Potential Barriers to Participating in Cancer Moonshot Biobank for Low-Income Patients with Cancer of Rural Maine

Background: The National Cancer Institute's Cancer Moonshot Biobank (CMB) aims to accelerate research on tumor sensitivity and resistance to standard-of-care therapies through collection and distribution of longitudinal biospecimens donated by research participants with cancer. Since low participation among historically underserved populations limits the generalizability of research done with biospecimens, CMB supports local community engagement activities. Objectives: We assessed the factors for enrollment in CMB and related precision oncology trials among rural, low-income adults with cancer who are served by the multi-site MaineHealth Cancer Care Network (MHCCN). We sought to address barriers thus identified. Methods: From October 2021 to May 2022, semi-structured interviews with MHCCN clinical research coordinators (4), oncologists (6), and patients (15) elicited perceived facilitators and barriers to participating in CMB and related trials for low-income rural Mainers. We developed a descriptive model of the steps by which patients become CMB participants based on reports from research coordinators. Factors impacting recruitment were identified at each step. Results: Rural clinics have limited staff to monitor patient lists and collect samples. Many oncologists were skeptical of clinical benefit and correspondingly reluctant to recruit vulnerable patients. Patients were generally open to CMB if recommended by their oncologist but expressed concerns that involvement in CMB or related research would consume limited time, lead to another biopsy, or threaten privacy. Conclusion: Addressing barriers for low-income, rural residents improves access for everyone. To reduce staff burden within a health system, better resourced sites can provide infrastructure and personnel support to sites with fewer resources. Education may correct misunderstandings and improve awareness of the benefits of CMB and related research involvement among research staff, oncologists, and patients.