EPID-11. IDENTIFYING BARRIERS TO CLINICAL RESEARCH: A PILOT STUDY TO IMPROVE ACCESS AND ENROLLMENT TO NEURO-ONCOLOGY TRIALS AT COLUMBIA UNIVERSITY CENTER MEDICAL CENTER (CUMC)

Abstract

Fewer than 3% of cancer patients participate in clinical trials. Among these, there is stark underrepresentation of racial and ethnic minorities, the economically disadvantaged, the elderly and those with limited access to academic centers. Nervous system involvement creates additional challenges to accrual including reduced capacity for informed decision-making and increased reliance on caregivers. To better identify barriers to trial enrollment, we designed and pre-tested a survey to elicit patient perceptions about clinical research and collect data on potential factors limiting participation. A 20-question survey was provided to patients at the time of their first outpatient visit. The survey was voluntary and administered over 10 weeks as part of a QI initiative conducted by Columbia’s Division of Neuro-Oncology. Questions assessed demographics (race/ethnicity, education, language, employment, marital status); support (presence of family, home services); transportation (commute type and time); receptivity to participation in research and rationales for refusal. Information on disease status and trial candidacy were also noted. 71 patients received the questionnaire; 57 (80%) responded. Median age was 55 years (range: 17–80). There were 33 (58%) men; 35 (61%) self-identified as non-Hispanic White. Diagnoses included high grade glioma (26%), CNS metastases (26%), meningioma (11%), primary CNS lymphoma (4%) and low-grade glioma (2%). Of 52 responders, 14 (27%) were unwilling to participate in research a priori; 27 (54%) if a placebo was involved. Despite a limited sample size, we found that college education (OR: 8.8 CI: 1.5–31.8) and shorter commute time (OR: 4.0; CI: 1.2–13.3) were significantly associated with willingness to consider trial enrollment – findings that are consistent with prior studies. Further research is needed to better identify, understand, and overcome barriers to enrollment. To that end, steps will be taken in the coming months to refine the questionnaire, define a population of interest and streamline logistics.