Influence of Initial Consultation Visit Type on Cancer Clinical Trial Enrollment

With the onset of COVID-19, many oncologists turned to telemedicine to provide some types of care, including consultations that led to clinical trial enrollment.

A team of researchers evaluated patients with breast cancer who were seen during the open enrollment period of a prospective randomized trial and determined factors that were associated with in-person initial consultation vs virtual initial consultation. Their findings were published in International Journal of Radiation Oncology, Biology, Physics.

The researchers identified 476 patient consultations (259 in-person and 271 telemedicine visits) conducted between June 1, 2020, and May 13, 2021. The patients were offered the choice between the 2 types of visits. At the beginning of the time period, telemedicine visits outnumbered the in-person visits, but they eventually declined. By September 2020, in-person consultations outnumbered the telemedicine visits.

Ultimately, 10% of the patients in the telemedicine consultation group were deemed eligible to participate in a clinical trial, and 76% of them chose to do so. Fourteen percent of the patients in the in-person consultation group were eligible, and 53% chose to enroll.

The researchers did not find any statistically significant difference among patients of different races or ethnicities when it came to in-person versus telemedicine visits.

The researchers did find, however, that increasing age was associated with decreased telemedicine use. Patients undergoing chemotherapy were also less likely to use telemedicine for their initial consultation visit. The researchers also noted that patients with low socioeconomic status, patients who were 85 or older, and patients from communities of color tended to have less digital access. Such disparities could be addressed, however, with expansion of reduced-cost or free internet access and assistance programs to help elderly people.

“Although our study showed that increasing age and unemployment were associated with decreased telemedicine usage, our study showed no statistically significant difference in age or employment status between eligible patients who enrolled and those who did not enroll on the trial, suggesting that decreased telemedicine usage in older and unemployed patients had no effect on clinical trial enrollment,” they wrote. “This should, however, be interpreted with caution given the low number of eligible patients for the trial.”

They also noted that effective physician-patient communication has been shown to be critically important in clinical trial enrollment. But the lack of difference in enrollment between the in-patient and virtual groups shows that both types of visit can be effective in establishing therapeutic alliance.

“Telemedicine may be an effective platform for clinical trial enrollment, though further strategies to improve its access are essential to not perpetuate already existing disparities in patient care and clinical trials,” the researchers concluded.

The study was limited by the number of patients eligible for the clinical trial and the diversity of patients, as the participants were all female patients with breast cancer.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Hardy-Abeloos C, Karp J, Xiao J, et al. Disparities in the uptake of telemedicine and implications for clinical trial enrollment in patients with breast cancer. Int J Radiat Oncol Biol Phys. Published online October 20, 2022. doi:10.1016/j.ijrobp.2022.10.016