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To the Editor: Dr Murthy and colleagues¹ report that cancer trial participation is low. Only 1.8% of white cancer patients enroll in therapeutic nonsurgical National Cancer Institute clinical trials. Among racial minorities, women, and elderly persons, even fewer enroll. The low inclusion rates together with an apparent selection bias for younger white people may pose a serious problem with generalizability.

Selection against elderly persons may be associated with exclusion criteria based on concomitant medication or disease. Such criteria may be applied to avoid confounders or for ethical reasons, but this action may result in a reduced comparability with the target patient population and thereby create its own ethical problems.

Administrative procedures may also introduce selection bias in the screening process. For example, in a study of 399 acutely ill patients, only 22% had received enough formal education to assume full understanding of the informed consent form and only 18% read . . . [Full Text of this Article]

Nina H. Bjarnason, MD, MFPM
nina.bjarnason@rh.dk
Department of Clinical Pharmacology
Copenhagen University Hospital
Copenhagen, Denmark

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