Geographic disparities in access to immunotherapy clinical trials for metastatic melanoma

Mulligan, Kathleen; Zheng, David X.; Xu, James R; Cullison, Christopher R.; Cwalina, Thomas B.; Beveridge, Mara; Scott, Jeffrey F.

doi:10.1007/s00403-022-02433-0

Cited by 7 publications

(2 citation statements)

References 13 publications

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“…5,13 Studies have also identified underrepresentation in CTs among older patients 14 and those living in rural areas. 15,16 The federally funded Canadian Partnership Against Cancer has called for research to better understand the barriers in the CT system to increase access for underrepresented populations. 17 Such measurement has also been identified by the American Society of Clinical Oncology as a key mechanism for reducing cancer disparities.…”

Section: Introductionmentioning

confidence: 99%

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Disparities in clinical trial enrollment at a Canadian comprehensive cancer center: A 15‐year retrospective study

Shapiro,

Santiago,

Pittman

et al. 2024

Cancer

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IntroductionDisparities in clinical trials (CTs) enrollment perpetuate inequities in treatment access and outcomes, but there is a paucity of Canadian data. The objective of this study was to examine disparities in cancer CT enrollment at a large Canadian comprehensive cancer center.MethodsRetrospective study of CT enrollment among new patient consultations from 2006 to 2019, with follow‐up to 2021 (N = 154,880), with the primary outcome of enrollment as a binary variable. Factors associated with CT enrollment were evaluated using multivariable Bayesian hierarchical logistic regression with random effects for most responsible physician (MRP) and geography, adjusted for patient characteristics (sex, age, language, geography, and primary care provider [PCP]), area‐level marginalization (residential instability, material deprivation, dependency, and ethnic concentration), disease (cancer site and stage), and MRP (department, sex, language, and training). A sensitivity analysis of the cumulative incidence of enrollment was conducted to account for differences in disease type and follow‐up length.ResultsCT enrollment was 11.2% overall, with a 15‐year cumulative incidence of 18%. Lower odds of enrollment were observed in patients who were female (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.78–0.86), ≥65 years (AOR vs. <40, 0.61; 95% CI, 0.56–0.66), non‐English speakers (0.72; 95% CI, 0.67–0.77), living ≥250 km away (AOR vs. <15 km, 0.71; 95% CI, 0.62–0.80), and without a PCP. Disease characteristics accounted for the largest proportion of observed variation (20.8%), with significantly greater odds of enrollment in patients with genitourinary cancers and late‐stage disease.ConclusionSignificant sociodemographic disparities were observed, suggesting the need for targeted strategies to increase diversity in access to cancer CTs in Canada.

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Section: Introductionmentioning

confidence: 99%

“…Furthermore, reviews of CTs leading to drug approvals by the FDA over the last decade found that women made up fewer than 40% of participants overall 5,13 . Studies have also identified underrepresentation in CTs among older patients 14 and those living in rural areas 15,16 …”

Section: Introductionmentioning

confidence: 99%