Do the Potential Medical Benefits of Phase 1 Pediatric Oncology Trials Justify the Risks? Views of the US Public.

Abstract

OBJECTIVES\nTo assess the US public s views on whether the potential medical benefits of phase 1 pediatric oncology trials justify the risks.\n\n\nSTUDY DESIGN\nOnline survey of a nationally representative sample of US adults. Participants were presented with a hypothetical scenario in which they have a 10-year-old child with advanced cancer. They were then offered the option of giving their child supportive care or trying one more potential treatment, in the research or clinical care setting, which has the same risks and potential medical benefits as the average phase 1 pediatric oncology trial. We assessed what percentage of respondents thought the potential medical benefits justify the risks.\n\n\nRESULTS\n1658 of the 2508 individuals who were sent the survey participated (RR= 66.1%). Of those who passed all three test questions indicating understanding, 67.1% in the research scenario and 58.5% in the clinical care scenario regarded the potential medical benefits of an average phase 1 pediatric oncology trial as equal to or greater than the risks. In addition, 53.4% of respondents in the research scenario thought it was appropriate for researchers to conduct a study in children with these risks and potential medical benefits, and 46.9% stated they would enroll their own child in such a trial.\n\n\nCONCLUSIONS\nA majority of the US public regards the potential medical benefits of average phase 1 pediatric oncology trials as justifying the risks. This finding suggests that these trials are ethically appropriate and approvable in patients who have no more effective treatment options. At the same time, a significant minority thought the potential medical benefits do not justify the risks, suggesting these trials should be approved only when they have significant social value. Moreover, approximately half of respondents regarded the trials as inappropriate and would not enroll their own child, underscoring the need for a rigorous informed consent process which accurately educates parents regarding the risks, potential medical benefits and alternatives, so they can decide whether to enroll their child based on their own preferences and goals.