A pool of research-aware US oncology clinical investigators must be developed to ensure patient recruitment rates meet demand.
Clinical trial recruitment benefits from a large pool of research-aware speciality physicians to refer patients to studies. However, there are concerns the US will experience a shortage of medical oncologists, major recruiters for cancer trials, and this will place pressures on clinical research.
“If such shortages increase physicians’ workload, strategies to ensure that clinical trials remain a priority for physicians will be needed”, write researchers in the Journal of the National Cancer Institute . Lack of time is often cited as a reason for physicians failing to recruit to clinical trials.
A 2010 US Institute of Medicine report said: “The inability to recruit, train, and retain a sufficient number of talented clinical investigators will ultimately compromise the ability to conduct cancer clinical trials in the US, to the detriment of the US biomedical research enterprise and to patients.”
Community Clinical Oncology Program (CCOP) or National Cancer Institute (NCI)-designated cancer centres are praised for giving physicians the support infrastructure to recruit patients to trials.
However, only two-thirds of physicians affiliated with these centres are involved with clinical trials. Consequently, the researchers propose targeted outreach to the remaining one-third could be an efficient way of increasing the clinical investigator base and patient recruitment rates.
Also, information technology, such as trial databases, could increase recruitment from physicians who lack research institute affiliation by allowing them to identify studies and eligible patients.
Realigning reimbursement and incentive systems to “more fully cover” costs related to clinical trials and reward physicians for their involvement are also proposed.
“Our results showed that financial incentives were associated with physicians’ clinical trials accrual volume, a finding consistent with previous work demonstrating that financial incentives influence physician behaviour and quality of care”, write the researchers.
However, there are concerns monetary payments to promote physician involvement in clinical trials could create incentives that conflict with the best interests of patients.
Importance of the physician
Mayo Clinic research published in 2009 found 76 per cent of patients expected their treating physician to inform them about current trials. These patients showed an interest participating in trials but lacked information, an issue that could be overcome by physician communication.
“If we want research to inform practice, we need a workforce of physicians who value the research and understand how to incorporate research results into their practice. Much of the American public looks to their physicians to do that”, says an article responding to the research .