A recent analysis by Hassal Lee, MD, PhD, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, and colleagues showed that one-way commuting distance is a key barrier to clinical trial enrollment for people who self-identify as a racial minority or socioeconomically disadvantaged. These findings were presented at the ASCO 2023 Annual Meeting in Chicago, IL.

Lee and colleagues used several databases, including the 2020 US Census, OpenStreetMaps, National Clinical Trial registry, and National Cancer Institute Designated Cancer Centers list, to identify these sociodemographic populations and calculate their one-way commuting distance to US cancer clinical trial centers. The commuting time cutoff was from half an hour to two hours’ travel to the center, and they conducted an R analysis, using Ggplot2 for the data visualizations. Their goal was to analyze the geographic distribution of these patient populations who are currently underrepresented in clinical trial enrollment in the US.

The researchers narrowed their analysis down to 78 high-volume trial centers based on clinical trial numbers between 2012 and 2022. Compared to the national average, these centers were in more socioeconomically affluent areas (+$27.6K USD; 95% confidence interval [CI], 23.1K-32.8K) with a greater proportion of self-identified White residents (+10.1% unpaired mean difference; 95% CI, 6.8%-13.7%). The range of absolute sum difference for equal racial representation of White, Black, and Asian/Mixed/Other groups at the top tenth percentile of all US hospitals (N = 7,623) was 2.4% to 35%. Lee and colleagues also generated map overlays for US cities with populations over 500,000 to show all prospective hospitals within the commuting distance cutoffs for racially diverse and socioeconomically disadvantaged populations.

“Our analysis identifies biases in the sociodemographics of populations living within commuting distance to US-based cancer trial sites and enables the determination of more equitably commutable prospective satellite hospital sites that could be mobilized for enhanced racial and socioeconomic representation in clinical trials,” the authors wrote, and the overlay maps they generated could help inform clinical trial design and enrollment strategies. However, they acknowledged that there are other trial recruitment barriers that need to be overcome in order to ensure equitable trial participant representation.

Source:

Lee H, Bates A, Marshall A, Callier S, Chambwe N, Janowitz T. Analysis and optimization of equitable US cancer clinical trial center access by travel time. Presented at the 2023 ASCO Annual Meeting; June 2-6, 2023; Chicago, IL, and virtual; Abstract 6524.