C118
Challenges of identifying cancer patients for randomised controlled trials (RCTs) from urology clinics: what lessons can we learn from SPARE? (CRUK/07/011)
Rebecca Lewis1, Robert Huddart1, Alison Birtle2, Jane Blazeby3, Emma Jones1, Emma Hall1, behalf of SPARE TMG1
1The Institute of Cancer Research, Sutton, UK, 2Lancashire Teaching Hospitals, Preston, UK, 3University of Bristol, UK
Background
Historically, RCTs of urological cancer treatments have been predominantly conducted within oncology clinics. Increasingly, as different treatment modalities are compared and RCTs in earlier stage disease are developed, there is a need to identify potential trial participants at an early stage in their treatment pathway through urology clinics. Data collected to support an RCT in muscle invasive bladder cancer comparing radical surgery to selective bladder preservation SPARE illustrate challenges that can arise.
Method
Oncology research nurses at each participating hospital were requested to keep screening logs of potential participants in the target population. Selected centres provided information on patient pathways through diagnosis to definitive treatment.
Results
Screening logs were commonly based on data collected from Multi-Disciplinary Team meetings (MDT). Of 108 patients offered the trial, 72 (66%) declined to participate and 49 (68%) of these stated that they had a treatment preference when they were offered the trial in the oncology clinic. 13% of patients not offered the trial were not approached because of a known treatment preference. 15 (5%) patients reported as ineligible were so because treatment would be delivered at a non-participating site.
Patient pathways varied greatly with some patients being seen by up to four specialists in at least two hospitals before their final treatment was decided.
Conclusion
The complex patient pathway and the number of professionals delivering care are significant challenges to patient recruitment for RCTs in urological cancers. To optimise recruitment, health professionals across a number of sites must be informed about the trial and know that the patient is a potential participant. MDTs attended by urologists and oncologists and early flagging of patient notes should facilitate identification of potential trial participants. Support available through the NCRN and CLRNs could be used to develop research infrastructure and facilitate recruitment in urology clinics.
