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Research Letter |

Patient Income Level and Cancer Clinical Trial Participation A Prospective Survey Study

Joseph M. Unger, PhD1; Julie R. Gralow, MD2; Kathy S. Albain, MD3; Scott D. Ramsey, MD4,5; Dawn L. Hershman, MD6
[+] Author Affiliations
1SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
2Seattle Cancer Care Alliance, University of Washington, Seattle
3Loyola University, Chicago Stritch School of Medicine, Maywood, Illinois
4University of Washington Medical Center, Seattle
5Fred Hutchinson Cancer Research Center, Seattle, Washington
6Columbia University, New York, New York
JAMA Oncol. 2016;2(1):137-139. doi:10.1001/jamaoncol.2015.3924.
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This survey finds that lower patient income level is associated with lower likelihood of clinical trial participation.

Cancer clinical trials provide the best evidence for showing the efficacy of new treatments. However, only a small percentage of adult patients with cancer participate in clinical trials.1 The issue of income disparities in clinical trial participation has been poorly addressed; limiting income disparities is important for ensuring rapid enrollment and fair access to trials. Our research group previously found that patients with annual household incomes below $50 000 were 27% less likely to participate in clinical trials.2 This provocative result was derived from one of many analyses of demographic and socioeconomic factors within a single, cross-sectional data set and so was considered hypothesis generating. The confirmation of this finding with prospectively collected data is critical for affirming its validity.

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Figure.
Odds of Clinical Trial Participation For Lower-Income Patients (<$50 0000/y) by Each Factor Included in the Multivariable Regression Model

Each square represents an odds ratio (OR), and each horizontal line is the 95% CI. The vertical line is the line of equal odds. For lower-income individuals, the odds of clinical trial participation were consistently lower (that is, to the left of the line of equal odds) within nearly all subgroups of all the factors included in this analysis. Only some of these findings are statistically significant, likely due to limited power. There was no statistical evidence that the association of income and clinical trial participation differed according to any of the covariates (interaction P > .15 in all cases).

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