A qualitative study evaluating causality attribution for serious adverse events during early phase oncology clinical trials.
BACKGROUND
In early phase oncology trials, novel targeted therapies are increasingly being tested in combination with traditional agents creating greater potential for enhanced and new toxicities. When a patient experiences a serious adverse event (SAE), investigators must determine whether the event is attributable to the investigational drug or not. This study seeks to understand the clinical reasoning, tools used and challenges faced by the researchers who assign causality to SAE's.


METHODS
Thirty-two semi-structured interviews were conducted with medical oncologists and trial coordinators at six Canadian academic cancer centres. Interviews were recorded and transcribed verbatim. Individual interview content analysis was followed by thematic analysis across the interview set.


RESULTS
Our study found that causality assessment tends to be a rather complex process, often without complete clinical and investigational data at hand. Researchers described using a common processing strategy whereby they gather pertinent information, eliminate alternative explanations, and consider whether or not the study drug resulted in the SAE. Many of the interviewed participants voiced concern that causality assessments are often conducted quickly and tend to be highly subjective. Many participants were unable to identify any useful tools to help in assigning causality and welcomed more objectivity in the overall process.


CONCLUSIONS
Attributing causality to SAE's is a complex process. Clinical trial researchers apply a logical system of reasoning, but feel that the current method of assigning causality could be improved. Based on these findings, future research involving the development of a new causality assessment tool specifically for use in early phase oncology clinical trials may be useful.
Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada.
Som D
SD
Mukherjee
Megan E
ME
Coombes
Mitch
M
Levine
Jarold
J
Cosby
Brenda
B
Kowaleski
Andrew
A
Arnold
D000970:Antineoplastic Agents / Q000009:adverse effects*; D015984:Causality; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology; D010820:Physicians; D036301:Qualitative Research
D000970:Antineoplastic Agents