Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Department of Medical Oncology and Hematology, Princes Margaret Cancer Center, Toronto, Ontario, Canada.
JCO Oncol Pract. 2020 Mar;16(3):e280-e289. doi: 10.1200/JOP.19.00450. Epub 2020 Jan 8.
Participation in cancer clinical trials (CCTs) for adolescents and young adults (AYAs) remains the lowest of any patient group with cancer. Little is known about the personal barriers to AYA accrual. The aim of this study was to explore AYA attitudes that influence CCT participation.
A mixed-methods approach was used. AYAs and non-AYAs (≥ 40 years) completed the Cancer Treatment subscale of the Attitudes Toward Cancer Trials Scales and 9 supplementary questions formed from interview analysis. Differences between AYA and non-AYA cohorts were analyzed using the Mann-Whitney test, and logistic regression models were constructed to evaluate the effect of demographics on perceptions of CCTs.
Surveys were distributed to 61 AYAs (median age, 29 years; range, 17-39 years) and 74 non-AYAs (median age, 55 years; range, 40-88 years). Compared with non-AYAs, AYAs perceived CCTs to be unsafe/more difficult (Personal Barrier/Safety domain; = .01). There were no differences based on age in other domains. AYAs were also more concerned with CCT interference in their long-term goals ( = .04). Multivariable ordered logistic regression identified increased personal barriers in the Personal Barrier/Safety domain for AYAs ( = .01), in patients with English as a second language (ESL; < .01), and in patients previously not offered a clinical trial ( = .03). Long-term goals were identified as a barrier in particular tumor types ( = .01) and in patients with ESL ( < .01), with a trend identified in AYAs ( = .12).
Age-related differences in attitudes toward CCTs suggest that tailored approaches to CCT accrual are warranted. Patient-centered delivery of information regarding CCTs, particularly in patients with ESL and who are trial naïve, may improve accrual.
青少年和年轻人（AYA）参与癌症临床试验（CCT）的比例仍然是所有癌症患者中最低的。对于影响 AYA 参与 CCT 的个人障碍知之甚少。本研究旨在探讨影响 AYA 参与 CCT 的态度。
采用混合方法。AYA 和非 AYA（≥40 岁）完成了癌症治疗子量表和 9 个补充问题，这些补充问题是从访谈分析中形成的。使用 Mann-Whitney U 检验分析 AYA 和非 AYA 队列之间的差异，并构建逻辑回归模型来评估人口统计学因素对 CCT 认知的影响。
共向 61 名 AYA（中位年龄 29 岁；范围 17-39 岁）和 74 名非 AYA（中位年龄 55 岁；范围 40-88 岁）发放了调查问卷。与非 AYA 相比，AYA 认为 CCT 更不安全/更困难（个人障碍/安全领域； =.01）。在其他领域，年龄无差异。AYA 还更担心 CCT 会干扰他们的长期目标（ =.04）。多变量有序逻辑回归确定了 AYA 个人障碍/安全领域的个人障碍增加（ =.01）、英语为第二语言（ESL）的患者（ <.01）和以前未提供临床试验的患者（ =.03）。长期目标在特定肿瘤类型（ =.01）和 ESL 患者（ <.01）中被确定为障碍，AYA 中也存在趋势（ =.12）。
对 CCT 的态度存在与年龄相关的差异，这表明需要针对 CCT 获得采取量身定制的方法。以患者为中心提供关于 CCT 的信息，特别是对 ESL 患者和初次参加试验的患者，可能会提高获得率。
