title: Survey of oncologists' perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials.
abstract: BACKGROUND
  Prior research has documented the under-representation in clinical trials of older patients with cancer. In part of a larger study to test the magnitude of these barriers to entering eligible older patients with carcinoma of the breast into clinical trials (Cancer and Leukemia Group B [CALGB] trial 9670), barriers to accruing eligible older patients to clinical trials were obtained from the physician's perspective.
  
  
  METHODS
  One hundred fifty-six physicians (85% oncologists) who treated patients with breast carcinoma at 10 CALGB institutions completed a questionnaire concerning what they perceived as barriers to enrolling older patients with breast carcinoma on clinical trials and possible interventions that may improve accrual.
  
  
  RESULTS
  Physicians' perceptions of the most important barriers to accrual of older patients were: 1) elderly patients have significant comorbid conditions that are not excluded by the protocol but that may affect how they would respond to treatment (16%); elderly patients have difficulty understanding what is required in a complicated treatment trial, resulting in poor compliance (16%); treatment toxicity (14%); and elderly patients often do not meet the eligibility criteria (15%). Oncologists most frequently suggested that the most effective interventions for improving the accrual of elderly patients to trials included making personnel available in the clinic to explain clinical trials to older patients and their families (25%) and providing physicians with educational materials concerning treatment toxicity in the elderly (18%).
  
  
  CONCLUSIONS
  Physicians viewed barriers to accruing older patients with breast carcinoma to clinical trials as multidimensional, with the most important involving protocol requirements, treatment specific issues, and older patients' medical and cognitive characteristics. Thus, a variety of interventions would be needed to improve accrual of older patients to clinical trials, including increasing physicians' knowledge concerning treatment toxicity in the elderly, simplifying protocol requirements, and reducing treatment toxicity.
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. alice_kornblith@dfci.harvard.edu
authors.forename: Alice B
authors.initials: AB
authors.lastname: Kornblith
authors.forename: Margaret
authors.initials: M
authors.lastname: Kemeny
authors.forename: Bercedis L
authors.initials: BL
authors.lastname: Peterson
authors.forename: Judith
authors.initials: J
authors.lastname: Wheeler
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.forename: Nancy
authors.initials: N
authors.lastname: Bartlett
authors.forename: Gini
authors.initials: G
authors.lastname: Fleming
authors.forename: Stephen
authors.initials: S
authors.lastname: Graziano
authors.forename: Hyman
authors.initials: H
authors.lastname: Muss
authors.forename: Harvey Jay
authors.initials: HJ
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D001943:Breast Neoplasms / Q000628:therapy*; D002986:Clinical Trials as Topic; D015897:Comorbidity; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D018579:Patient Selection; D010465:Perception; D012307:Risk Factors