Few Counties With High Cancer Mortality Had Trials

TOPLINE:

A greater percentage of counties with the highest cancer mortalities had no trials vs counties with the lowest cancer mortalities. No trials occurred in 85% of high-mortality counties and 82% of counties with more than one measure of social vulnerability, specifically.

METHODOLOGY:

• Researchers analyzed US-based phase 1-3 cancer treatment trials registered on ClinicalTrials.gov from 2017 to 2022.
• A total of 6710 trials were open to enrollment in 2022 across 1836 sites, with data supplemented from the US Census Bureau, National Cancer Institute, Centers for Disease Control and Prevention, and US Department of Agriculture.
• Geographic differences in trial availability were evaluated, including 5-year trends in trials per capita and mapping 1-hour drive time areas around sites.
• Counties were categorized by trial availability: No trials, limited portfolio (1-99 trials), or broad portfolio (≥ 100 trials).
• The study included data on population, land area, rurality, social vulnerability, cancer incidence, cancer mortality, and oncologist presence.

TAKEAWAY:

• No trials occurred in 65% of those counties ranked as being of the lowest three quartiles in terms of cancer mortality.
• Less than 9% of counties had a broad portfolio ≥ 100 trials, representing 48% of the population aged ≥ 55 years.
• More than 70% of US counties had no active cancer treatment trials in 2022, representing 19% of the population aged ≥ 55 years.
• Counties with oncology care sites but no trials represent potential areas for expanding trial reach and diversity.
• The number of active oncology trials increased by 4% annually from 2017 to 2022, but the number of sites per person decreased by 3% annually.

IN PRACTICE:

“[C]ounties with care sites that currently have limited or no research infrastructure represent places with the potential to expand research because of the presence of oncologists. Strategies to reduce existing barriers to running trials will be needed to engage these clinicians in research, however, such as addressing complex trial designs, regulatory burdens, resource needs, and training and support of providers,” the authors of the study wrote.

SOURCE:

This study was led by M. Kelsey Kirkwood, MPH, of the American Society of Clinical Oncology in Alexandria, Virginia, and colleagues. It was published online in JCO Oncology Practice.

LIMITATIONS: 

The study’s limitations included the lack of control groups and potential biases in data collection and interpretation. The geographic focus on US counties may limit the generalizability of the findings to other regions. Additionally, the reliance on ClinicalTrials.gov data may have resulted in underreporting of trial sites, potentially biasing the results.

DISCLOSURES:

David M. Waterhouse, MD, MPH, disclosed receiving consulting fees from multiple pharmaceutical companies, including Bristol Myers Squibb, AbbVie, and Merck. Jeffrey M. Peppercorn, MD, MPH, is the editor in chief of JCO Oncology Practice and was recused from the peer review of this manuscript. Ishwaria M. Subbiah, MD, MS, reported receiving research funding from Bayer, Novartis, Pfizer, and other companies. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.