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February 24, 1989

The Cost to Patients of Participating in Clinical Trials-Reply

Author Affiliations

National Cancer Institute Bethesda, Md

National Cancer Institute Bethesda, Md

JAMA. 1989;261(8):1151. doi:10.1001/jama.1989.03420080064025

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In Reply.—  The fact that most insurance contracts explicitly exclude the patient-care costs of clinical trials of investigational agents is an important disincentive for physicians and patients to participate in trials. The extent to which insurance companies enforce the research exclusion is variable, but there are disquieting signs that this tendency is increasing. The National Cancer Institute, together with concerned investigators and members of public interest groups, has begun a dialogue with segments of the insurance industry that will, we hope, lead to a continuation of the productive working relationship that has existed for years and enabled the entry of suitable patients into clinical trials.Despite this obstacle, however, many important trials in oncology are conducted with conventional agents (for example, most breast adjuvant studies). Most clinical investigators have experienced little or no problem with insurance reimbursement to patients in trials where no investigational drug is involved. Currently, the cooperative