Game Show Addresses Poor Enrollment in Cancer Clinical Trials

Nick Mulcahy

April 29, 2010

April 29, 2010 (Washington, DC) — Less than 5% of eligible adult cancer patients participate in clinical trials in the United States, according to a poster presented at the American Association for Cancer Research 101st Annual Meeting.

"It's a daunting statistic," said lead author Jane Kennedy, MSSW, manager of patient advocacy at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee.

Ms. Kennedy and colleagues at Vanderbilt decided to address some of the educational and informational issues behind the poor enrollment.

"Lack of information and commonly held beliefs or myths are among the biggest barriers to enrollment," they write in their AACR poster abstract.

But the Vanderbilt team also had a less obvious insight: "traditional methods of education can be intimidating, frightening, or even boring."

They also believe that the timing of education might be a key.

"The most difficult time to educate patients about cancer clinical trials is at the time of diagnosis," they write.

Their solution to the aggregate problems of myths, scary and dull information, and poor timing was to take a novel approach: a game show designed not for cancer patients themselves, but for people without cancer in the community.

"They, or someone close to them, will have cancer in their lifetime," said Ms. Kennedy.

The game show is a fusion of the well-known television programs Jeopardy, Saturday Night Live, and a Discovery Channel show called MythBusters.

The concept was enticing.

Ms. Kennedy and her team invited 50 community members to a pilot version of show, and 46 attended.

The game show was also effective, said Ms. Kennedy. In an audience where 70% had college degrees, there was a 20% jump in knowledge about clinical trials as measured by pre- and postshow evaluations.

Can Patients Afford to Participate in Clinical Trials?

The Vanderbilt team intends to develop and package their interactive game for use by other centers and professionals.

The game addresses 10 common myths about cancer research that are ultimately answered by video of clinicians and researchers from Vanderbilt.

The myths, which Ms. Kennedy described as general knowledge in the field, are answered in a short "takeaway message" and in a longer more detailed way.

The game debunked a number of these myths, such as trials are risky and not safe, you cannot drop out of a clinical trial once you enroll, and cancer clinical trials are a "last resort."

One myth — that health insurance will not cover the costs of a clinical trial — is partially true, the authors acknowledge.

"Contrary to popular belief, cancer clinical trials are not free," the game show explanation states. "There are drugs, tests, scans, and labs that are free and provided by the study. Other drugs, scans, labs, and visits received at the same visit are considered standard. These are called standard of care, and they are billed to the patient's health insurance. Each health insurance has its own policy about whether or not they will pay a clinical trial's standard of care."

The matter of reimbursements to patients is part of the crisis in cancer clinical trials in the United States, according to the recent report from the Institute of Medicine.

"Even if patients are eligible for trials and are informed about the option by their physicians, they may decline participation because of financial concerns," states the report, which was chaired by John Mendelsohn, MD, president of the University of Texas M.D. Anderson Cancer Center in Houston.

The Institute of Medicine report reiterates the point of the Vanderbilt game: coverage of patient care costs in clinical trials by health insurers is "inconsistent."

"Federal and state health benefits plans, private health insurers, and the Centers for Medicare and Medicaid Services should establish consistent payment policies to cover patient care costs," advises the report.

The researchers have disclosed no relevant financial relationships.

American Association for Cancer Research (AACR) 101st Annual Meeting: Abstract 972. Presented April 18, 2010.


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