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Socioeconomics affect participation in cancer clinical trials
Lower-income patients with cancer appeared considerably less likely than higher-income patients to participate in clinical trials, according to findings from a prospective survey study.
“Clinicians should be aware that lower-income patients are likely more sensitive about how to pay for clinical trial treatment, including direct costs like copays or coinsurance or indirect or hidden costs of clinical trial participation, such as taking time off work for extra clinic visits,” Joseph M. Unger, PhD, assistant member of the public health sciences division at the Fred Hutchinson Cancer Research Center, told HemOnc Today. “In an era of heightened public awareness about socioeconomic disparities in access to vital common resources, this finding represents an example where lower income individuals are facing barriers that could potentially be removed.”
Joseph M. Unger
Only a small percentage of adults with cancer participate in clinical trials; however, the role income disparities plays in trial participation has not been established, Unger and colleagues wrote.
Unger and colleagues previously analyzed socioeconomic and demographic factors in a single cross-sectional data set, and they determined patients with annual household incomes less than $50,000 were 27% less likely to participate in clinical trials. Although they considered the result provocative, they wanted to confirm the observation in prospectively collected data.
Unger and colleagues used data from a prospective cooperative group survey study that assessed barriers to clinical trial participation. The survey was conducted at eight cancer clinics from diverse geographic areas.
The analysis included patients with newly diagnosed breast, lung or colorectal cancers. Researchers collected income data and other patient characteristics, and they followed patients for up to 6 months to assess clinical trial participation.
The researchers identified 1,581 eligible patients, and the final analysis included 1,262 patients for whom complete income data were available.
Most patients were women (84%), aged younger than 65 years (71%) and not black (93%).
Results showed patients with an annual income below $50,000 were 32% less likely to participate in clinical trials than those with higher incomes (7% vs. 12%; OR = 0.68; 95% CI, 0.47-0.99).
Clinical trial participation decreased as annual household income decreased, peaking at 17% for those with an income of $50,000 or higher, then declining to 13% for patients with income of $20,000 to $49,999, and 11% for those with incomes less than $20,000 (OR = 0.75; 95% CI, 0.58-0.96).
If more lower-income patients participated in clinical trials, the trials would be more expeditious, which would help accelerate the development of new treatments.
“Future work should seek to clarify which specific costs are barriers, and to identify ways to help lower-income patients with those costs,” Unger said. – by Anthony SanFilippo
For more information:
Joseph M. Unger, PhD, can be reached at SWOG Statistical Center, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-C102, P.O. Box 19024, Seattle, WA 98109-1024; email: junger@fredhutch.org.
Disclosure: The researchers report no relevant financial disclosures.