Only 7% of Patients With Cancer Enroll in Clinical Trials

This transcript has been edited for clarity. 
Hello. I’m Dr Maurie Markman, from City of Hope. I want to briefly discuss a very interesting paper. The paper itself and the data are interesting, but the implications are perhaps even more so. The paper has a pretty standard academic title, but its implications are what I want to briefly highlight.
“National Estimates of the Participation of Patients With Cancer in Clinical Research Studies Based on Commission on Cancer Accreditation Data” was published in the Journal of Clinical Oncology earlier this year. 
The authors start by noting that there have been estimates that 2%-3% of cancer patients participate in clinical trials. Now, this would be an hour-long conversation about why that is and what the implications of that are. It’s sad that we’re making decisions about the treatment of 100% of patients based on 2%-3%. Older patients, for example, who make up the vast majority of cancer patients, are grossly underrepresented in trials. We know about all of that. 
This particular analysis looked at data from the Commission on Cancer and came to the conclusion that, in fact, somewhere around 7% of cancer patients participate in treatment trials. Now, some have lauded this, as was stated in this report, as “Isn’t this great? Instead of 2%-3%, you’re twice as high. You can look at that and say, wow — this is now an accurate analysis” — and it’s atrocious. At 7%, that’s not even 1 of 10 patients, even if this is accurate. 
Not that the authors have done anything wrong, because I can’t come up with a better way of doing it, but were the data from the information that was sent in from each of these hospitals audited? You can understand why an individual center might beef up their accrual, for a variety of reasons. I don’t know if it was or wasn’t audited. For a source of truth, I think one needs to ask that question. 
Again, the major point here is that it is an objective perspective, to some extent, and shouldn’t be ignored. But still, it’s only 7%. 
It’s noted that National Cancer Institute (NCI) centers had about 22% of their patients participating in clinical trials. You can say that NCI centers only had 22%, but again, there’s much to discuss about that. That’s still only 1 of 5. In community programs, where a very large majority of patients with cancer are cared for, 4.1% of patients participated in therapeutic trials.
There was an integrated network centers group that reported 5.7%, so that number is 1 of 20 or 1 of 15 — certainly less than 1 of 10. 
Do we need to do a better job? Yes. We need to figure out why we are not having trials that are, quite frankly, relevant for the vast majority of our patients. Why is that? Can we do better? Can we develop pragmatic trials that are answering questions that are relevant to oncologists every day for their patients, and maybe even for the majority of patients? Can we figure out a way of paying for this? Can we figure out a way of doing it easily? There are so many questions to ask. 
Again, this is an interesting point that 7% of patients participate in cancer trials. We can perhaps quote that now, but it is still far from adequate. 
Thank you for your attention.