What makes pediatric cancer trials so popular?

By Jeremy Manier

Gina Kolata has an interesting story in the New York Times today about the lack of volunteers for cancer research trials, but she left out a facet that has puzzled me: Even though few adults enter cancer studies, the vast majority of kids with cancer do get enrolled in trials. Why?

Kolata offers many possible reasons for the shortage of adult volunteers, including anxiety and a reluctance to make the extra office visits that a trial often requires. But those are factors in pediatric cancer too. And yet at least 75 percent of kids with cancer get enrolled in trials, compared with just 3 percent for adult patients. We did a piece recently for the University of Chicago Medical Center magazine describing how clinical trials have transformed pediatric cancer care for the better. Among other things, the studies probably raise adherence to treatment regimens because each center must document that participants follow the required course of therapy.

One likely reason for the adult-pediatric gap, as Kolata mentions, is that many adult patients are satisfied with existing treatments, especially for types of cancer with a good prognosis. If a regimen of surgery plus chemotherapy is likely to work, and patients can get the chemo at a local cancer treatment center, they’re less motivated to make the trip to a major research center conducting a trial.

But once again, the same factors could affect pediatric trials. Many pediatric treatments are highly successful, and parents would seem to have less incentive to enter their children in trials. Yet they do enter those trials, time after time.

Could one answer be that we adults are sometimes more hyper-vigilant about our children’s health than our own? Are we just more willing to suffer inconveniences for the sake of our kids? Perhaps entering a study that could result in extending the lives of other adult patients by a few months or years seems like insufficient payoff. But give those same months or years to a pediatric patient, and the calculus starts to look better, the time gained somehow more precious.

Maybe recruiters for cancer trials should try an experiment with prospective patients: Imagine you were making this decision not for yourself, but for your child. Would you be satisfied with the standard of care, or would you want to try something that might improve your child’s outcome, if only by a little? And if you would do it for your child (and most people do), why not do it for yourself?

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