Abrahão Renata, Alvarez Elysia M, Waters Austin R, Romero Crystal C, Gosdin Melissa M, Naz Hiba, Pollock Brad H, Kirchhoff Anne C, Keegan Theresa H M
Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA.
Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA.
Pediatr Blood Cancer. 2022 Apr;69(4):e29479. doi: 10.1002/pbc.29479. Epub 2021 Dec 16.
Despite efforts to increase participation of adolescents and young adults (AYAs; 15-39 years) in cancer clinical trials (CTs), enrollment remains very low. Even when provided access to CTs, AYAs are less likely to participate than children and older adults. A better understanding of oncologist- and AYA survivor-reported barriers, facilitators, and potential areas for CT enrollment improvement is needed.
From December 2019 to August 2020, we conducted 43 semi-structured interviews with oncologists (n = 17) and AYA cancer survivors (n = 26) who were offered and/or participated in CTs at cancer centers in California and Utah. Thematic analyses were used to interpret the findings.
Oncologists identified a lack of available CTs, strict eligibility criteria, lack of awareness of open CTs, and poor communication between pediatric and adult oncologists as major barriers to enrollment. AYA cancer survivors identified financial and psychosocial barriers, and a poor understanding of what a CT means and its potential benefits as barriers to enrollment. Areas for improvement identified by oncologists and AYAs include educational, financial, and psychosocial support to AYAs. Oncologists also emphasized the need to increase CT availability, improve awareness of open CTs, and better communication between both pediatric and adult oncologists and oncologists and AYAs.
For AYAs with cancer, a lack of CT eligibility and physician awareness of open CTs likely factor into their lower CT enrollment. Potential strategies to improve AYA enrollment in CTs require comprehensive collaboration between pediatric and adult institutions, as well as educational, psychosocial, and financial support to AYAs.
尽管已努力提高青少年和青年成年人（15 - 39岁）参与癌症临床试验（CT）的比例，但入组率仍然很低。即使有机会参与CT，青少年和青年成年人比儿童和老年人参与的可能性更小。需要更好地了解肿瘤学家和青少年及青年癌症幸存者报告的障碍、促进因素以及CT入组改善的潜在领域。
2019年12月至2020年8月，我们对在加利福尼亚州和犹他州癌症中心提供和/或参与CT的肿瘤学家（n = 17）和青少年及青年癌症幸存者（n = 26）进行了43次半结构化访谈。采用主题分析来解释研究结果。
肿瘤学家认为可用CT数量不足、严格的入选标准、对开放CT的知晓度缺乏以及儿科和成人肿瘤学家之间沟通不畅是入组的主要障碍。青少年及青年癌症幸存者认为经济和心理社会障碍以及对CT含义及其潜在益处的理解不足是入组的障碍。肿瘤学家和青少年及青年成年人确定的改进领域包括对青少年及青年成年人的教育、经济和心理社会支持。肿瘤学家还强调需要增加CT的可用性，提高对开放CT的知晓度，以及改善儿科和成人肿瘤学家之间以及肿瘤学家与青少年及青年成年人之间的沟通。
对于患有癌症的青少年及青年成年人，CT入选资格的缺乏和医生对开放CT的知晓度可能是其CT入组率较低的因素。提高青少年及青年成年人CT入组率的潜在策略需要儿科和成人机构之间的全面合作，以及对青少年及青年成年人的教育、心理社会和经济支持。
