Sedrak Mina S, Mohile Supriya G, Sun Virginia, Sun Can-Lan, Chen Bihong T, Li Daneng, Wong Andrew R, George Kevin, Padam Simran, Liu Jennifer, Katheria Vani, Dale William
Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, United States of America.
Department of Medicine, Hematology/Oncology, University of Rochester, Rochester, NY, United States of America.
J Geriatr Oncol. 2020 Mar;11(2):327-334. doi: 10.1016/j.jgo.2019.07.017. Epub 2019 Jul 31.
Oncologists can be one of the major barriers to older adult's participation in research. Multiple studies have described academic clinicians' concerns for not enrolling older adults onto trials. Although the majority of older adults receive their cancer care in the community, few studies have examined the unique challenges that community oncologists face and how they differ from oncologist-related barriers in academia.
Semi-structured interviews were conducted by telephone or face-to-face with 44 medical oncologists (24 academic-based and 20 community-based) at City of Hope from March to June 2018. Interviews explored oncologists' perceptions of barriers to clinical trial enrollment of older adults with cancer. Data were analyzed using qualitative content analysis.
Of the 44 participants, 36% were women and 68% were in practice for >10 years. Among the entire sample, stringent eligibility criteria (n = 20) and oncologist concerns for treatment toxicities (n = 15) were the most commonly cited barriers. Compared to academic oncologists, community oncologists more often cited patient attitudes, beliefs, and understanding (n = 9 vs. n = 2) and caregiver burden (n = 6 vs. n = 0). In contrast, compared to community oncologists, academic oncologists more often cited oncologist bias (n = 10 vs. n = 3) and insufficient time/support (n = 4 vs. n = 1).
Differences in perceptions among academic and community oncologists about trials suggest that barriers are multifaceted, complex, and vary by practice setting. Interventions to increase trial accrual among older adults with cancer may benefit from being tailored to address the unique barriers of different practice settings.
肿瘤学家可能是老年人参与研究的主要障碍之一。多项研究描述了学术临床医生对不将老年人纳入试验的担忧。尽管大多数老年人在社区接受癌症治疗，但很少有研究探讨社区肿瘤学家面临的独特挑战以及这些挑战与学术界肿瘤学家相关障碍的差异。
2018年3月至6月，通过电话或面对面访谈的方式，对希望之城的44名医学肿瘤学家（24名学术型和20名社区型）进行了半结构化访谈。访谈探讨了肿瘤学家对老年癌症患者临床试验入组障碍的看法。采用定性内容分析法对数据进行分析。
44名参与者中，36%为女性，68%从业超过10年。在整个样本中，严格的入选标准（n = 20）和肿瘤学家对治疗毒性的担忧（n = 15）是最常被提及的障碍。与学术肿瘤学家相比，社区肿瘤学家更常提及患者的态度、信念和理解（n = 9对n = 2）以及照顾者负担（n = 6对n = 0）。相比之下，与社区肿瘤学家相比，学术肿瘤学家更常提及肿瘤学家的偏见（n = 10对n = 3）和时间/支持不足（n = 4对n = 1）。
学术型和社区型肿瘤学家对试验的看法存在差异，这表明障碍是多方面的、复杂的，并且因执业环境而异。增加老年癌症患者试验入组率的干预措施可能需要针对不同执业环境的独特障碍进行量身定制才会有益。
