How Sociodemographics, Presence of Oncology Specialists, and Hospital Cancer Programs Affect Accrual to Cancer Treatment Trials

TLDR

Ongoing partnership with professional societies may be an effective approach to strengthen accrual to clinical trials. The study examined how socioeconomic factors, the number of oncologists, and the presence of approved cancer programs influence accrual to NCI‑sponsored cancer treatment trials, aiming to identify ways to increase enrollment, particularly among older adults. The authors used national data to identify 24,332 NCI‑sponsored trial participants and then analyzed accrual patterns across age, sex, geography, insurance, socioeconomic proxies, oncologist availability, and multidisciplinary cancer program presence. Accrual was high for pediatric patients but low after adolescence; Black, Asian‑American, and Hispanic adults had lower enrollment than white peers; suburban counties and higher socioeconomic areas had the greatest accrual; enrolled patients were less likely uninsured and more likely Medicare; and both the number of oncologists and the presence of approved cancer programs were positively associated with trial enrollment, underscoring the need to boost participation among older adults.

Abstract

We chose to examine the impact of socioeconomic factors on accrual to National Cancer Institute (NCI)-sponsored cancer treatment trials.We estimated the geographic and demographic cancer burden in the United States and then identified 24,332 patients accrued to NCI-sponsored cancer treatment trials during a 12-month period. Next, we examined accrual by age, sex, geographic residence, health insurance status, health maintenance organization market penetration, several proxy measures of socioeconomic status, the availability of an oncologist, and the presence of a hospital with an approved multidisciplinary cancer program.Pediatric patients were accrued to clinical trials at high levels, whereas after adolescence, only a small percentage of cancer patients were enrolled onto clinical trials. There were few differences by sex. Black males as well as Asian-American and Hispanic adults were accrued to clinical trials at lower rates than white cancer patients of the same age. Overall, the highest observed accrual was in suburban counties. Compared with the United States population, patients enrolled onto clinical trials were significantly less likely to be uninsured and more like to have Medicare health insurance. Geographic areas with higher socioeconomic levels had higher levels of clinical trial accruals. The number of oncologists and the presence of approved cancer programs both were significantly associated with increased accrual to clinical trials.We must work to increase the number of adults who enroll onto trials, especially among the elderly. Ongoing partnership with professional societies may be an effective approach to strengthen accrual to clinical trials.