Most U.S. cancer trials conducted in more affluent, less diverse areas
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Key takeaways:
- Most cancer clinical trials conducted in the U.S. occur in more affluent areas that have higher proportions of white individuals.
- New York ranked as city with most hospitals in diverse areas.
Most of the major cancer clinical trial centers in the U.S. are located near more affluent and white populations compared with the national average, according to results published in JAMA Oncology.
Catchment populations of the centers investigated had a median annual income almost $20,000 above the national average.
“Our study identified biases in the sociodemographics of populations within 1-hour commuting distance to U.S.-based cancer clinical trial sites,” Tobias Janowitz, MD, PhD, associate professor at Cold Spring Harbor Laboratory, told Healio.
Background and methodology
Healio recently reported on an examination of trial enrollment, which noted white individuals (7.2%) participated more than Black (4.4%) and Latinx (4.2%) individuals.
Edward S. Kim, MD, MBA, FACP, FASCO, an associate medical editor for Healio | HemOnc Today, and vice physician-in-chief and professor in the department of medical oncology and therapeutics research at City of Hope National Medical Center, said during a Friends of Cancer Research webinar in February, “We have to create a lot of easy buttons for folks in order to participate meaningfully in these clinical trials.”
Building diversity includes having established centers near underserved areas.
Janowitz and colleagues wanted to determine the sociodemographics of current major cancer clinical trial centers and how that could play a part in the disparity.
“We felt that it was important to use available data and a quantitative approach to get an overview of the population distributions around clinical trial centers,” Janowitz said.
Researchers used data from the 2020 U.S. Census and American Community Survey, as well as several other organizations including the national trial registry at nct.gov and National Cancer Institute–designated Cancer Centers list, for their longitudinal quantitative study.
They measured population distributions on data between 2006-2020 based on socioeconomic deprivation indices and self-reported race within 30-minute, 1-hour and 2-hour, one-way commutes to 78 major cancer centers across the country, and they compared them with the national average.
The 78 centers conduct roughly 94% of the nation’s cancer trials, Janowitz said.
Results and next steps
Catchment areas within 30 minutes of major cancer centers had more affluent populations with lower deprivation indices compared with the mean US county population.
Populations in these areas had significantly higher median annual income (+$18,900 unpaired mean difference; 95% CI, $15,700-$22,400).
These areas had a higher proportion of white residents compared with the mean U.S. county population (+10.1% unpaired mean difference; 95% CI, 6.8%-13.7%).
White individuals comprised more than half of the catchment areas of 61 cancer trial sites, Asian/multiracial/other individuals made up more than 50% of three locations, and Black individuals comprised more than half of one center’s area.
Researchers filtered the top 20th and 50th percentiles of locations based on the diversity score of their catchment areas, and New York and Houston ranked as the top two cities with the most hospitals in diverse locations. Chicago and Dallas also appeared in the top five of both lists.
Study investigators hope these methods can help other researchers recruit more diverse trial participants, but Janowitz said they will have to be tested prospectively.
“Clinical trials should be accessible to all,” Janowitz said in a press release. “We offer a new approach for these and other sites to use available data in designing more equitable clinical trials.”
References:
- Better cancer trials could be around the corner (press release). Available at: https://www.cshl.edu/better-cancer-trials-could-be-around-the-corner/. Posted March 21, 2024. Accessed March 21, 2024.
- Lee H, et al. JAMA Oncology. 2024;doi:10.1001/jamaoncol.2023.7314.
For more information:
Tobias Janowitz, MD, PhD, can be reached at janowitz@cshl.edu.
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