Scoping Review: Barriers and Facilitators to Enrollment in Pediatric Oncology Clinical Trials

Surpassed only by injury, cancer is the second-leading cause of death among children in the United States (American Cancer Society [ACS], 2021). In 2021, 10,500 children under 15 years old [...]
Cancer is the second-leading cause of death among children in the United States. Oncology clinical trials are designed to investigate new potential therapies. Approximately 60% of children with cancer are treated on clinical trials. The purpose of this scoping review of the literature is to explore what is known about barriers and facilitators to enrollment in pediatric oncology clinical trials. Arskey and O'Malley's (2005) methodological framework guided the scoping review. The electronic databases of PubMed and SCOPUS were searched for relevant publications. Thirty publications met eligibility criteria, which included empirical publications related to barriers and facilitators to enrollment in pediatric oncology clinical trials. Results and discussion of barriers and facilitators were organized by using a modified version of the Social Ecological Model (SEM). Trial-level barriers included lack of an available trial, trials closed to accrual, and eligibility criteria. Individual factors included age, sex, race/ethnicity, insurance status, cancer characteristics, and motivation. Interpersonal factors included parents' desire for continuity of care by health care providers, physicians' discussions with parents and children about clinical trials, and physicians' attitudes about clinical trials. Organizational factors that influenced enrollment included local availability of a clinical trial and continuity of care. No studies of community or policy-level barriers and facilitators were found. Theoretically based studies need to be conducted to identify factors at SEM levels not previously studied and investigate interventions to address factors that adversely affect enrollment. Furthermore, interdisciplinary collaboration among nurses and other professionals working at each SEM level is vital to surmount enrollment obstacles. Key Words: Clinical trials, oncology, cancer, pediatric, enrollment.