Lower income patients less likely to participate in cancer clinical trials

June 03, 2012

MAYWOOD, Il. -- Lower-income cancer patients are less likely to participate in cancer clinical trials, according to a study co-authored by Loyola University Medical Center oncologist Kathy Albain, MD, FACP. Patients with incomes of less than $50,000 per year were 27 percent less likely than higher-income patients to participate in clinical trials, and those with incomes less than $20,000 were 44 percent less likely to participate. Fifty-three percent of patients with incomes less than $20,000 per year expressed concerns about their costs of participating in clinical trials. By comparison, only 24 percent of patients earning more than $100,000 per year expressed concerns over cost. Results were presented during the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago.

"We must be more vigilant in educating our lower-income patients about the value of participating in clinical trials," Albain said. "We also need to do a better job addressing misperceptions they may have about the costs of participating in clinical trials, and present all options available to them for reimbursement."

Albain chaired the committee that developed and designed the study. The study was a collaboration between SWOG (formerly known as the Southwest Oncology Group) and NexCura®. SWOG is a clinical trials network supported largely by the National Cancer Institute. NexCura, until its recent sale, had run an online treatment decision tool that many cancer advocacy organizations made available to patients.

Researchers did an online survey of 5,499 patients who were newly diagnosed with breast, prostate, lung or colorectal cancers. Overall, 9 percent of these patients participated in clinical trials. Income was the only socioeconomic or demographic factor that was significantly associated with participation in clinical trials.

Clinical trials give cancer patients access to new drugs, new treatment approaches and other investigational treatments before they are widely available -- while ensuring patients receive, at the minimum, the best standard of care. Patients also receive care at leading health care sites.

The National Cancer Institute says that costs for patients who participate in clinical trials are not appreciably higher than costs for patients who do not participate. Nevertheless, the study found that cost still was a significant concern among lower-income patients. Researchers said lower-income patients may be more sensitive to direct costs, such as co-pays and co-insurance, and indirect costs, such as time off from work for extra clinic visits.

Albain said it is critically important that all segments of society receive the benefits of clinical trials. Moreover, including all segments of the population is necessary to ensure the validity of the findings. "If a whole segment is missing or is under represented in a clinical trial, we won't know whether the findings will hold up for that segment," she said
Albain is a professor in the Division of Hematology/Oncology in the Department of Medicine of Loyola University Chicago Stritch School of Medicine. Co-authors are Joseph Unger (first author), Carol Moinpour, Judy Petersen and John Crowley of the SWOG Statistical Center, Fred Hutchinson Cancer Research Center; Dawn Hershman of Columbia University Medical Center; and Kendra Burg of NexCura.

Loyola University Health System

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