The Influence of Older Age on Physician and Patient Decision-Making Regarding Enrollment to Breast Cancer Clinical Trials.
Notice bibliographique
Résumé
Abstract Background: More than 50% of breast cancers occur in women ≥65 years. Clear guidelines for treatment do not exist for this population, however, due to underrepresentation of older patients on clinical trials. We reported that patients 65 and older are significantly underrepresented in Southwest Oncology Group (SWOG) trials, particularly in breast cancer. (Hutchins, 1999) We conducted a prospective study (S0316) to determine physician- and patient-perceived barriers to breast cancer clinical trial enrollment in older versus younger patients.Methods: Eight geographically diverse SWOG institutions, 5 academic and 3 community, participated in S0316. Breast cancer patients were registered at time of systemic treatment decision-making. The study prospectively assessed reasons behind patients' and physicians' decisions to either enroll in or decline clinical treatment trials, including demographics, return rates to the institution, trial availability, and eligibility. Patient questionnaires elicited concerns about treatment toxicities, confidence in medical staff or institution, opposition or support by family/friends, and financial or time commitment concerns. Physician questionnaires elicited factors influencing decisions either not to discuss a trial or not to enroll the patient, including treatment toxicities, patient age or medical status, demands on personal or staff time, and reimbursement issues. Results were compared between patients <65 vs. ≥65 years.Results: 1,079 patients were registered and eligible, and 909 (84%) returned for follow-up. Clinical trial participation was 16%. The major reason for non-accrual was either trial unavailability or ineligibility (60%). Older patients were less likely to be eligible for trials (65% vs. 78%, p=.004). If eligible, trial participation rates did not differ significantly by age (34% vs. 40%, p=.32). Treatment-specific issues were the most common reasons cited by all patients for non-participation. Patients ≥65 more often were concerned about side effects (p=.02), had friends opposed to participation (p=.001), or believed that participation would not benefit other generations (p=.009). Concerns about transportation, time commitment, or posing a burden to family were similar between age groups. Physicians discussed trial participation when trials were available and patients were eligible with 76% <65 years versus 58% ≥65 years (p=.008). The study regimen and toxicity were the most common reasons influencing physician decisions not to discuss a trial, but did not differ between age groups. For patients ≥65 years, 14% of physicians indicated age as a reason the patient did not participate vs. 3% for patients <65 years (p=.002).Conclusions: Trial unavailability or patient ineligibility are major reasons for lack of enrollment on breast cancer clinical trials for patients of all ages in this prospective study. Older patients were less likely to be eligible for trials, but if eligible participated at similar rates to younger patients. Older age should not deter physicians in recommending clinical trials. Addressing stringent eligibility criteria may improve accrual rates of older patients.Supported by the Breast Cancer Research Foundation and the SWOG Hope Foundation Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3077.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».