Using ONCODOC as a Computer-Based eligibility screening system to improve accrual onto breast cancer clinical trials

Abstract

While clinical trials offer cancer patients the optimum treatment approach, historical accrual of such patients has not been very successful. OncoDoc is a decision support system designed to provide best therapeutic recommendations for breast cancer patients. Developed as a browsing tool of a knowledge base structured as a decision tree, OncoDoc allows physicians to monitor the contextual instanciation of patient characteristics to build the best formal equivalent of an actual patient. Used as a computer-based eligibility screening system, depending on whether instanciated patient parameters are matched against guideline knowledge or available clinical trial protocols, it provides either evidence-based therapeutic options or relevant patient-specific clinical trials. Implemented at the Institut Gustave Roussy and routinely used at the point of care, it enhanced physician awareness of open trials and increased of 17% patient enrollment onto clinical trials. However, the analysis of the reasons for non-accrual of potentially eligible patients showed that physicians’ psychological reluctance to refer patients to clinical trials, measured during the experiment at 25%, may not be resolved by the simple dissemination of personnalized clinical trial information.