‘Substantial geographic disparities’ worsening in cancer clinical trial availability
Click Here to Manage Email Alerts
Geographic disparities in the availability of cancer clinical trials throughout the United States have worsened over time, according to study data published in JAMA Network Open.
Although the number of cancer clinical trials taking place has increased over the past decade, “minoritized and historically marginalized populations” are enrolled at a noticeably lesser rate, according to Rishi Robert Sekar, MD, MS, a Society of Urologic Oncology fellow at University of Michigan, and colleagues.
“Substantial geographic disparities in cancer clinical trials availability exist throughout the United States, with the most socially vulnerable counties being far less likely to have any trial and having only a fraction of trials available — a disparity that has worsened over time,” they wrote in a research letter. “This study contributes new perspectives to the role of [social determinants of health] in disparities in clinical trial participation by exploring community level measures of [social determinants of health] via [social vulnerability index (SVI)], providing a national-level analysis, and demonstrating trends over the past 15 years.”
Methodology
Sekar and colleagues conducted a cohort study to examine potential associations between county-level social determinants of health and clinical trial availability across the United States.
Researchers utilized data linkage from ClinicalTrials.gov, SEER and the CDC SVI as a county-level measure of social determinants of health to perform cross-sectional and longitudinal analyses.
They included phase 2 and 3 interventional trials from 2007 to 2022 for prostate, breast, lung, colorectal, bladder, uterine and kidney cancer and melanoma.
Two measures of trial availability served as the study’s primary outcomes: the presence of any trial within a county and the total number of trials within a county.
Study investigators stratified counties into SVI quintiles, with 1 being the least socially vulnerable and 5 being the most socially vulnerable. A time plot assisted in assessing trends regarding trial availability throughout the length of the study period.
Results, next steps
Among the 3,142 counties in the United States with a mean SVI of 0.5 and median population of 10,163 (interquartile range, 4,448–26,107) in the study, 144 counties (4.6%) had a Commission on Cancer hospital.
During the study period, 1,834 counties (58.4%) had any cancer clinical trial available. A multivariable analysis of 2,908 counties with an available SEER cancer incidence trial, the most socially vulnerable counties appeared to be less likely to have any trial (49.6% vs. 70%; OR = 0.33; 95% CI, 0.25-0.43) and had fewer population-adjusted trials (223.4 vs. 579.2; incidence rate ratio = 0.39; 95% CI, 0.28-0.53), when compared with the least socially vulnerable counties.
“Limitations of this study include not accounting for patient-level factors, patient travel beyond their county of residence, or the decision to enroll in a trial,” researcher wrote. “Despite these limitations, this study emphasizes the role of [social determinants of health] in the disparate availability of cancer clinical trials and demonstrates the need to identify socially vulnerable communities for expansion of trial opportunities toward improving representation in studies and ensuring equitable cancer care.”
Collapse
Read more about
Click Here to Manage Email Alerts