Nick Mulcahy

June 04, 2012

June 4, 2012 (Chicago, Illinois) — Clinical trials are not easily accessible to low-income and poor people, according to a study presented here at the 2012 Annual Meeting of the American Society of Clinical Oncology (ASCO).

Researchers found that income strongly predicts the likelihood that a patient will participate in a clinical trial. This even applied to patients older than 65 years, most of whom are covered by Medicare, report the researchers, led by Joseph M. Unger, MS, PhC, a health services researcher and statistician at the SWOG Statistical Center at the Fred Hutchinson Cancer Research Center in Seattle, Washington.

The researchers surveyed 5499 newly diagnosed cancer patients from 2007 to 2011.

Patients who reported an annual income below $50,000 were 27% less likely to participate in a clinical trial than those reporting a higher income. Patients who reported an annual income below $20,000 were 44% less likely to participate in clinical trials than those reporting a higher income.

In a multivariate analysis, the researchers controlled for age, education, sex, race, medical conditions, and distance to a clinic, and still found that income on its own was associated with clinical trial participation.

"It's important to understand why a lower income leads to diminished participation," Sylvia Adams, MD, from the New York University (NYU) School of Medicine in New York City, told Medscape Medical News. Dr. Adams is an ASCO spokesperson who was not involved in the study.

A cancer diagnosis hits low-income people "harder" than more affluent people, said Dr. Adams, who is the rare combination of a clinical trials investigator (in breast cancer and cancer immunotherapies) who works with many low-income patients. "I see patients who are mainly underserved minorities," she said about her work at Bellevue Hospital Center, NYU's public hospital.

Lower-income people tend to have less access to information, language barriers, child-care challenges, and fewer social and financial resources, she explained.

Dr. Adams believes that ASCO has resources that can help remedy the lower levels of clinical trial participation by lower-income patients; cancer.net, the ASCO-sponsored Web site, can be an educational resource for patient advocates and for patients about clinical trials, she noted.

The novelty of this study is that income was directly reported by patients, said Dr. Unger. The data source was a Web-based treatment decision tool used by patients. They were all newly diagnosed with breast, lung, colorectal, or prostate cancer, and all were older than 18 years.

"This is the first time in a large national study that we have actual patient-reported income on which to base this finding," Dr. Unger said in a press release.

Previous research has shown some association between cancer clinical trial enrollment and income, said Dr. Unger at a meeting press conference. However, the income measures were indirect, he said.

The study results hint at what keeps lower-income people from more robustly participating in clinical trials; concern about how to pay for participation was "much higher" among lower-income people, said Dr. Unger.

Dr. Adams sees a few bright spots in the study data.

Of all the patients surveyed, 40% had discussed clinical trials with their physicians; that's "very substantial," said Dr. Adams. Also, 45% of these discussions led to offers of clinical trial participation, and 51% of those offers led to enrollment in a clinical trial. Dr. Adams called the enrollment percentage "very reasonable." In the end, the overall clinical trial participation rate was 9%.

Dr. Unger has disclosed no relevant financial relationships. One coauthor reports being in an employment/leadership position with NexCura, which provided the online treatment decision tools. Dr. Adams reports financial ties to GlaxoSmithKline.

2012 Annual Meeting of the American Society of Clinical Oncology: Abstract CRA6009. Presented June 3, 2012.

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