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Doctors, Patients Face Different Barriers to Clinical Trials (continued)

Role of Primary Care Physicians
Ninety percent of the primary care physicians who responded to the Harris survey stated they would like to see more of their patients participate in clinical trials. But a third study, suggests that primary care providers may not feel suited to handling clinical trial matters. In a series of NCI-sponsored focus groups conducted during June and July of 2000, 48 primary care physicians and nurse practitioners discussed their views regarding clinical trials.

Most of this group believed that oncologists were better suited to discuss cancer clinical trials with patients. The primary care providers didn't feel they had the time to learn about studies, discuss them with patients, or do the necessary paperwork. Some had the perception that clinical trials are inferior to standard care, appropriate only if other treatments fail. Also, many had misconceptions about placebos, concerned that their patients would be assigned to receive no treatment. Only one thought patients might get better care by participating in a trial.

However, primary care providers did express a strong interest in learning more about trials studying the prevention of cancer, such as the Study of Tamoxifen and Raloxifene (STAR) to prevent breast cancer. They thought that if they had easy access to information about clinical trials in their local area, especially prevention trials, they would be better equipped to discuss trial participation with their patients.

Time for Action
"These surveys have defined the issues," Comis said. There is "enough information to move" toward three obvious targets: "We have to raise the level of awareness among patients and doctors, address the real, legitimate problems of the doctors, and bring the level of resources up to what is required."

Public awareness programs on cancer trials are being planned by the partners of the Summit Series on Clinical Trials, a group working to improve the understanding of cancer clinical trials and the National Dialogue on Cancer, a group that brings together principal leaders of key national cancer organizations, agencies and institutions from the public, private and non-profit areas.

The National Cancer Institute (NCI) is doing its part, too. Under a new national system, the NCI hopes to change the way it develops, conducts, reviews and supports clinical trials.

Part of this new system includes the Cancer Trials Support Unit (CTSU),which is designed to make it easier to enrollment patients into clinical trials. The CTSU provides participating physicians with a single access point to the NCI's entire phase III clinical trials system, and helps with access to protocols, training, and educational information. Additionally, NCI is developing education initiatives to better inform physicians, nurses and the public about clinical trials.