e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Barriers and enablers to cancer clinical trial participation and initiatives to improve opportunities for rural cancer patients: A scoping review  (#288)

Narelle J McPhee 1 , Claire Nightingale 2 , Eva Segelov 3 4 , Samuel Harris 5 , Eli Ristevski 6
  1. School of Rural Health, Monash University, Bendigo, Victoria, Australia
  2. Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  3. Department of Oncology, Monash University, Clayton, Victoria, Australia
  4. Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
  5. Department of Medical Oncology, Bendigo Health, Bendigo, Victoria, Australia
  6. Monash University, Monash Rural Health, Warragul, Victoria, Australia

Introduction: Rural cancer patients have reduced access to cancer clinical trials than those living in urban areas. This is one of many existing inequities that needs addressing to improve cancer outcomes for rural residents. Given the paucity of literature on the participation of rural residents in cancer clinical trials, we conducted a scoping review to investigate three research questions: 1.What is the participation rate of rural cancer patients in clinical trials? 2.What are the barriers and enablers to participation? 3.What initiatives facilitate participation of rural cancer patients in clinical trials?

Methods: A scoping review using the Joanna Briggs Institute methodology was conducted to investigate the participation rates of rural cancer patients, barriers and enablers and initiatives that facilitate participation. The databases searched included, MEDLINE(OVID), EMBASE(OVID), CINAHL, Cochrane Database of Systematic Reviews, PsycInfo and Scopus. 

Results: A total of 2556 articles were identified; 48 articles met the inclusion criteria.  Studies originated from the United States of America(42); Australia(5) and the United Kingdom(1) and over half (54%) were rurally located.  Participation rates ranged from less than 1% to 90%.  Barriers included travel and distance, absence of a trial protocol, cost, physician attitude and knowledge.  Enablers included multidisciplinary tumour board meetings, molecular profiling, larger hospitals, willingness to travel and finance related.  Clinical trial networks and teletrials are initiatives being utilised to increase the participation of rural cancer patients.  One physician and three patient educational initiatives demonstrated an increase in clinical trial knowledge. 

Conclusion: When given the opportunity, rural cancer patients participate in cancer clinical trials.  Ongoing efforts are required to overcome the structural and clinical barriers that prevent participation in clinical trials and there is an opportunity to further explore the role and influence of the physician.  Evaluation of the cost return of initiatives and standardised measures of participation are also required.