Effect of Patient Socioeconomic Status on Access to Early-Phase Cancer Trials

Noor, Aisyah Mohd; Sarker, Debashis; Vizor, S.; McLennan, Blair Kp; Hunter, Sarah; Suder, Aneta; Møller, Henrik; Spicer, James; Papa, Sophie

doi:10.1200/jco.2012.45.0999

Cited by 48 publications

(28 citation statements)

References 28 publications

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“…Recently, the Clinical Trials Transformation Initiative (CTTI), a public-private partnership of more than 60 organizations from across the clinical trial enterprise, released a set of recommendations to guide study teams on how to efficiently and effectively plan for clinical trial recruitment (31). Attention should also be paid to enhancing accrual for minority and underserved patients who may otherwise be underrepresented, particularly in early phase trials (32, 33). Although more research is needed to further develop the evidence base for accrual, a number of resources and a curated library of relevant journal articles are available at NCI’s AccrualNet website (34, 35).…”

Section: Discussionmentioning

confidence: 99%

Challenges Facing Early Phase Trials Sponsored by the National Cancer Institute: An Analysis of Corrective Action Plans to Improve Accrual

Massett

Mishkin

Rubinstein

et al. 2016

Clinical Cancer Research

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Section: Discussionmentioning

confidence: 99%

Challenges Facing Early Phase Trials Sponsored by the National Cancer Institute: An Analysis of Corrective Action Plans to Improve Accrual

Massett

Mishkin

Rubinstein

et al. 2016

Clinical Cancer Research

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“…Hence, it can be assumed that an unbalanced distribution of GPs could translate into health inequities [38, 39]. A mismatched distribution of GPs constitutes a major challenge for public and community health.…”

Section: Discussionmentioning

confidence: 99%

General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

Bauer

Brueggmann

Ohlendorf

et al. 2016

BMC Health Serv Res

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BackgroundGeographical variation of the general practitioner (GP) workforce is known between rural and urban areas. However, data about the variation between and within urban areas are lacking.MethodWe analyzed distribution patterns of GP full time equivalents (FTE) in German cities with a population size of more than 500,000. We correlated their distribution with area measures of social deprivation in order to analyze preferences within neighborhood characteristics. For this purpose, we developed two area measures of deprivation: Geodemographic Index (GDI) and Cultureeconomic Index (CEI).ResultsIn total n = 9034.75 FTE were included in n = 14 cities with n = 171 districts. FTE were distributed equally on inter-city level (mean: 6.49; range: 5.12–7.20; SD: 0.51). However, on intra-city level, GP distribution was skewed (mean: 6.54; range: 1.80–43.98; SD: 3.62). Distribution patterns of FTE per 10^4 residents were significantly correlated with GDI (r = −0.49; p < 0.001) and CEI (r = −0.22; p = 0.005). Therefore, location choices of GPs were mainly positively correlated with 1) central location (r = −0.50; p < 0.001), 2) small household size of population (r = −0.50; p < 0.001) and 3) population density (r = 0.35; p < 0.001).ConclusionIntra-city distribution of GPs was skewed, which could affect the equality of access for the urban population. Furthermore, health services planners should be aware of GP location preferences. This could be helpful to better understand and plan delivery of health services. Within this process the presented Geodemographic Index (GDI) could be of use.

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“…This is consistent with prior studies which have demonstrated that of patients who were successfully screened for phase I trials and who met eligibility criteria, age was not an independent factor of enrollment. (28, 29)…”

Section: Discussion/conclusionmentioning

confidence: 99%

The Role of Age on Dose-Limiting Toxicities in Phase I Dose-Escalation Trials

Schwandt

Harris

Hunsberger

et al. 2014

Clinical Cancer Research

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Purpose Elderly oncology patients are not enrolled in early phase trials in proportion to the numbers of geriatric patients with cancer. There may be concern that elderly patients will not tolerate investigational agents as well as younger patients resulting in a disproportionate number of dose-limiting toxicities (DLTs). Recent single-institution studies provide conflicting data on the relationship between age and DLT. Experimental Design We retrospectively reviewed data about patients treated on single-agent, dose-escalation, phase I clinical trials sponsored by the Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute. Patients’ dose levels were described as percentage of maximum tolerated dose (%MTD), the highest dose level at which <33% of patients had a DLT, or recommended phase II dose (RP2D). Mixed-effect logistic regression models were used to analyze relationships between the probability of a DLT and age and other explanatory variables. Results Increasing dose, increasing age, and worsening performance status (PS) were significantly related to an increased probability of a DLT in this model (p<0.05). There was no association between dose level administered and age (p=0.57). Conclusions This analysis of phase I dose-escalation trials involving over 500 patients older than 70 years of age, is the largest reported. As age and dose level increased and PS worsened, the probability of a DLT increased. While increasing age was associated with occurrence of DLT, this risk remained within accepted thresholds of risk for phase I trials. There was no evidence of age bias on enrollment of patients on low or high dose levels.

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Effect of Patient Socioeconomic Status on Access to Early-Phase Cancer Trials

Cited by 48 publications

References 28 publications

Challenges Facing Early Phase Trials Sponsored by the National Cancer Institute: An Analysis of Corrective Action Plans to Improve Accrual

Challenges Facing Early Phase Trials Sponsored by the National Cancer Institute: An Analysis of Corrective Action Plans to Improve Accrual

General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

The Role of Age on Dose-Limiting Toxicities in Phase I Dose-Escalation Trials

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