Lower-Income Cancer Patients Less Likely to Participate in Clinical Trials

Newly diagnosed cancer patients with an annual income of less than $50,000 are 32% less likely to participate in clinical trials than patients with incomes over $50,000, according to a new prospective survey study published online in JAMA Oncology.

The finding is important because oncology clinical trials provide the best evidence for showing the efficacy of new cancer treatments, and the issue of income disparities in trial participation has not been addressed properly, notes Joseph M. Unger, PhD, of the Fred Hutchinson Cancer Research Center, lead author of the new study. Limiting income disparities is not only needed to ensure fair access to clinical trials and make the newest available treatments available to people of all income levels, but also to speed up enrollment, improve the generalizability of study outcomes, and to allow trials to be conducted more quickly, thus speeding the development of new treatments.

Dr Unger and his colleagues used data from a survey of adult patients with newly diagnosed breast, lung, or colorectal cancer. All patients were enrolled before making any treatment decisions and followed for 6 months to assess whether they participated in a clinical trial. Of the 1581 patients eligible for the study, data on annual income was available for 80% (1262) of the patients. Patients were predominantly younger than 65 years old, female, and not African American. Researchers adjusted for factors that could potentially influence trial participation rates: age, sex, race (self-reported), education, travel distance, and disease stage.

Trial participation among higher-income patients was 17% versus 12% among lower-income patients. Trial participation decreased as annual household income decreased from $50,000 or higher to between $20,000 and $49,999 and to less than $20,000 (17% versus 13% versus 11%, respectively).

“Lower-income patients are likely more sensitive to marginal financial expenditures than higher-income patients,” the authors wrote.

Incentives or reimbursements to patients for participating in the trials may be appropriate, the researchers state, but care must be taken that they not be coercive.

“One approach to alleviate the financial risk associated with clinical trial participation would be to cover the excess costs of participation, including copayments and coinsurance,” the authors suggested.

Direct compensation to clinical trial participants has also been recommended, as has consideration about time off needed from work, child care, and transportation in order to improve access to clinical trials for lower-income patients.

Future studies are needed to examine how to overcome financial barriers to clinical trial participation.