CHICAGO, IL—Fewer than 5% of adults with cancer enroll in clinical trials, despite such enrollment being critical to evaluate new therapies. The question is, “why?” asked investigators in a presentation at the 2014 American Society of Clinical Oncology (ASCO) Annual Meeting.

To determine barriers to enrollment, Kenneth L. Kehl, MD, of the Brigham and Women’s Hospital, Boston, MA, and colleagues surveyed a population- and practice-based patient sample (or surrogates) 3 to 6 months after diagnoses of lung cancer or colorectal cancer.

“We assessed whether respondents learned that clinical trial participation might be an option and, if so, with whom they first discussed this possibility,” they reported.

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Of 7,887 patients, 1,114 (14.1%) reported discussing clinical trial participation, with most—92.7% of subsequent clinical trial participants and 75.8% of nonparticipants—learning about clinical trials from their clinicians.

Only 287 patients enrolled in a clinical trial; 3.6% of all patients and 25.8% of those who discussed clinical trials.

Of 2,173 patients who received chemotherapy for stage III/IV lung or stage IV colorectal cancer, 25.7% discussed clinical trials, and 7.6% (29.5% of discussants) enrolled.

Discussion of clinical trials was more common among college-educated patients (odds ratio [OR], 1.9; 95% CI: 1.5-2.5 vs. less than a high school education) and among those with incomes greater than $60,000 per year (OR, 1.7; 95% CI: 1.4-2.2 vs. less than $20,000 per year). Discussion was less common among older patients (OR, 0.96; 95% CI: 0.95-0.97), those who were African American and Asian, and those with comorbidities.

These factors, however, “were not significantly associated with enrollment among patients discussing trials,” Dr. Kehl reported. “Enrollment was higher among patients reporting shared versus physician-driven decisions (P < 0.05).” He added that patients with at least three self-reported comorbid conditions were significantly less likely to participate.

Dr. Kehl said that efforts to increase clinical trial participation might include engagement of clinicians and patient education about trial options. In addition, patient concerns about trials should be assessed and communication between providers and eligible patients optimized.


  1. Kehl KL, Arora NK, Schrag D et al. Abstract 6509. Presented at: 2014 American Society of Clinical Oncology (ASCO) Annual Meeting; May 30-June 3, 2014; Chicago, IL.