title: Clinical trial enrollment of rural patients with cancer.
abstract: OBJECTIVE
  The goal of this study was to examine the effect of a rural community clinical oncology program-based cancer-care intervention program that was launched to increase the number of rural patients with cancer enrolled in clinical trials.
  
  
  METHODS
  Five rural counties in eastern North Carolina served as intervention communities, and five rural counties in South Carolina served as the comparison region. The intervention counties used a rapid tumor-reporting system, a nurse facilitator who identified and prompted oncologists to enter patients into clinical trials, a quarterly newsletter to primary-care physicians about cancer treatment and clinical trials, and a health educator who focused on community-wide education regarding cancer prevention, treatment, and clinical trial information. Outcomes included changes in knowledge and attitudes about clinical trials among the primary-care providers who were surveyed and enrollment in clinical treatment trials for breast and colorectal cancer, as analyzed by comparing practice pattern data from before and after the intervention.
  
  
  RESULTS
  The results indicate that the intervention was not effective. The proportion of primary-care physicians who were aware of clinical trials for their patients with cancer rose slightly in comparison counties (26% to 34%) but remained constant (41% to 43%) in intervention counties. Perceived patient and actual physician barriers toward clinical trial participation were reported by the physicians. A minority of potentially eligible patients with breast or colon cancer in both North Carolina and South Carolina were enrolled in clinical trials.
  
  
  CONCLUSIONS
  These data suggest that different types of interventions may be needed to improve accrual to cancer treatment trials in rural communities. In addition, the role that primary-care providers play in encouraging patients with cancer to participate in clinical treatment trials needs further exploration.
authors.affiliation: Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1063, USA.
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.forename: M Robert
authors.initials: MR
authors.lastname: Cooper
authors.forename: Nancy
authors.initials: N
authors.lastname: Stark
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Ricketts
authors.forename: Sara
authors.initials: S
authors.lastname: Tropman
authors.forename: Teresa
authors.initials: T
authors.lastname: Hatzell
authors.forename: Tim
authors.initials: T
authors.lastname: Aldrich
authors.forename: James
authors.initials: J
authors.lastname: Atkins
mesh_terms: D001943:Breast Neoplasms; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D018579:Patient Selection; D012424:Rural Population