Recruitment of Adolescents and Young Adults to Cancer Clinical Trials--international Comparisons, Barriers, and Implications

The last 30 years have seen significant improvements in survival rates for children and older adults. In contrast, the 5-year survival rate among 20 to 39 year olds has been static at around 70% since 1986. Data from the United States, Australia, Italy, and the United Kingdom suggest that this age group also has the lowest rate of clinical trial participation. In the United States, just 2% of patients aged 20 to 29 years enter trials, in contrast with an estimated 60% of patients under 15 years of age. In the United Kingdom, the nadir in accrual is for patients aged 35 to 39 years, of whom only 7.5% are recruited, compared to 52.7% of patients below 15 years of age. This level of trial activity may be associated with the lack of improvement in survival for the older age group. Strategies to increase the numbers of adolescents and young adults (AYA) recruited to cancer clinical trials have become a focus of research activity in several countries. This article explores possible barriers to recruitment of AYA and summarizes current policies in the United States and the United Kingdom to increase accrual of young adults with cancer to clinical trials.