Gaps in care highlight the need to expand access to clinical cancer trials

Abstract

Many of those who are the most likely to face a cancer diagnosis live in geographical parts of the United States with little or no access to cancer clinical trials according to a study published in JCO Oncology Practice.¹

In more than 1200 US counties, which are home to 43% of the population aged 55 years or older, cancer clinical trials were limited (1–99 trials) or lacking (zero trials). In addition, 26% of this population lived beyond an hour’s drive of a site with >100 trials.

Other factors associated with limited or no access to clinical trials included living in a nonmetropolitan county (85% had no trials vs. 44% of metropolitan counties) and living in a county with the highest cancer mortality (85% had no trials vs. 65% of those with lower cancer mortality). Social vulnerability (derived from US Census demographic and socioeconomic data) also was linked to limited access to clinical trials, with 26% of counties with high social vulnerability having at least one trial vs. 31% of those with lower social vulnerability.

Although the uneven spread of trials across the country with potential clusters around large cancer centers was expected, the lead author of the study, Kelsey Kirkwood, MPH, associate director and data scientist for the Center for Research and Analytics of the American Society of Clinical Oncology, says that she and her colleagues were “surprised by the few counties with broad portfolios of cancer trials where patients with uncommon cancer diagnoses might find suitable options.”

The study found that only 9% of all US counties (276 counties) had a broad portfolio of 100 clinical trials or more. Only 1 in 50 nonmetropolitan counties had broad trial portfolios, whereas 1 in 20 metropolitan counties did.

Kirkwood says that the study’s findings help to pinpoint where the gaps in care are to facilitate bringing cancer trials closer to patients and their communities.

“Care sites located in counties with limited or no trial offerings are potential places to expand reach and diversity of clinical trial participation,” she says, “especially in a time of technological advancements and building momentum for clinical trial decentralization.”

She and her colleagues also will be looking at regions with active trials in rural or minority communities as potential models for successful, diverse recruitment into clinical trials. “Our goal is to use these insights to support research sites across diverse geographic areas, aiming to improve representation so that trial participation better reflects the population of patients seeking cancer treatment,” she says.