Social Vulnerability Hinders Clinical Trial Participation in Gastrointestinal Cancer Surgery Patients

This study examines how neighborhood social vulnerability impacts clinical trial participation for gastrointestinal (GI) cancer surgery patients.

Clinical trials are critical to cancer care but often exclude disadvantaged groups.

The Vizient Clinical Database (CDB), which captures 98% of academic medical centers, 110+cancer hospitals and 700+community hospitals, was queried for gastroesophageal, pancreatic, and colorectal cancer patients who underwent surgical resection from July 2018-June 2023. The Vizient Vulnerability Index (VVI), comprised of 9 census tract-level domains, was used to study the association between social vulnerability and trial participation.

399,446 patients were identified, 7,680 (1.9%) of whom participated in a clinical trial. Clinical trial participants were less likely to be socially vulnerable (OR 0.71, P<0.0001), particularly in the VVI domains of economic and education, and to have undergone resection at a community hospital (OR 0.38, P<0.0001). High social vulnerability decreased the odds of enrollment for patients who underwent surgery at community hospitals by a greater degree than those who underwent surgery at academic/specialized centers (OR 0.52 vs. 0.75; P<0.0001 for interaction). Trial participants were less likely to be female (OR 0.84, P<0.0001), Black (OR 0.69, P=0.0002), and have Medicaid insurance (OR 0.81, P<0.0001).

Among gastrointestinal cancer surgery patients, female sex, Black race, Medicaid insurance, and neighborhood social vulnerability, particularly economic and education vulnerability, were associated with lower odds of clinical trial enrollment. The factor that most inhibited trial enrollment was surgery at a community hospital, and this influence was compounded by social vulnerability.