Disparities in Lung Cancer Clinical Trial Discussion and Enrollment at a Safety Net Hospital

Abstract

Background: Boston Medical Center (BMC) is a safety net hospital that serves a diverse patient population with various socio-demographic backgrounds. It is crucial to understand whether such factors serve as barriers to care. Previous studies have investigated disparities among specific populations, such as African Americans, and have used the accounts of cancer survivors or oncologists, but few studies have addressed barriers that encompass multiple minority populations in a safety net hospital. This study investigates disparities in care regarding clinical trial discussion and enrollment in lung cancer patients. Methods: 1,121 patients with a diagnosis of lung cancer between January 2015 to December 2020 at BMC were included in this study. Electronic medical records were searched for keywords “clinical trial” or “enroll”, or by filtering oncology notes for “research encounter.” Each chart was reviewed for one of three categories: 1) clinical trial discussed and patient enrolled, 2) clinical trial discussed but patient not enrolled, 3) clinical trial not discussed. Socio-demographic variables such as age, gender, race, ethnicity, city, primary language, median household income, insurance, and education level were also collected. SPSS version 26.0 was used for chi-squared and t-test statistical analysis. Results: Of 1,121 patients, 50.4% were of minority race, 16.9% did not speak English, 8% were Hispanic, 70.6% had an education of high school or below, and 70.6% belonged to a lower median house-hold income (<$84,000). Clinical trial was discussed in 141 patients (12.6%) and of those, 22 (15.6%) were enrolled. Although clinical trial enrollement has been historically low at BMC, we enrolled more African American patients (50%). When looking at age, clinical trial discussions were conducted more with younger patients (68.19 vs 71.37, p=0.001). There was no significant difference in clinical trial discussion or enrollment between gender, race, ethnicity, primary language, median household income, insurance, or education level. Conclusion: Overall, BMC’s clinical trial discussion and enrollment rate were found to be similar across various socio-demographic factors. The only difference identified was clinical trials were discussed more with younger populations. This indicates that patients presenting with lung cancer to BMC experience minimal disparities in care regarding clinical trial discussion and enrollment.