HJAR May/Jun 2022

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2022 53 SamMakhoul, MD Director of Clinical Research CARTI in adult cancers. One of the differences is where the patients are treated. Most chil- dren with cancer are cared for at specialized children’s cancer centers that are often af- filiated with academic centers, while up to 85% of adult cancer patients are treated in a community setting. Adult cancer research is mainly conducted in academic settings, leaving a good percentage of the cancer population unrepresented. Structural barriers, such as the availability of cancer clinics that offer clinical trial par- ticipation and transportation for rural and elderly patients, are responsible for 50% of nonparticipation. The availability of clinical trials for the patients’ histology and stage and narrow eligibility criteria eliminate an additional 18% of patients from enrollment. Physician attitude is a major determinant of enrollment to cancer clinical trials. Despite physicians acknowledging that clinical trials provide high-quality care (87%) and benefit enrolled patients (83%), 50% of the patients for whom a protocol was available and who were eligible did not participate due to phy- sician preference. Finally, traditionally, pa- tient attitude is cited as the main reason for nonparticipation, but approximately 55% of white patients and 60% of Black patients agreed to participate in either a treatment trial or cancer control trial when offered, as reported by Unger and colleagues in a problems related to distance and transpor- tation (provide clinical trial awareness and education; outreach to underserved patient populations; remote consenting and follow up and remote monitoring). Tackling physician engagement is the sec- ond most important intervention. In 2022, every oncologist and staff member caring for cancer patients must be aware and com- mitted to offering a clinical trial option to their patients. Clinical trials are not an af- terthought or a luxury. They are another treatment option and, sometimes, the only life-saving option. Finally, educating cancer patients and dispelling their concerns about clinical trials is crucial. The future is promising. But are we ready to create it? n Sam Makhoul, MD, is a hematologist/oncologist withmore than 20 years of experience and currently serves as themedical director of clinical research at CARTI, Arkansas’s largest community-based can- cer care provider. Under his direction, the clinical research teamseeks to build a network spanning the entire state and offers the newest life-saving treat- ment options available to all Arkansans. Before join- ing the CARTI team, he served at UAMS as the chief of hematology/oncology and the Laura Hutchins hematology/oncology chair. In addition, he helped develop the clinical research programat theWinthrop P.Rockefeller Cancer Institute and was the principal investigator of clinical trials. meta-analysis of patient agreement to par- ticipate in cancer clinical trials published in 2022. These numbers challenge the fre- quently cited reason for low accruals on cancer clinical trials among the cancer population in general and the Black popu- lation in particular (enrollment of Blacks remains at 2.7% of all clinical trial subjects, while they represent 12.4% of theAmerican population). The main reasons cited by 70% of those who chose not to enroll were their desire to control their treatment choice, avoiding protocol treatment side effects, or their dislike of the idea of randomization. A small percentage of patients had concerns about coverage or transportation. Interventions that address the main rea- sons for nonparticipation in clinical trials are likely to result in high return on invest- ment. Expanding research to the commu- nity increases diversity and representation, allows generalizability of the results, and is likely to increase engagement of community oncologists and primary care physicians in research and hence in the dissemination of the results to the general population. Lever- aging technology (standardizing treatment order sets; clinical trial matching based on molecular data in collaboration with public or private service providers) and taking ad- vantage of telemedicine that flourished dur- ing the COVID-19 pandemic will solve many “Despite physicians acknowledging that clinical trials provide high-quality care (87%) and benefit enrolled patients (83%), 50% of the patients for whomaprotocolwas availableandwhowereeligible did not participate due to physician preference.”