A prospective analysis of the influence of older age on physician and patient decision-making when considering enrollment in breast cancer clinical trials (SWOG s0316)

Purpose. Patients older than 65 years are underrepresented in clinical trials. We conducted a prospective study (SWOG S0316) to determine physicianand patient-perceived barriers to breast cancer clinical trial enrollment for older patients. Methods. Eight geographically diverse SWOG institutions participated. The study assessed patients' and physicians' decisions to enroll in or decline clinical treatment trials, including demographics, trial availability, and eligibility. Patient and physician questionnaires elicited concerns related to treatment, medical status, age, family, and financial or transportation concerns. Results. A total of 1,079 patients were registered and eligible and 909 (84%) returned for follow-up. The major reason for nonaccrual was either trial unavailability or ineligibility (60%). Older patients were less likely to be eligible for trials (65% for age >65 years vs. 78% for age <65 years). If eligible,trialparticipationratesdidnotdiffersignificantlybyage (34%forage>65yearsvs.40%forage<65years).Patients >65yearsmoreoftenwereconcernedaboutsideeffects,had friends opposed to participation, or believed that participation would not benefit other generations. When trials were availableandpatientswereeligible,physiciansdiscussedtrial participation with 76% of patients <65 years versus 58% of patients >65 years of age. For patients >65 years, 11% of physicians indicated age as a reason they did not enroll a patient in a clinical trial. Conclusion. Trial unavailability or patient ineligibility were the major reasons for lack of enrollment in breast cancer clinical trials for patients of all ages in this prospective study. Older patients were less likely to be eligible for trials, but if eligible they participated at similar rates to younger patients.