Impact of travel costs on disparities in precision oncology clinical trials

Genotype-matched trial participation often requires referrals from institutions offering comprehensive genomic profiling (CGP) testing to those conducting these trials, entailing potential financial burdens. The impact of travel costs on trial participation remains unclear.

This retrospective cohort study (2020-2022) evaluated 1127 patients with metastatic solid tumors referred to a single cancer center for trial participation following CGP testing. Primary and secondary outcomes were participation in genotype-matched and genotype-nonmatched trials, respectively. Multivariable logistic regression assessed the association between travel costs and trial participation.

Of the 1127 patients, 127 (11%) participated in genotype-matched trials and 114 (10%) in genotype-nonmatched trials. The median travel cost (round-trip public transportation) was $17 (range $3-$982). Multivariable regression showed that patients with travel costs ≥$100 were significantly less likely to participate in genotype-matched trials than those with travel costs <$100 [7% versus 13%; odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.30-0.88]. Genotype-matched trial participation likelihood decreased as travel costs increased from <$100 to $100-200 and ≥$200 (13% versus 9% versus 6%; OR = 0.70, 95% CI 0.28-1.52; OR = 0.46, 95% CI 0.22-0.85). Travel costs did not affect genotype-nonmatched trial participation. Genotype-matched trial participants had a shorter median time from initial clinic appointment to trial participation than genotype-nonmatched trial participants (21 versus 31 days, P = 0.006).

Increased travel costs were associated with a decreased likelihood of genotype-matched trial participation after CGP testing, highlighting the need for reformed clinical trial platforms to alleviate financial travel burdens.