Evidence map›Paper›PMID 36215065›Full record

ArticleThe oncologist2022

Physician Perspectives on Reducing Curative Cancer Treatment Intensity for Populations Underrepresented in Clinical Trials.

Gabrielle B Rocque, Courtney Andrews, Valerie M Lawhon, Stacey A Ingram, Rachel M Frazier, Mary Lou Smith, Lynne I Wagner, Lisa Zubkoff, Lauren P Wallner, Antonio C Wolff

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The oncologist, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03248258 (Enhancing Shared Decision-Making in Metastatic Breast Cancer), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03248258 completednot on this map

Enhancing Shared Decision-Making in Metastatic Breast Cancer (Qualitative Study)

TypeobservationalSponsorUniversity of Alabama at BirminghamRan2017 to 2022Enrolled200ConditionsDecision Making ,Shared, De-escalationArmsQualitative Interview or Focus group discussions
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Gabrielle B RocqueDivision of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.ORCID 0000-0003-4188-9785
Courtney AndrewsInstitute for Human Rights, University of Alabama at Birmingham, Birmingham, AL, USA.
Valerie M LawhonDivision of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Stacey A IngramDivision of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Rachel M FrazierDivision of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Mary Lou SmithResearch Advocacy Network, Plano, TX, USA.
Lynne I WagnerWake Forest School of Medicine, Winston Salem, NC, USA.
Lisa ZubkoffO'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
Lauren P WallnerRogel Cancer Center, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA.
Antonio C WolffThe Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHistorically, clinical trials involved adding novel agents to standard of care to improve survival. There has been a shift to an individualized approach with testing less intense treatment, particularly in breast cancer where risk of recurrence is low. Little is known about physician perspectives on delivering less intense treatment for patients who are not well represented in clinical trials.

methodsOpen-ended, individual qualitative interviews with medical oncologists explored their perspectives on trials that test less intense treatment for patients with cancer, with a focus on breast cancer. Interviews were audio-recorded and transcribed. Four independent coders utilized a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted.

resultsOf the 39 participating physicians, 61.5% felt comfortable extrapolating, 30.8% were hesitant, and 7.7% would not feel comfortable extrapolating trial outcomes to underrepresented populations. Facilitators of comfort included the sentiment that "biology is biology" (such that the cancer characteristics were what mattered), the strength of the evidence, inclusion of subset analysis on underrepresented populations, and prior experience making decisions with limited data. Barriers to extrapolation included potential harm over the patient's lifetime, concerns about groups that had minimal participants, application to younger patients, and extending findings to diverse populations. Universally, broader inclusion in trials testing lowering chemotherapy was desired.

conclusionsThe majority (92%) of physicians reported that they would de-implement treatment for patients poorly represented in clinical trials testing less treatment, while expressing concerns about applicability to specific subpopulations. Further work is needed to increase clinical trial representation of diverse populations to safely and effectively optimize treatment for patients with cancer.

trial registrationNCT03248258.

Indexed as

Breast NeoplasmsPhysiciansFemaleHumansbreast cancerclinical trialsde-escalationde-implementationphysician perspectivesqualitative

Identifiers

PMID36215065
PMCPMC9732232

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.