Aims:
Cancer clinical trials (CCTs) have well described benefits for patients, including improved health outcomes. However, participation in CCTs is low among people based in non-metropolitan areas. This project aimed to examine the barriers and enablers influencing access to CCTs from 2013-16 by patients in the Loddon Mallee Region (LMR) of Victoria.
Methods:
Trial type, trial funder and participation by LMR cancer patients was identified using Clinical Trials Australia data and discussions with regional and metropolitan health services. This provided the first known population view of LMR CCT participation rates. Semi-structured interviews were conducted with key clinical stakeholders of radiation and medical oncology departments in the LMR (Bendigo and Mildura hospitals) and Melbourne (Peter MacCallum Cancer Centre in Melbourne).
Results:
Over the study period, 150 patients participated in CCTs in the two key Melbourne hospitals (mainly breast, lymphoma and solid tumours) and 65 in Bendigo (mainly prostate). This is less than 1% of the newly diagnosed cancer population in the region. Patients residing in the sub-region closest to Melbourne or in Bendigo had highest rates of participation. Clinicians identified barriers included low patient awareness of CCTs, distance/travel options, extra workload related to identifying and enrolling patients, having ready access to information about available trials and trials being locally-available. Melbourne clinicians raised the need for sufficient skills, infrastructure and critical mass to run effective CCTs for non-metropolitan patients, exacerbated by the increasing complexity of trials.
Conclusion:
The participation in and types of trials accessed by LMR patients is influenced by where treatment occurs and the sub-region they live. Increasing CCT participation may require increased patient awareness, consolidated trials information and systems for patient identification and referral. A LMR referral target could be important to drive change.