Travel time linked to participation in genotype-matched cancer trials
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Key takeaways:
- Longer travel time appeared associated with lower participation in genotype-matched clinical trials.
- Decentralized trials and other interventions may help reduce travel burden for trial participants.
Greater travel time appeared associated with reduced participation in genotype-matched clinical trials among patients with cancer who underwent comprehensive genomic profiling, according to results of a study conducted in Japan.
The findings — which researchers believe translate to other regions, including the United States — highlight the need for more research into strategies that may reduce travel burdens for trial participants, investigators concluded.
“As genotype-matched trials become increasingly pivotal in the era of precision oncology, geographic disparities in participation emphasize the potential need for interventions to address these inequities,” researcher Yuji Uehara, MD, medical oncologist at the National Cancer Center Hospital in Japan, told Healio. “Potential interventions might include financial assistance programs or the decentralization of clinical trials.”
Background and methods
Genotype-matched trials require referrals from institutions that offer comprehensive genomic profiling testing to clinical trial sites.
Trial participation often is associated with considerable travel burden, according to study background.
Uehara and colleagues assessed whether travel distance or time appeared associated with participation in genotype-matched clinical trials among patients who underwent comprehensive genomic profiling.
“Recent research on geographic disparities has primarily concentrated on access to standard therapies and general cancer clinical trials,” Uehara said. “Yet, in this precision oncology era, the effects of geographic disparities on participation in genotype-matched trials after [comprehensive genomic profiling] are still unexplored.”
The retrospective cohort study included patients with advanced or metastatic solid tumors referred to National Cancer Center Hospital in Japan for participation in genotype-matched trials between June 2020 and June 2022. Study participants received trial referrals after comprehensive genomic profiling and discussion by molecular tumor boards.
Enrollment in genotype-matched trials served as the primary endpoint. Enrollment in all-cancer clinical trials served as a secondary endpoint.
Results
The analysis included 1,127 patients (mean age, 62 years; range, 16-85; 52% women), all of whom lived in Japan. Results showed 127 (11%) enrolled in genotype-matched trials and 241 (21%) enrolled in all-cancer clinical trials.
Trial participants had a median travel distance of 38 km (range, 21-107) and median travel time of 55 minutes (range, 35-110).
Multivariable regression that accounted for 23 covariates showed travel distance ( 100 km vs. < 100 km) did not correlate significantly with likelihood of participation in genotype-matched trials (OR = 0.64; 95% CI, 0.4-1.02).
However, patients who reported median travel time of 120 minutes or more appeared significantly less likely than those with shorter travel time to participate in genotype-matched trials (OR = 0.51; 95% CI, 0.29-0.84).
Likelihood of participation in genotype-matched trials declined as travel time increased (OR for < 40 minutes vs. 40 to 120 minutes = 0.74 95% CI, 0.48-1.17; OR for < 40 minutes vs. > 120 minutes = 0.41; 95% CI, 0.22-0.74).
Researchers observed no associations between travel time or travel distance and likelihood of all-cancer clinical trial participation.
“Increased travel time was found to be significantly associated with a decreased likelihood of participation in genotype-matched trials,” Uehara told Healio. “It suggests that geographic disparities are associated with inequities in precision oncology, and an inequity in accessibility to these trials poses an ethical problem.
“Surprisingly, longer travel distances showed only a modest association with a reduced likelihood of participation in such trials,” Uehara added. “Also, prior research has not established a definitive association between travel distance and participation in cancer clinical trials. Thus, when evaluating geographic disparities in precision oncology, travel time might be a more suitable indicator of travel burden than travel distance.”
Implications and next steps
Despite the limitations inherent in a single-country study, the findings could be applicable to the United States and other regions, Uehara told Healio.
“This research was conducted at the largest cancer center in Japan and showed rates of participation in genotype-matched trials comparable to those observed in the United States, according to previous research,” Uehara said. “Additionally, other studies have reported geographic disparities in cancer care, such as access to cancer screening or oncofertility services in the U.S. This suggests that similar disparities might exist in the context of genotype-matched trial participation.”
Several questions must be addressed in future research, Uehara said.
“We did not evaluate factors such as travel cost, marital status and educational status, all of which might influence genotype-matched trial participation,” Uehara said. “Additionally, we did not take into account insurance status, which could also be associated with participation in the U.S. Further investigations are required to explore these associations.
“Moreover, many cancer centers worldwide are conducting decentralized trials,” Uehara added. “After these are firmly implemented, it will be important to determine if the association between travel time and genotype-matched trial participation has been mitigated.”
For more information:
Yuji Uehara, MD, can be reached at yuueha2@ncc.go.jp.
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