Primary care physicians' attitudes, knowledge, and practices related to cancer clinical trials.

BACKGROUND: Participation of patients in cancer clinical trials is disappointingly low and several physician-based factors are thought to be responsible. METHODS: In 1998-1999, the National Cancer Institute (NCI) conducted a probability survey of three primary care physician groups to gain a better understanding of the barriers to clinical-trial patient accrual from their perspective. RESULTS: Findings from this survey of 706 primary care physicians indicate that the vast majority (98%) refer their patients with cancer to a specialist for cancer treatment and rarely bring up the topic of cancer clinical trials. Frequently cited reasons for not mentioning clinical trials are preferring to leave that discussion to the oncologist (41%) and being unaware of any clinical trials that may be available for the patient (37%). CONCLUSION: Primary care physicians may represent an important untapped resource for introducing the concept of clinical trials as an option to newly diagnosed cancer patients.

Role of the Cancer Information Service in a national education initiative on cancer clinical trials.

Although the participation of cancer patients in clinical trials is critical to the identification of new treatment protocols that improve survival or reduce treatment side effects, usually fewer than 3% of all newly diagnosed patients are enrolled in clinical trials. The ability to recruit more of these patients to clinical trials would increase the number of studies that could be done and would move promising new treatments more quickly into routine practice. This paper examines the role that the Cancer Information Service (CIS) played in the nationwide education initiative sponsored by the National Cancer Institute to increase accrual to clinical trials. Efforts to increase patient and public awareness of clinical trials as a treatment option are described, and the unique role of the CIS in response to the education initiative is highlighted. The effect of the initiative on accrual is discussed, and recommendations for additional studies are provided.

Patient education: history, development, and current directions of the American Cancer Society and the National Cancer Institute.

With their unique perspectives in the identification, design, promotion, and evaluation of cancer patient education programs and services, the National Cancer Institute and the American Cancer Society have the abilities to meet a wide variety of cancer patient education needs. With federal support and connections to national organizations and the comprehensive and clinical cancer center networks, the National Cancer Institute has access to nationwide experts in medical care and the resources to develop, design, and promote quality, state-of-the-art education programs. The American Cancer Society, with its strong volunteer community base, can pull together local expertise and collaborate with local organizations to meet the special needs of local population groups. In addition, the American Cancer Society volunteer committees have the flexibility to individualize programming and resources to answer specific patient/family education problems. As the number of people affected by cancer continues to raise, and as organizations realize the need to maximize their resources with collaborative efforts, the National Cancer Institute and the American Cancer Society are challenged to focus their energies on the patient education initiatives that build upon and combine their unique strengths.

Domiciliary chemotherapy for malignant disease.

A prospective trial was carried out comparing hospital-based chemotherapy with domiciliary chemotherapy. Fifteen women received cisplatin combination regimens to treat gynecologic cancers. The first course was given in a hospital inpatient setting, and subsequent courses were given to each patient in her domicile. Seventy-four courses were given at home under the direction of a nurse trained to administer chemotherapy. There were no extravasations or anaphylactic reactions. In the period immediately following the at-home administration, no patient required hospitalization for dehydration or for adverse reactions to the chemotherapy. Written interviews with patients and family members were conducted after completion of the course of treatment. No patient wanted to return to the hospital environment. All patients preferred to be treated at home, usually because of the increased privacy, convenience, and lessened anxiety.

Cancer patient education: what, where, and by whom?

Cancer patients and their families experience numerous psychological, physiological, informational, and educational needs. In response to these needs, health care professionals are planning and implementing educational activities that range from standard one-to-one patient teaching sessions to more sophisticated educational programs involving groups of patients and their families. These activities are occurring in hospitals, outpatient clinics, physicians' offices, and in the community. Health care professionals are relying on printed educational materials and a variety of audiovisual resources to reinforce verbal communication with patients and their families. During the diagnostic and treatment phases of the patients' illness, the educational activities are designed to allay apprehensions and provide patients with knowledge about specific tests and procedures. In the posttreatment and rehabilitation phases, patients are given important information and taught self-care techniques and skills to cope with their disease. Innovative teaching strategies, such as imagery, are being used to help meet the special needs of cancer patients. The challenge to the educator is to recognize the patients' varied needs and to determine which educational strategies are most effective generally and are most effective at what stage during the patients' illness.

Preparing cancer patients to administer medication.

Leucovorin calcium is given to cancer patients receiving high-dose methotrexate to retard the onset of serious side effects. Precise adherence to dose and schedule is essential, and it is necessary that patients who self-administer their drug know how to open the ampules and withdraw the correct amount without wastage. Educational resource materials were developed to be given to patients when the leucovorin calcium was dispensed. This paper describes the development and evaluation of the resource materials.