Socioecological Factors Associated With Lung Cancer Clinical Trial Participation: Real-world California Cancer Registry Data
Abstract
INTRODUCTION
Racial/ethnic minority enrollment in oncological clinical trials (CT) remains a persistent priority. Using a population-based cancer registry, we identify whether modifiable policy-, health system-, and patient-domains are associated with CT enrollment.
PATIENT AND METHODS
We analyzed retrospective data from the Los Angeles Cancer Surveillance Program between 2002 and 2021 to identify lung cancer cases and receipt of treatment in a cancer protocol (CT enrollment vs. not enrolled). We assessed patient- (eg, Charlson comorbidity score, socioeconomic status, and insurance type), health system- (facility designated cancer center status), and policy- (2014 FDA guideline to report demographic CT enrollment data) domain levels of influence. We used a multivariable logistic regression model to identify these associations.
RESULTS
Only 0.88% (n = 599/68,245) of our cohort enrolled in a CT protocol. Individuals who were seen at cancer-designated facilities (CoC, NCI, NCCN) were significantly more likely to be enrolled in CT (OR = 5.57[3.69, 8.33]) compared to those not seen at a cancer-designated facility. We also found an inverse association between comorbidity categories and CT enrollment (OR: 1 vs. 0 = 0.72 [0.59, 0.88], 2 vs. 0 = 0.51 [0.37, 0.69], 3 + vs. 0 = 0.25 [0.16, 0.37]). Among Black individuals, those on Medicaid had lower odds of being enrolled in CT compared to those on Medicare (OR: 0.05 [95% CI, 0.01, 0.68]). This pattern was similar across all…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 599 participants or records.
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