Clinical trials more accessible to rural areas, but barriers still persist
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Key takeaways:
- Higher percentages of the U.S. population live closer to clinical trial sites than they did a decade ago.
- Decentralization could help improve access more in rural communities.
CHICAGO — More individuals with advanced cancers in the U.S. live within 30 miles of a clinical trial site than a decade ago, but those in rural areas, those with pancreatic disease and American Indians/Alaskan Natives still have access issues.
According to data presented at ASCO Annual Meeting and simultaneously published in JAMA Oncology, 65.7% of patients with metastatic pancreatic cancer reside within 30 miles of a relevant clinical trial site.
The rates have gone up considerably compared with those published in 2015 for patients with breast cancer (81.8% vs. 45.6%), prostate cancer (81.5% vs. 50.2%) and colorectal cancer (62.9% vs. 52.2%), and overall lung (82%) compared favorably to what had been reported for non-small cell lung cancer (38.4%).
“This actually surprised me,” Wade Swenson, MD, MPH, MBA, FACP, oncologist/hematologist at Lakewood Health Systems and Stevens Community Medical Center, and founder and president of Rural Cancer Institute, told Healio. “This is more access than I thought there would be, but I really feel like we have a long way to go, and I think looking at something that might disrupt the market such as direct-to-patient clinical trials may be that piece that would help.”
‘A striking difference’
Swenson and colleagues investigated geographic proximity to clinical trial sites using the clinicaltrials.gov database. They examined trials open on Nov. 25, 2022, actively recruiting individuals for breast, prostate, colorectal, lung and pancreatic cancer.
The overall results encouraged Swenson, but racial inequities and his own experiences still highlighted persistent problems.
Between 40.9% and 60.8% of American Indian or Alaskan Natives lived within 30 miles of a trial site depending on their cancer, while at least 84% of Asians did.
“In Minnesota where I practice, we do have a lot of natives, but they tend not to be within our health system,” Swenson said.
“I would drive about an hour in a couple different directions to be at a reservation and they have a different health system,” he added. “We have reached out and tried to potentially develop some relationships to work on these issues, and we’re still in the early conversations about that. I don’t know their willingness to necessarily integrate into our health system to try to fix a perceived problem like this, but it’s a major issue that needs to be addressed. It’s a striking difference.”
Swenson also noted that the clinical trial sites in his group’s analysis may not all have been active.
“There’s a trial next to my hometown where I actually called that trial site — they weren’t open,” he said. “This is based on what we have from clinicaltrials.gov, but when I dug into it a little bit further, it wasn’t necessarily trial centers open for patients to enroll in.”
From collaboration to decentralization
Swenson sees more access for individuals in rural areas than he did several years ago, but he also has dealt with the difficulties associated with living away from more populated areas.
Healio previously reported on the AACR Cancer Disparities Progress Report 2024, which found individuals who live in either nonmetropolitan or rural areas had a 38% higher incidence of and mortality risk from lung cancer than those who live in metropolitan and urban areas.
“I was at a rural practice for 17 years where we had a clinical trial nurse, we would screen 200 consecutive patients and not have patients who were eligible for a trial,” he said.
Swenson added later, “It’s not uncommon for us to put a patient on trial and we can’t send a sample in because we can’t find dry ice in our town, or we can’t do the labs. They require the patients travel to the main site for labs, where it would be so easy to do some of those things. Just looking at this from a patient perspective and a provider perspective, we need to rethink how we administrate clinical trials.”
Collaboration with larger cancer centers can be extremely beneficial.
“We’re 4 hours from Mayo Clinic, and a third of our patients go to Mayo at some point in their care,” Swenson said. “It’s very informal, but it works. They do a great job of collaborating, and they do a great job of communicating with us and the patient. I don’t know if it needs to be anything formalized necessarily, as long as there’s a good working relationship.”
Swenson believes decentralization with direct-to-patient and virtual trials could be the key to unlocking access to these underserved communities.
“As a rural oncologist, as a community oncologist, we’re looking for trials we can enroll patients in — ideally a phase 3 trial, where there’s some evidence behind it and patients are more willing to consider enrolling,” he said.
“It’s a different dynamic when you’re driving to a clinical trial site or you’re a rural patient. You’re really looking for value in that clinical trial,” he added. “There is room for improvement here. The existing infrastructure for clinical trials has definitely improved in the last decade, according to this [study], and I believe that’s true. We have ability now to transform delivery in clinical trials and that will continue to improve.”
For more information:
Wade Swenson, MD, MPH, MBA, FACP, can be reached at drswenson@lakewoodhealthsystem.com or wade@ruralcancer.org.
References:
American Association for Cancer Research. AACR Cancer Disparities Progress Report 2024. Available at: https://cancerprogressreport.aacr.org/disparities/. Published May 15, 2024. Accessed June 3, 2024.
Swenson W, et al. Abstract 11048. Presented at: ASCO Annual Meeting 2024; May 31-June 4, 2024; Chicago.
Swenson WT, et al. JAMA Oncol. 2024;doi:10.1001/jamaoncol.2024.1690.
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Swenson W, et al. Abstract 11048. Presented at: ASCO Annual Meeting; May 31-June 4, 2024; Chicago.
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