Socioecological Factors Associated With Lung Cancer Clinical Trial Participation: Real-world California Cancer...

Racial/ethnic minority enrollment in oncological clinical trials (CT) remains a persistent priority. Using a population-based cancer registry, we identify whether modifiable policy-, health system-, and patient-domains are associated with CT enrollment.

We analyzed retrospective data from the Los Angeles Cancer Surveillance Program between 2002 and 2021 to identify lung cancer cases and receipt of treatment in a cancer protocol (CT enrollment vs. not enrolled). We assessed patient- (eg, Charlson comorbidity score, socioeconomic status, and insurance type), health system- (facility designated cancer center status), and policy- (2014 FDA guideline to report demographic CT enrollment data) domain levels of influence. We used a multivariable logistic regression model to identify these associations.

Only 0.88% (n = 599/68,245) of our cohort enrolled in a CT protocol. Individuals who were seen at cancer-designated facilities (CoC, NCI, NCCN) were significantly more likely to be enrolled in CT (OR = 5.57[3.69, 8.33]) compared to those not seen at a cancer-designated facility. We also found an inverse association between comorbidity categories and CT enrollment (OR: 1 vs. 0 = 0.72 [0.59, 0.88], 2 vs. 0 = 0.51 [0.37, 0.69], 3 + vs. 0 = 0.25 [0.16, 0.37]). Among Black individuals, those on Medicaid had lower odds of being enrolled in CT compared to those on Medicare (OR: 0.05 [95% CI, 0.01, 0.68]). This pattern was similar across all race/ethnicity groups (interaction P < .03).

Using population-based data, our findings underscore that racial/ethnic disparities in CT enrollment could be mitigated by addressing where individuals get cancer care, broadening comorbidity restrictions, and expanding cancer care research facilities in underserved areas.