Rural–urban differences in discussions of cancer treatment clinical trials

Abstract

Objective Compare the characteristics of rural and urban callers to NCI’s Cancer Information Service (CIS), and explore the association of geographic location and discussion of cancer clinical trials. Methods Using CIS call data from 2006–2008, we assigned a rural or urban designation to caller ZIP codes using Rural-Urban Commuting Area Codes. Calls which discussed clinical trials were analyzed using univariate and multivariate analyses. Results The CIS received 227,579 calls from 2006–2008 where geographic location could be determined. Overall, 10.3% of calls included a discussion of clinical trials; there were significantly more discussions among urban dwellers than rural individuals (10.5% vs. 9.4%, respectively). Multivariate regression analyses supported the univariate findings. In addition, compared to other callers, patients (OR 5.58 [95% CI: 4.88,6.39]) and family and friends (6.26 [5.48,71.5]) were significantly more likely to discuss clinical trials. Conclusion Urban callers were more likely than their rural counterparts to discuss cancer treatment trials, placing individuals living in rural areas at a disadvantage in learning about and communicating with their providers about possible participation in clinical trials. Practice implications Through its multiple access points, the CIS can serve as an important source of clinical trials information for rural cancer patients, family members, and providers.

Factors associated with biomedical research participation within community‐based samples across 3 National Cancer Institute–designated cancer centers

“…To achieve diversity in biomedical research participation, health systems including safety‐net systems serving diverse populations need to have the capacity and willingness to engage with research at the institutional level. As noted in prior studies, lack of access to research‐intensive academic medical centers limits access to cutting‐edge research that potentially could reduce health disparities …”

“…As noted in prior studies, lack of access to research-intensive academic medical centers limits access to cutting-edge research that potentially could reduce health disparities. 8,9,11,17,27…”

“…7 Medical distrust, fear of research motives, a lack of awareness regarding the value of research, and clinician/researcher attitudes and perceptions are examples of individual-level barriers to research participation. 1,6,[8][9][10][11] System-level and institutional-level barriers such as a lack of a comprehensive platform to increase awareness and engagement among patients, restrictive eligibility criteria, a lack of access to medical care, and cost all impact familiarity, exposure, and participation in biomedical research, particularly for vulnerable populations. Likewise, underrepresentation in cancer clinical trials also extends to rural areas and people and communities with low socioeconomic status.…”

Rural–urban residence and cancer survival in high‐income countries: A systematic review

“…For example, patients living in rural areas had more unhealthy behaviors and were less likely to participate in colorectal cancer screening; differences in stage at diagnosis, the prevalence of comorbidities, and the treatment received, as well as access to oncology services and options for treatment, could also have contributed to lower survival from colorectal cancer in rural areas . A United States study showed that rural patients are less likely to receive information regarding participation in cancer treatment trials than urban residents, which may contribute to worse survival in rural and remote regions …”

Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients with Cancer

“…4,10,13–16 Racial and ethnic minorities — particularly African Americans — bear the greatest cancer burden in the United States, so they should be adequately represented in cancer research. 17–19 Under-representation of racial and ethnic minorities also limits the generalizability of research findings.…”