title: Can the referring surgeon enhance accrual of breast cancer patients to medical and radiation oncology trials? The ENHANCE study.
abstract: BACKGROUND
  The accrual rate to clinical trials in oncology remains low. In this exploratory pilot study, we prospectively assessed the role that engaging a referring surgeon plays in enhancing nonsurgical oncologic clinical trial accrual.
  
  
  METHODS
  Newly diagnosed breast cancer patients were seen by a surgeon who actively introduced specific patient-and physician-centred strategies to increase clinical trial accrual. Patient-centred strategies included providing patients, before their oncology appointment, with information about specific clinical trials for which they might be eligible, as evaluated by the surgeon. The attitudes of the patients about clinical trials and the interventions used to improve accrual were assessed at the end of the study. The primary outcome was the clinical trial accrual rate during the study period.
  
  
  RESULTS
  Overall clinical trial enrolment during the study period among the 34 participating patients was 15% (5 of 34), which is greater than the institution's historical average of 7%. All patients found the information delivered by the surgeon before the oncology appointment to be very helpful. Almost three quarters of the patients (73%) were informed about clinical trials by their oncologist. The top reasons for nonparticipation reported by the patients who did not participate in clinical trials included lack of interest (35%), failure of the oncologist to mention clinical trials (33%), and inconvenience (19%).
  
  
  CONCLUSIONS
  Accrual of patients to clinical trials is a complex multistep process with multiple potential barriers. The findings of this exploratory pilot study demonstrate a potential role for the referring surgeon in enhancing nonsurgical clinical trial accrual.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Ottawa General Hospital, and University of Ottawa, Ottawa, ON;
authors.forename: A
authors.initials: A
authors.lastname: Arnaout
authors.affiliation: Division of Medical Oncology, Department of Medicine, Ottawa General Hospital, and University of Ottawa, Ottawa, ON;
authors.forename: I
authors.initials: I
authors.lastname: Kuchuk
authors.affiliation: Division of Medical Oncology, Segal Cancer Centre, and Jewish General Hospital, Montreal, QC;
authors.forename: N
authors.initials: N
authors.lastname: Bouganim
authors.affiliation: Department of Oncology, McMaster University, Hamilton, ON;
authors.forename: G
authors.initials: G
authors.lastname: Pond
authors.affiliation: Division of Medical Oncology, Department of Medicine, Ottawa General Hospital, and University of Ottawa, Ottawa, ON;
authors.forename: S
authors.initials: S
authors.lastname: Verma
authors.affiliation: Division of Medical Oncology, Department of Medicine, Ottawa General Hospital, and University of Ottawa, Ottawa, ON;
authors.forename: R
authors.initials: R
authors.lastname: Segal
authors.affiliation: Division of Medical Oncology, Department of Medicine, Ottawa General Hospital, and University of Ottawa, Ottawa, ON;
authors.forename: S
authors.initials: S
authors.lastname: Dent
authors.affiliation: Division of Medical Oncology, Department of Medicine, Ottawa General Hospital, and University of Ottawa, Ottawa, ON;
authors.forename: S
authors.initials: S
authors.lastname: Gertler
authors.affiliation: Division of Medical Oncology, Department of Medicine, Ottawa General Hospital, and University of Ottawa, Ottawa, ON;
authors.forename: X
authors.initials: X
authors.lastname: Song
authors.affiliation: Clinical Trials Department, Ottawa Hospital Research Institute, Ottawa, ON.
authors.forename: F
authors.initials: F
authors.lastname: Kanji
authors.affiliation: Division of Medical Oncology, Department of Medicine, Ottawa General Hospital, and University of Ottawa, Ottawa, ON;
authors.forename: M
authors.initials: M
authors.lastname: Clemons
keywords: Clinical trials; accrual strategies