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Women in Thoracic Surgery

47. National Enrollment of Lung Cancer Clinical Trials is Disproportionate Based on Race and Health Care Access

May 6, 2023

103rd Annual Meeting, the Los Angeles Convention Center, Los Angeles, CA, USA
Los Angeles Convention Center, 408B
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Despite declining lung cancer mortality in the United States, there are still inordinate differences in survival rates of racial and ethnic minorities. Financial barriers have also been shown to affect lung cancer screening rates with those in the lowest socioeconomic status (SES) having higher risk of death. Improvements in lung cancer treatment can be obtained through clinical trials, yet it has been shown there are disparities in clinical trial enrollment of other cancer types. The purpose of this study was to evaluate disparities in clinical trial enrollment specifically in lung cancer to aid in future enrollment initiatives.

We identified patients diagnosed with lung cancer from 2004-2018 in the National Cancer Database. Patients were categorized in two groups: enrolled and not enrolled in clinical trial based on the "rx_summ_other" data element. We evaluated clinical, demographic, and institutional characteristics associated with trial enrollment using bi- and multivariate analysis adjusting for clustering at the institutional level.

Among 1.7 million patients with lung cancer, 7813 (0.5%) patients enrolled in clinical trials. Patients enrolled in clinical trials were more likely to have higher SES levels and identified as non-Hispanic White (n=6064, 83.5%) compared to non-Hispanic Black (n=722, 9.2%) and Hispanic (n=201, 2.6%, p<0.001). Black patients were the most disproportionally represented racial group when comparing ratios of those diagnosed with lung cancer to trial enrollment. Enrolled patients were more frequently treated at academic programs (n=3358, 43%, p<0.001), had private insurance (n=2397, 31%) or Medicare (n=4392, 56%), p<0.001), and travelled further for treatment compared to unenrolled patients (36 miles (CI 33-39) vs 27 miles (CI 27.1-27.4), p<0.001).

After adjusting for demographic and clinical factors, lung cancer trial enrollment was significantly less likely among Blacks and Hispanics, patients with Medicaid or uninsured, or treatment received at community-based cancer programs (Table). Patients in the lowest SES group were the least likely to enroll (OR 0.82, CI 0.7-0.9, p<0.001).

Enrollment in lung cancer trials disproportionally excludes black patients, those in the lowest SES, community cancer programs, and the uninsured and underinsured. These disparities in demographic and clinical trial access for trial participation suggest a need for improved enrollment strategies.

Minyoung Kwak (1), Aria Bassiri (1), Boxiang Jiang (1), Jonathan Hue (1), Jillian Sinopoli (1), Leonidas Tapias Vargas (1), Philip Linden (1), Christopher Towe (1), (1) University Hospitals Cleveland Medical Center, Cleveland, OH

Daniel Boffa

Invited Discussant

I am a thoracic surgeon in New Haven Connecticut, who focuses on the surgical managment of benign and malignant diseases of the lung and esophagus.  I conduct research in health policy, comparative effectiveness and biomarkers.  I am interested in quality in complex care and work with the Commission on Cancer's quality improvement effort.  

Minyoung Kwak

Abstract Presenter

Current thoracic surgery fellow at UH/Case Western Reserve University, expected graduation in summer 2024.  My professional interests include thoracic oncology, minimally-invasive surgery, oncoimmunology, social determinants of health, and heathcare equity.  When I am not at work, I enjoy the outdoors, live music, visual and performance arts, and potluck dinners.

Specialties: Multi-Specialty, General Interests of CardioThoracic Surgeons, Ethics, Professional Affairs, Ethics, General Thoracic, Thoracic, Lung, Anatomy and Conditions, Lung--Cancer, Lung--Other, Treatment/Procedure/Operation/Surgery, Lung, Lung--Cancer, Lung--Other