Physician perspectives on cancer clinical trials and barriers to minority recruitment.

Clinical trials provide the foundation on which advances in cancer therapies are built. Yet, relatively few in the eligible adult population participate, 3% to 5%,1 and much of the research is based on data collected from samples lacking racial and economic diversity.2 Though the research community recognizes the importance of having diverse clinical trial participants, barriers to recruitment exist at multiple levels.2-4 Cultural, structural, and psychological barriers for patients and providers have been documented.1-11 Barriers such as lack of accessible and affordable research trials5,8 and a patient’s inability to qualify for or comply with specified research protocols7,10 characterize common structural hurdles for patients, especially those who are medically underserved.2 Patient fears and mistrust of the research community also are powerful cultural barriers.2,5,8,10,12,13 Although patient barriers are important, equally challenging physician barriers have received far less attention. Structural hurdles such as physicians’ lack of awareness of available trials, problems with data management, and the absence of adequate physician compensation for time devoted to studies are considered as physician barriers.1,10,14 In addition, “cultural barriers” such as fear of losing patients and distrust of institutions conducting clinical trials exist among providers.10 Research suggests that physician referral is one of the most effective means of recruiting patients onto cancer clinical trials (CCTs).13,15 Yet, factors that affect a physician’s choice to discuss a trial with a patient, especially those who are racial and/or ethnic minorities, remain underexplored. The purpose of this study was to examine local cancer providers’ knowledge about CCTs and attitudes toward minority participation in CCTs.