BARRIERS TO CLINICAL-TRIALS .3. KNOWLEDGE AND ATTITUDES OF HEALTH-CARE PROVIDERS

The role of clinical trials is becoming extremely important for our un derstanding of the effects of different therapeutic modalities of canc er treatment and the value of their interactions. Participation of pat ients in clinical trials remains disappointingly low, with less than 3 % of the estimated 1.17 million patients with newly diagnosed cancers entering the studies. Several physician-based factors hinder accrual o f patients-(1) lack of awareness of or access to clinical trials, (2) physician bias that the trial therapy is not as good as the ''standard therapy'' even though the standard therapy may provide a response rat e of less than 20%, (3) physician's concern about losing patients to f ollow-up, (4) the complexity of the clinical trial(s), which requires excessive amount of time to discuss, implement, and follow-up the pati ent, (5) the lack of equitable compensation for the physician's time a nd effort, and (6) excessive costs of laboratory and radiologic tests that are not paid by the agency or group sponsoring the study, particu larly in Phase I and II trials. These factors are confounded by the la ck of institutional review boards in several community hospitals, asso ciated with a complex and lengthy procedure to institute such a board. The article presents recent surveys dealing with attitudes and practi ces of health care providers toward clinical trials. The National Canc er Institute, the American Cancer Society, and other societies, groups , and agencies, including the health insurance industry, should contin ue to encourage and support clinical trials.