title: Discussions about clinical trials among patients with newly diagnosed lung and colorectal cancer.
abstract: BACKGROUND
  Clinical trials are essential to establish the effectiveness of new cancer therapies, but less than 5% of adults with cancer enroll in trials. In addition to ineligibility or lack of available trials, barriers to enrollment may include limited patient awareness about the option of participation.
  
  
  METHODS
  We surveyed a multiregional cohort of patients with lung or colorectal cancer (or their surrogates) three to six months after diagnosis. We assessed whether respondents reported learning that clinical trial participation might be an option, and, if so, with whom they discussed trials. We used logistic regression to assess the association of patient characteristics with discussing trial participation and enrolling in trials. All statistical tests were two-sided.
  
  
  RESULTS
  Of 7887 respondents, 1114 (14.1%) reported discussing the possibility of clinical trial participation; most learned about trials from their physicians, and 287 patients (3.6% of all patients, 25.8% of trial discussants) enrolled. Among 2173 patients who received chemotherapy for advanced (stage III/IV lung or stage IV colorectal) cancer, 25.7% discussed trials, and 7.6% (29.5% of trial discussants) enrolled. Discussions were less frequent among older patients, African American or Asian vs white patients, and those with lower incomes and more comorbidity. Enrollment was higher among patients reporting shared vs physician-driven decisions (all P < .05).
  
  
  CONCLUSIONS
  In this population-based cohort, only 14% of patients discussed participation in clinical trials. Discussions were more frequent among advanced cancer patients but were still reported by a minority of patients. Strategies to expand access to trials and facilitate patient-provider communication about participation may accelerate development of better cancer therapeutics.
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Kehl
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
authors.forename: Neeraj K
authors.initials: NK
authors.lastname: Arora
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Clauser
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Fletcher
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (KLK, NLK); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (NKA, SBC, CNK); Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA (DS); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA); University of California, Los Angeles and RAND Corporation, Santa Monica, CA (KK); Department of Population Medicine (RHF) and Department of Health Care Policy (NLK, JZA), Harvard Medical School, Boston, MA. keating@hcp.med.harvard.edu.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D002755:Choice Behavior; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D003142:Communication; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006801:Humans; D007182:Income; D057226:Information Seeking Behavior; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010358:Patient Participation; D018579:Patient Selection; D011795:Surveys and Questionnaires; D014481:United States; D044465:White People / Q000706:statistics & numerical data