Novel use of clinical pathways to improve clinical trial accrual.

• DOI: 10.1200/op.2024.20.10_suppl.414
• Publication Date: 2024-09-30T13:33:33Z
• Authors: Joanna Addonizio; Alex Post; Matthew Rice; Carly Powell; Sunyi Zhang; Trang N. Nguyen; Hao-Yu Chang; Shruti Gupta; Erica Fox; David Michael Jac...

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Background: Fewer than 10% of adult cancer patients participate in clinical trials. Clinical pathways platforms have traditionally sought to improve trial accrual by displaying available trials for eligible patients. Our team explored how Pathways navigation data can also be used to identify eligible patients of poorly accruing trials and provide study investigators with a near real-time data feed of those patients. Methods: Providers at Dana-Farber Cancer Institute are asked to navigate the pathways decision-support platform and order systemic cancer therapies 7 days in advance of administration to assist with authorization. We invited Principal Investigators (PIs) of poorly accruing trials to collaborate with our Pathways data team through our Pathways to Accrual to Clinical Trials (PACT) service. Through PACT, PIs are informed of patients who were navigated to nodes involving the trial in question but received standard therapy instead. PIs are given access to a Tableau Dashboard that is updated with new data daily and receive weekly reminders about the dashboard. The current analysis includes two trials that have been using PACT for at least one year. We reviewed monthly trial accrual rates from the time of the trials opening until March 2024. The dataset did not meet criteria for Poisson analysis, so Fischer’s exact test was used to compare accrual rates. We ensured the denominator of potentially eligible patients was relatively consistent. Results: DF-21-519 accrued 16 patients over 14 months prior to PACT and 33 patients over 12 months using PACT. DF-22-028 accrued 0 patients over 6 months prior to PACT and 12 patients over 14 months using PACT. Collectively, use of PACT more than doubled accrual rates for the involved trials (one-tailed p = 0.048). Conclusions: A real-time Pathways data feed can be used to identify patients for appropriate clinical resources. Here, we show how our PACT program helped to more than double clinical trial accrual for the involved studies. Scaling this technology across a broader swath of clinical trials could be an important advance for trial participation for users of this pathways platform.

Trial Accruals, Pre PACT Accrual Rate, Pre PACT (Accruals/month) Accruals, Post PACT Accrual Rate, Post PACT (Accruals/month)

DF-21-519 16 accruals in 14 mo 1.14 33 accruals in 12 mo 2.75

DF-22-028 0 accruals in 6 mo 0 12 accruals in 14 mo 0.86

Total 16 accruals in 20 mo 0.8 45 accruals in 26 mo 1.73

one-tailed p is 0.048