Obstacles to the accrual of patients to clinical trials in the community setting.

摘要: Data indicate that substantial pool of candidates exists, especially in the community setting, for enrollment clinical oncologic trials. However, only a small proportion cancer patients are actually enrolled. Obstacles to accrual include physician determinants, patient organizational issues, and health care system factors. Physicians can influence enlistment their capacity as either referring or study investigator. A practitioner's medical orientation may impact likelihood referral. reluctant enroll cite logistic practical problems potential disrupting relationships; trial's protocol also be questioned. Patient refusals participate trials stem from concerns, psychosocial wariness toxic treatment effects. Organizational issues affecting have not been extensively studied; an institutional review board's view research major factor. Health factors such escalating costs prohibitive reimbursement policies third-party payers adversely affect accrual, will require new commitment minimizing costs. Continued evaluation barriers is warranted. Once these recognized, randomized intervention required identify ways overcome them.