Disparities in the clinical trial participation of adult cancer patients

Abstract

9524 Background: Only 2–4% of newly diagnosed adult cancer patients participate in clinical trials, and the reasons for low participation are unclear. Methods: We conducted a cross-sectional study of clinical trial participation including 1,839 cancer patients (breast, colorectal, lung, and prostate) in Wisconsin. Covariates of interest included demographic (age, gender, race, marital status), economic (employment status, income level, education) and clinical (type of malignancy, modality of treatment, use of alternative therapies, influence of cancer support groups) factors as well as satisfaction with care. Chi-square tests were calculated for participation in clinical trials and whether patients were told about clinical trial options. Results: Patient participation in clinical trials varied by cancer site: breast cancer (9.8%), colorectal cancer (11.0%), lung cancer (11.6%) and prostate cancer (2.5%). Of the patients that did not participate in a clinical trial, 60% reported they were not told about trials as a treatment option. Overall, clinical trial participation did not vary according to age, income, education, or employment status. Sample size limitations prevented adequate analysis of the association between race/ethnicity and trial participation. Factors that were associated with an increase in participation were increased time traveled for care (breast p=0.02, lung p=0.04), living in a more rural setting (lung p=0.009), treatment with chemotherapy (breast p=0.007, colorectal p=0.001, lung p=0.03), openness to alternative therapies (breast p=0.05, colorectal p=0.004), and having treatment decisions influenced by support groups (breast p=0.05, lung p=0.02). Additionally, patients were less likely to be told about participation in a clinical trial if they were not satisfied with the care they received (colorectal p=0.009, lung p=0.001, prostate p=0.03). Conclusions: While participation in clinical trials among cancer patients remains low, it is alarming that 60% of the subjects in our study who did not participate in a trial stated they were not told that clinical trials were a treatment option. Patient satisfaction with care and cancer specific support groups, among other factors, appears to be related with participation in clinical trials. No significant financial relationships to disclose.