Patient Income Level and Cancer Clinical Trial Participation

TLDR

Socioeconomic status is linked to oncology care quality, yet its influence on clinical trial participation remains poorly understood, underscoring the need to identify income‑related barriers to broaden trial accessibility and improve generalizability. The study aimed to evaluate how income, education, and demographic factors affect clinical trial participation among a large cohort of patients using an Internet‑based treatment decision tool. Researchers conducted logistic regression analyses on data from 5,499 patients surveyed between 2007 and 2011, assessing attitudes toward trials and conditioning on cancer type. In a survey of 5,499 patients, only 9% ultimately enrolled in clinical trials, and lower income was a significant independent predictor of non‑participation (OR 0.73), with cost concerns disproportionately affecting lower‑income patients and persisting even among those with Medicare coverage.

Abstract

Studies have shown an association between socioeconomic status (SES) and quality of oncology care, but less is known about the impact of patient SES on clinical trial participation.We assessed clinical trial participation patterns according to important SES (income, education) and demographic factors in a large sample of patients surveyed via an Internet-based treatment decision tool. Logistic regression, conditioning on type of cancer, was used. Attitudes toward clinical trials were assessed using prespecified items about treatment, treatment tolerability, convenience, and cost.From 2007 to 2011, 5,499 patients were successfully surveyed. Forty percent discussed clinical trials with their physician, 45% of discussions led to physician offers of clinical trial participation, and 51% of offers led to clinical trial participation. The overall clinical trial participation rate was 9%. In univariate models, older patients (P = .002) and patients with lower income (P = .001) and education (P = .02) were less likely to participate in clinical trials. In a multivariable model, income remained a statistically significant predictor of clinical trial participation (odds ratio, 0.73; 95% CI, 0.57 to 0.94; P = .01). Even in patients age ≥ 65 years, who have universal access to Medicare, lower income predicted lower trial participation. Cost concerns were much more evident among lower-income patients (P < .001).Lower-income patients were less likely to participate in clinical trials, even when considering age group. A better understanding of why income is a barrier may help identify ways to make clinical trials better available to all patients and would increase the generalizability of clinical trial results across all income levels.