Addressing Financial Barriers to Patient Participation in Clinical Trials: ASCO Policy Statement.

Research conducted through clinical trials is essential for evaluating new treatment modalities, establishing new standards of cancer care, and ultimately improving and prolonging the lives of patients with cancer. However, participation in trials has been low, and this is attributable to various factors including patient financial barriers. Such financial barriers include the rising cost of cancer care; a lack of transparency in coverage policy; and the perception of ethical, compliance, or institutional impediments to patient financial support. ASCO convened a roundtable discussion with a variety of stakeholders to define the scope of the problem, as well as to identify clinical practice and policy solutions applicable at the institutional and system-wide levels. This statement summarizes key discussions from the ASCO Roundtable, as well as findings from the literature, and provides ASCO's recommendations for overcoming financial barriers that may otherwise prevent participation in clinical trials. These recommendations broadly address the following key areas: (1) improving the policy environment for coverage of clinical trials; (2) facilitating transparency among providers, patients, and payers for trial-related out-of-pocket costs; (3) refuting the specter of inducement to enable targeted financial support for patients; and (4) improving the available data on costs of cancer clinical trials.

[1]  H. Lynch,et al.  Addressing Financial Barriers to Enrollment in Clinical Trials. , 2018, JAMA oncology.

[2]  I. Cohen,et al.  A Framework for Ethical Payment to Research Participants , 2018, The New England journal of medicine.

[3]  Pengxiang Li,et al.  Association of Patient Out-of-Pocket Costs With Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents. , 2017, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  A. Mansfield,et al.  Representation of Minorities and Women in Oncology Clinical Trials: Review of the Past 14 Years. , 2018, Journal of oncology practice.

[5]  G. Samsa,et al.  Out-of-Pocket Costs, Financial Distress, and Underinsurance in Cancer Care , 2017, JAMA oncology.

[6]  J. Griggs,et al.  Charting the Future of Cancer Health Disparities Research: A Position Statement From the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. , 2017, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  M. Leblanc,et al.  The impact of positive SWOG treatment trials on population survival. , 2017 .

[8]  R. Pazdur,et al.  Reevaluating Eligibility Criteria - Balancing Patient Protection and Participation in Oncology Trials. , 2017, The New England journal of medicine.

[9]  A. Jemal,et al.  Do cancer survivors change their prescription drug use for financial reasons? Findings from a nationally representative sample in the United States , 2017, Cancer.

[10]  N. Lin,et al.  Prior Authorization for Medications in a Breast Oncology Practice: Navigation of a Complex Process. , 2017, Journal of oncology practice.

[11]  Matthew P. Banegas,et al.  Financial Hardships Experienced by Cancer Survivors: A Systematic Review , 2017, Journal of the National Cancer Institute.

[12]  Suzanne M. Miller,et al.  Randomized Trial of a Web-Based Intervention to Address Barriers to Clinical Trials. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  A. Jemal,et al.  Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  P. Newcomb,et al.  Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  Hang Lee,et al.  Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program. , 2016, The oncologist.

[16]  Suzanne M. Miller,et al.  Financial Concerns About Participation in Clinical Trials Among Patients With Cancer. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[17]  S. Ramsey,et al.  Patient Income Level and Cancer Clinical Trial Participation: A Prospective Survey Study. , 2016, JAMA oncology.

[18]  M. Newton,et al.  Oral Antineoplastic Agents: Assessing the Delay in Care , 2015, Chemotherapy research and practice.

[19]  C. Grady,et al.  Clinical research: Should patients pay to play? , 2015, Science Translational Medicine.

[20]  Laura A. Levit,et al.  Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  B. Moy,et al.  Recognizing the Financial Burden of Cancer Patients in Clinical Trials. , 2015, The oncologist.

[22]  Juan Wisnivesky,et al.  Geographic accessibility to clinical trials for advanced cancer in the United States. , 2015, JAMA internal medicine.

[23]  Laura A. Levit,et al.  American Society of Clinical Oncology policy statement update: the critical role of phase I trials in cancer research and treatment. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  Spencer E. Harpe,et al.  Out-of-Pocket Costs and Oral Cancer Medication Discontinuation in the Elderly , 2014, Journal of managed care & specialty pharmacy.

[25]  J. Griggs,et al.  American Society of Clinical Oncology policy statement on medicaid reform. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[26]  B. Moy,et al.  Alleviating financial burden for cancer patients in clinical trials. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  C. Tangen,et al.  Retention of Black and White Participants in the Selenium and Vitamin E Cancer Prevention Trial (SWOG-Coordinated Intergroup Study S0000) , 2014, Cancer Epidemiology, Biomarkers & Prevention.

[28]  H. Kantarjian,et al.  High cancer drug prices in the United States: reasons and proposed solutions. , 2014, Journal of oncology practice.

[29]  Aaron N. Winn,et al.  Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  R. Kurzrock,et al.  Barriers to study enrollment in patients with advanced cancer referred to a phase I clinical trials unit. , 2013, The oncologist.

[31]  P. Newcomb,et al.  Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. , 2013, Health affairs.

[32]  A. Abernethy,et al.  The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience. , 2013, The oncologist.

[33]  Katherine L Kahn,et al.  Enrollment of patients with lung and colorectal cancers onto clinical trials. , 2013, Journal of oncology practice.

[34]  A. Abernethy,et al.  Financial toxicity, Part I: a new name for a growing problem. , 2013, Oncology.

[35]  L. Minasian,et al.  Effect of state-mandated insurance coverage on accrual to community cancer clinical trials. , 2012, Contemporary clinical trials.

[36]  Nicole Martino,et al.  Commonly performed procedures in clinical research: a benchmark for payment. , 2012, Contemporary clinical trials.

[37]  G. Jacobson,et al.  Medicare Advantage 2014 Spotlight: Enrollment Market Update , 2012 .

[38]  Eric J Feuer,et al.  Projections of the cost of cancer care in the United States: 2010-2020. , 2011, Journal of the National Cancer Institute.

[39]  C. Rudin,et al.  The Impact of Insurance on Access to Cancer Clinical Trials at a Comprehensive Cancer Center , 2010, Clinical Cancer Research.

[40]  E. Emanuel,et al.  Clarifying Confusions about Coercion , 2005, The Hastings Center report.

[41]  Ezekiel J Emanuel,et al.  Undue Inducement: Nonsense on Stilts? , 2005, The American journal of bioethics : AJOB.

[42]  Sarah M. Greene,et al.  Organizational barriers to physician participation in cancer clinical trials. , 2005, The American journal of managed care.

[43]  Harlan M Krumholz,et al.  Participation in cancer clinical trials: race-, sex-, and age-based disparities. , 2004, JAMA.

[44]  M. Schonlau,et al.  Incremental treatment costs in national cancer institute-sponsored clinical trials. , 2003, JAMA.

[45]  D. Gandara,et al.  Prospective evaluation of cancer clinical trial accrual patterns: identifying potential barriers to enrollment. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[46]  L. Fehrenbacher,et al.  Cost of care for patients in cancer clinical trials. , 2000, Journal of the National Cancer Institute.