Clinical Trials and Hope

"Where there is no vision, there is no hope."
- George Washington Carver

Her cancer had recurred and we talked about her treatment options. She knew, based on our prior discussions, that her choices were limited. She had undergone several operations, each more involved than the last. She had received radiation therapy and chemotherapy together. Now, the cancer was making it more difficult for her to speak and was worsening her pain. Her health, however, was otherwise excellent. What should she do now?

"Tell me more about clinical trials," she wanted to know. We had more than one option to offer.

Why do people enter clinical trials? A 2004 article in the Journal of Clinical Oncology (22:4212-18, 11/1/2004) explores factors that influence entry for patients, physicians, and research associates.

Although patients understand that the trial might help other people in the future, the strongest predictor that an individual patient will enter a trial is the measure of their hope that they, themselves, would personally benefit.

Patients are also more likely to enter trials when they feel that the decision is straightforward, when the research associate spends plenty of time with them, when the physician is convinced that the trial asks an important scientific question, and when the research associate is not worried about the potential side effects. These factors drive participation in trials.

Trials are becoming safer, as well. First, research oversight is much more intense than it was a few years ago, as any clinical researcher can attest. In addition, the agents being tested are more targeted and less toxic. An article in JAMA (292:2130-40, 11/3/2004) confirms that the risk of drug toxicity leading to death in Phase I cancer trials has decreased dramatically over the past 15 years.

I decided to become an academic cancer clinician when I realized that it would allow my patients to receive the best possible care. I feared completing a 35-year career only to learn at the end that I had faithfully treated my own cancer patients incorrectly over and over and over again. The chance to participate in clinical research has helped me to reach toward the goal of continually improving the care I provide while potentially helping many people that I will never meet.

My patient entered the clinical trial not knowing if she would benefit. Because someone far from Wisconsin had the vision to develop, test, and manufacture a new anti-cancer compound, trials are available. Because people here at MCW have the energy and skills to open, oversee, and offer clinical trials, my patient has new hope. We all hope she has a dramatic response.

Bruce H. Campbell, MD, FACS
Professor of Otolaryngology and Communication Sciences
Chief, Division of Head and Neck Oncology
Interim Director, Froedtert & The Medical College of Wisconsin Cancer Center

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.