title: Use of a clinical assistant to screen patients with genitourinary cancer to encourage entry into clinical trials and use of supportive medication: a pilot project at a Canadian cancer center.
abstract: BACKGROUND
  The central goal of cancer care is to improve patient outcomes through advancing medical knowledge. Therefore, participation in clinical trials is encouraged to demonstrate efficacy and understand toxicities of medical interventions. In the oncology setting, these interventions are also frequently accompanied by clinical care to maintain bone health throughout the course of disease. In this study we examined the use of a study screener to enhance accrual and highlight bone health issues in a tertiary referral cancer center.
  
  
  METHODS
  A study screener was introduced into 4 separate genitourinary clinics in a tertiary referral cancer center. Over a retrospective and subsequent prospective 10-week period, clinical trial accrual and bone health parameters were measured.
  
  
  RESULTS
  There were no statistically significant differences between the retrospective and prospective periods in probability of approaching a patient for clinical trials (P = .60), accrual rates (P = .80), or proportion of patients later found ineligible (P = .31). The difference in initiation of calcium and vitamin D between the retrospective and prospective patients was statistically significant (P < .0001) and the difference between cohorts for starting treatment with zoledronic acid or denosumab was statistically significant (P = .02) and approached significance for the prostate cancer patients (P = .12).
  
  
  CONCLUSIONS
  This pilot study suggests that in an academic setting, there is appropriate physician awareness of clinical trial availability, however the use of medication to improve bone health is suboptimal, and requires further research to identify and remove barriers to appropriate use including additional evidence of beneficial toxicity-benefit and cost-benefit ratios.
authors.affiliation: School of Medicine, Queen's University, Toronto, Ontario, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Lun
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
authors.forename: Srikala S
authors.initials: SS
authors.lastname: Sridhar
authors.forename: Ian F
authors.initials: IF
authors.lastname: Tannock
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Joshua
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001842:Bone and Bones / Q000187:drug effects; D002118:Calcium / Q000627:therapeutic use; D002170:Canada; D002986:Clinical Trials as Topic / Q000379:methods*; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D011446:Prospective Studies; D012189:Retrospective Studies; D014565:Urogenital Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D014807:Vitamin D / Q000627:therapeutic use; D000077211:Zoledronic Acid
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D004164:Diphosphonates; D007093:Imidazoles; D014807:Vitamin D; D000069448:Denosumab; D000077211:Zoledronic Acid; D002118:Calcium
keywords: Bladder; Denosumab; Kidney; Prostate; Vitamin D; Zoledronic acid