Addressing clinical trial barriers in lung cancer: Patient-reported impact of resources on trial participation.

Abstract

e13561 Background: Despite being the leading cause of cancer-related death, patients (pts) with lung cancer have low participation rates in clinical trials. While participation barriers are well documented, accrual rates haven’t improved. To understand factors impacting pt decision making regarding clinical trial participation, we surveyed pts with lung cancer to identify support services that could facilitate participation. Methods: We developed an anonymous 16-item survey and distributed via the Lung Cancer Research Foundation database, social media, and pt support groups. The survey assessed demographics, stage, trial participation status, outcomes, and perceptions. We developed Likert scale questions to assess how each support resource influenced trial participation decisions. Free text responses were categorized. Analyses included descriptive statistics, Fisher’s exact tests, and logistic regression to predict the likelihood of trial participation. Results: 314 pts participated in this survey. Pt demographics included age (63% 18-64y, 37% 65y+), sex at birth (78% female), race/ethnicity (82% white, 18% non-white), sexual orientation (65% heterosexual, 34% LGBTQ/other), cancer stage (62% metastatic, 38% non-metastatic). 78% of pts report not participating in a therapeutic clinical trial; among the reasons given, 56% were never offered a trial, 27% held misperceptions regarding timing of trial discussion (only considered after cancer progression on standard therapy or as last resort), 10% report ineligibility. Other reasons included lack of study availability (6%), care delivery issues (8%), pt hesitancy (4%), travel distance (3%). 91% of pts ranked coordinating appointments/more flexible scheduling and increased access to study team as ‘likely or more’ to lead them to consent, while providing Uber/gas card/meals/parking or having a demographically representative study team ranked as not likely to influence consenting. On multivariate analysis, having a demographically representative medical team led to significantly higher likelihood of trial participation among non-white (60%) vs white pts (34%; OR 0.27, p = 0.002), and in LGBTQ/other (45%) vs heterosexual pts (35%; OR 5.07, p = 0.002). Analysis also showed higher likelihood of trial participation among women (OR 0.41), LGBTQ/other (OR 5.07), and non-white pts (OR 0.27) if provided a referral to support groups/educational resources (all p < 0.05). Conclusions: This study of pts with lung cancer demonstrates that flexible scheduling and trial team access drive clinical trial participation. Over half of non-participating patients reported never being offered a trial, and many misunderstood trial timing. Key interventions include improving team access and representation, flexible scheduling, and enhancing trial awareness throughout treatment, regardless of disease stage.