TY - JOUR
T1 - Opportunities and challenges in incorporating ancillary studies into a cancer prevention randomized clinical trial
AU - Goodman, Phyllis J.
AU - Tangen, Catherine M.
AU - Darke, Amy K.
AU - Arnold, Kathryn B.
AU - Hartline, Jo Ann
AU - Yee, Monica
AU - Anderson, Karen
AU - Caban-Holt, Allison
AU - Christen, William G.
AU - Cassano, Patricia A.
AU - Lance, Peter
AU - Klein, Eric A.
AU - Crowley, John J.
AU - Minasian, Lori M.
AU - Meyskens, Frank L.
N1 - Funding Information:
The first ancillary study activated was the Prevention of Alzheimer’s Disease by Vitamin E and Selenium (PREADVISE), funded by the National Institute on Aging [5–7]. The objective of this study was to evaluate the effect of
Funding Information:
This work was supported in part by Public Health Service Cooperative Agreement grant CA37429 and UM1 CA182883 awarded by the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, and in part by the National Center for Complementary and Alternative Medicine (National Institutes of Health). It was also supported in part by NIA R01 AG19241 (PREADVISE), NEI EY014418 (SEE), NHLBI (RO1HL071022) (RAS) and NCI R01CA124862 (ACP). Study agents and packaging were provided by Perrigo Company (Allegan, MI, USA), Sabinsa Corporation (Piscataway, NJ, USA), Tishcon Corporation (Westbury, NY, USA) and DSM Nutritional Products Inc. (Parsipanny, NJ, USA).
Funding Information:
The Respiratory Ancillary Study (RAS) was funded by the National Heart, Lung and Blood Institute and also required active participation [10, 11]. The objective of this study was to understand whether vitamin E and/or selenium can slow the loss of lung function that occurs naturally with aging. The accrual goal was 3000 participants, with as many current smokers as possible. Participants were followed with regular pulmonary function tests (PFT).
Publisher Copyright:
© 2016 Goodman et al.
PY - 2016/8/12
Y1 - 2016/8/12
N2 - Background: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) was a randomized, double-blind, placebo-controlled, prostate cancer prevention study funded by the National Cancer Institute and conducted by SWOG (Southwest Oncology Group). A total of 35,533 men were assigned randomly to one of four treatment groups (vitamin E + placebo, selenium + placebo, vitamin E + selenium, placebo + placebo). At the time of the trial's development, NIH had invested substantial resources in evaluating the potential benefits of these antioxidants. To capitalize on the knowledge gained from following a large cohort of healthy, aging males on the effects of selenium and/or vitamin E, ancillary studies with other disease endpoints were solicited. Methods: Four ancillary studies were added. Each drew from the same population but had independent objectives and an endpoint other than prostate cancer. These studies fell into two categories: those prospectively enrolling and following participants (studies of Alzheimer's disease and respiratory function) and those requiring a retrospective medical record review after a reported event (cataracts/age-related macular degeneration and colorectal screening). An examination of the challenges and opportunities of adding ancillary studies is provided. The impact of the ancillary studies on adherence to SELECT was evaluated using a Cox proportional hazards model. Results: While the addition of ancillary studies appears to have improved participant adherence to the primary trial, this did not come without added complexity. Activation of the ancillary studies happened after the SELECT randomizations had begun resulting in accrual problems to some of the studies. Study site participation in the ancillary trials varied greatly and depended on the interest of the study site principal investigator. Procedures for each were integrated into the primary trial and all monitoring was done by the SELECT Data and Safety Monitoring Committee. The impact of the early closure of the primary trial was different for each of the ancillary trials. Conclusions: The ancillary studies allowed study sites to broaden the research opportunities for their participants. Their implementation was efficient because of the established infrastructure of the primary trial. Implementation of these ancillary trials took substantial planning and coordination but enriched the overall primary trial. Trial registration:NCT00006392-S0000: Selenium and Vitamin E in Preventing Prostate Cancer (SELECT) (4 October 2000).NCT00780689-S0000A: Prevention of Alzheimer's Disease by Vitamin E and Selenium (PREADVISE) (25 June 2002).NCT00784225-S0000B: Vitamin E and/or Selenium in Preventing Cataract and Age-Related Macular Degeneration in Men on SELECT SWOG-S0000 (SEE) (31 October 2008).NCT00706121-S0000D: Effect of Vitamin E and/or Selenium on Colorectal Polyps in Men Enrolled on SELECT Trial SWOG-S0000 (ACP) (26 June 2008).NCT00063453-S0000C: Vitamin E and/or Selenium in Preventing Loss of Lung Function in Older Men Enrolled on SELECT Clinical Trial SWOG-S0000 (26 June 2003).
AB - Background: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) was a randomized, double-blind, placebo-controlled, prostate cancer prevention study funded by the National Cancer Institute and conducted by SWOG (Southwest Oncology Group). A total of 35,533 men were assigned randomly to one of four treatment groups (vitamin E + placebo, selenium + placebo, vitamin E + selenium, placebo + placebo). At the time of the trial's development, NIH had invested substantial resources in evaluating the potential benefits of these antioxidants. To capitalize on the knowledge gained from following a large cohort of healthy, aging males on the effects of selenium and/or vitamin E, ancillary studies with other disease endpoints were solicited. Methods: Four ancillary studies were added. Each drew from the same population but had independent objectives and an endpoint other than prostate cancer. These studies fell into two categories: those prospectively enrolling and following participants (studies of Alzheimer's disease and respiratory function) and those requiring a retrospective medical record review after a reported event (cataracts/age-related macular degeneration and colorectal screening). An examination of the challenges and opportunities of adding ancillary studies is provided. The impact of the ancillary studies on adherence to SELECT was evaluated using a Cox proportional hazards model. Results: While the addition of ancillary studies appears to have improved participant adherence to the primary trial, this did not come without added complexity. Activation of the ancillary studies happened after the SELECT randomizations had begun resulting in accrual problems to some of the studies. Study site participation in the ancillary trials varied greatly and depended on the interest of the study site principal investigator. Procedures for each were integrated into the primary trial and all monitoring was done by the SELECT Data and Safety Monitoring Committee. The impact of the early closure of the primary trial was different for each of the ancillary trials. Conclusions: The ancillary studies allowed study sites to broaden the research opportunities for their participants. Their implementation was efficient because of the established infrastructure of the primary trial. Implementation of these ancillary trials took substantial planning and coordination but enriched the overall primary trial. Trial registration:NCT00006392-S0000: Selenium and Vitamin E in Preventing Prostate Cancer (SELECT) (4 October 2000).NCT00780689-S0000A: Prevention of Alzheimer's Disease by Vitamin E and Selenium (PREADVISE) (25 June 2002).NCT00784225-S0000B: Vitamin E and/or Selenium in Preventing Cataract and Age-Related Macular Degeneration in Men on SELECT SWOG-S0000 (SEE) (31 October 2008).NCT00706121-S0000D: Effect of Vitamin E and/or Selenium on Colorectal Polyps in Men Enrolled on SELECT Trial SWOG-S0000 (ACP) (26 June 2008).NCT00063453-S0000C: Vitamin E and/or Selenium in Preventing Loss of Lung Function in Older Men Enrolled on SELECT Clinical Trial SWOG-S0000 (26 June 2003).
KW - Ancillary studies
KW - Prostate cancer
KW - Randomized controlled trial
KW - Study implementation
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U2 - 10.1186/s13063-016-1524-9
DO - 10.1186/s13063-016-1524-9
M3 - Article
C2 - 27519183
AN - SCOPUS:84988442710
VL - 17
JO - Trials
JF - Trials
SN - 1745-6215
IS - 1
M1 - 400
ER -