美国癌症治疗试验的地理分布状况:研究是否位于患者居住地?

IF 4.7 3区 医学 Q1 ONCOLOGY JCO oncology practice Pub Date : 2024-10-02 DOI:10.1200/OP.24.00261
M Kelsey Kirkwood, Caroline Schenkel, Dominique C Hinshaw, Suanna S Bruinooge, David M Waterhouse, Jeffrey M Peppercorn, Ishwaria M Subbiah, Laura A Levit
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引用次数: 0

摘要

目的:在本研究中,我们描述了美国癌症治疗试验的地理分布情况,以确定差距和有针对性地改善癌症患者获得研究机会的机会:我们对在 ClinicalTrials.gov 上注册的美国 I-III 期癌症治疗试验开放注册的年份(2017-2022 年)的总体情况和各县的情况进行了统计,并补充了美国人口普查局、国家癌症研究所、美国疾病控制和预防中心以及美国农业部的数据。我们评估了试验可用性的地域差异。我们评估了人均试验次数的 5 年趋势,并绘制了试验点周围 1 小时车程范围的地图:结果:2022年,共有6,710项试验在1,836个地点开放注册。与2017年相比,试验增加了4%,而试验点每年人均减少了3%。2022年,美国70%的县没有报告活跃试验(2,211/3,143),占年龄≥55岁人口的19%。86%的非大都会县没有试验,而大都会县的这一比例为44%。各县的癌症死亡率和社会脆弱性(根据美国人口普查的人口和社会经济数据得出的指数)不同,试验的可获得性也不同。在没有试验的县中,有 18% 的县拥有肿瘤专家护理点(n = 618)。值得注意的是,在年龄≥55岁的人群中,有26%的人居住在距离试验点≥100个小时车程以外的地方:结论:美国大多数县的试验项目有限或根本没有,这种差距在非大都市、社会脆弱性高和癌症死亡率高的县中更为明显。需要努力促进不同医疗机构的参与,以促进公平的试验机会,并确保参与试验的患者符合获批后将接受干预的患者的特征。拥有肿瘤治疗点但没有试验的县提供了潜在的扩展区域。
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State of Geographic Access to Cancer Treatment Trials in the United States: Are Studies Located Where Patients Live?

Purpose: In this study, we describe the geographic distribution of US cancer treatment trials to identify disparities and opportunities for targeted improvements in access to research for people with cancer.

Methods: US-based phase I-III cancer treatment trials registered on ClinicalTrials.gov were tabulated for the years they were open to enrollment (2017-2022), overall and by county, and supplemented with data from the US Census Bureau, National Cancer Institute, Centers for Disease Control and Prevention, and US Department of Agriculture. We evaluated geographic differences in trial availability. We assessed 5-year trends in trials per capita and mapped 1-hour drive time areas around sites.

Results: A total of 6,710 trials were open to enrollment in 2022 across 1,836 sites. Trials increased by 4%, whereas sites decreased by 3% annually per capita from 2017. Seventy percent of US counties had no reported active trials in 2022 (2,211/3,143), representing 19% of people age ≥55 years. Eighty-six percent of nonmetropolitan counties had no trials versus 44% of metropolitan counties. Trial availability varied by county-level cancer mortality and social vulnerability (an index derived from demographic and socioeconomic data from the US Census). Eighteen percent of counties without trials had oncologist care sites (n = 618). Notably, 26% of people age ≥55 years lived beyond an hour drive of a site with ≥100 trials.

Conclusion: Most US counties have limited to no trial offerings, a disparity magnified in counties that are nonmetropolitan, with high social vulnerability, and with high cancer mortality. Effort to facilitate diverse site participation is needed to promote equitable access to trials and to ensure patients participating in trials match the characteristics of patients who will receive interventions once approved. Counties with oncology care sites but no trials provide potential expansion areas.

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