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Lower-income patients less likely to participate in clinical trials

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CHICAGO — Lower-income patients were observed to be less likely to participate in clinical trials, even when making allowance for age, according to national survey of cancer patients.

Previous studies had demonstrated an association between socioeconomic status and quality of oncology care, but they failed to determine the impact of socioeconomic status on decision making about clinical trial participation.

“Only 2% to 3% of adult cancer patients participate in NCI-sponsored clinical trials. While clinical trial enrollment by age, race and sex has been well studied, participation by income is not well-studied, largely because patient low-income rates are rarely available,” Joseph M. Unger, MS, PhC, a health services researcher and statistician with the SWOG Statistical Center at the Fred Hutchinson Cancer Research Center in Seattle, said during a press conference. “Also, these studies typically have low accounting for patient medical conditions, which can be an important confounding factor.”

In order to assess patterns of clinical trial treatment decision making according to socioeconomic status and demographic issues, Unger and colleagues surveyed 5,499 newly-diagnosed cancer patients from 2007 to 2011 using a Web-based treatment decision tool in which patients reported their data.

Eligible patients had a new diagnosis of breast, lung, colorectal or prostate cancer, and they were aged more than 18 years old.

Of the 5,499 patients polled, 40% discussed clinical trial options with their physicians; 45% of discussions led to offers of clinical trial participation; and 51% of offers led to clinical trial participation. The overall clinical trial participation rate was 9%. In a multivariate model including all socioeconomic status and demographic factors — as well as the covariates comorbidity status and “distance-to-clinic,” a measurement of convenience — income remained a predictor of clinical trial participation (OR=0.73, 95% CI, 0.57-0.94; P=.01).

“This observation of lower clinical trial participation among lower-income patients was consistent even in the insured subpopulation of patients aged 65 or older who have access to Medicare, indicating that insurance access did not necessarily explain the findings,” Unger said.

“Since clinical trial treatments offer state-of-the-art treatments, this finding raises concern about whether all income levels have equal access to trials,” Unger added. “From the perspective of clinicians and researchers, better participation of lower-income patients could speed the conduct of clinical trials and better assure the applicability of clinical trial results to all income levels.”

For more information:

Unger  JM. Abstract #CRA6009. Presented at: the 2012 American Society of Clinical Oncology Annual Meeting; June 1-5, 2012; Chicago.

Disclosure: Dr. Burg reports an employment/leadership position with NexCura. Additional researchers on the study report no relevant financial disclosures.