  METHODS
  The ethnic/racial distribution of 29,859 subjects < 20 years of age entered onto National Cancer Institute-sponsored clinical trials between January 1, 1991, and June 30, 1994, was compared with the expected distribution of patients of the same age in the United States.
  
  
  RESULTS
  The Children's Cancer Group and Pediatric Oncology Group had 29,134 (97.6%) of the total study entries among < 20-year-old subjects during the 3.5 years of surveillance. The adult cooperative groups accounted for < 3% of the clinical trials entries in the 15-19-year age range. When analyzed nationally by region, the under-representation of the older adolescent subjects was universal. From other analyses, the two pediatric cooperative groups were estimated to have registered > 94% of the children < 15 years of age who were expected to have been diagnosed to have cancer, but only 21% of the cancer patients in the 15-19-year age group.
  
  
  CONCLUSIONS
  The national pediatric cancer cooperative groups allow the majority of American children < 15 years of age and their families equal opportunity to access clinical cancer trials, regardless of race or ethnicity. Among patients 15-19 years of age, however, > 75% are not being enrolled by any cooperative group sponsored by the National Cancer Institute. Thus, older adolescents are disadvantaged with respect to access to the national clinical trials, regardless of their race or ethnicity.
authors.affiliation: Children's Cancer Group, Arcadia, California, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Bleyer
authors.forename: H
authors.initials: H
authors.lastname: Tejeda
authors.forename: S B
authors.initials: SB
authors.lastname: Murphy
authors.forename: L L
authors.initials: LL
authors.lastname: Robison
authors.forename: J A
authors.initials: JA
authors.lastname: Ross
authors.forename: B H
authors.initials: BH
authors.lastname: Pollock
authors.forename: R K
authors.initials: RK
authors.lastname: Severson
authors.forename: O W
authors.initials: OW
authors.lastname: Brawley
authors.forename: M A
authors.initials: MA
authors.lastname: Smith
authors.forename: R S
authors.initials: RS
authors.lastname: Ungerleider
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000706:statistics & numerical data*; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009316:National Institutes of Health (U.S.); D009369:Neoplasms / Q000628:therapy*; D010358:Patient Participation; D014481:United States