Bolstering access to clinical trials: Sociodemographic characteristics of patients enrolled in interventional clinical trials within a large, NCORP-designated community oncology practice setting.

Abstract

1523 Background: Access to clinical trials is an important aspect of cancer care given rapidly changing treatment paradigms.Most patients with cancer including those belonging to racial/ethnic minoritized groups are treated in community oncology settings, but only a minority ( < 5%) of these patients are enrolled on clinical trials. Barriers to trial enrollment in community oncology settings have been well described at the patient, provider, and system levels. The National Cancer Institute Community Oncology Program (NCORP) aims to address these barriers- and improve equity in trial enrollment- by providing support and infrastructure for community oncology practices to conduct clinical trials. Kaiser Permanente Northern California (KPNC) is a large integrated health system comprising thirty cancer trial sites and is part of the Kaiser Permanente NCORP, one of the largest NCORP-designated sites. In this study, we compared sociodemographic characteristics of patients enrolled in interventional trials with the overall cancer population within KPNC. Methods: We evaluated all patients enrolled on interventional cancer clinical trials within KPNC between 1/1/2015-12/31/2022. We abstracted demographic and clinical characteristics from the KPNC cancer registry. We compared characteristics to the incident cancer population diagnosed over the study period across KPNC. We used Pearson chi squared tests (categorical), binomial tests (binary) and one-sample t tests (continuous) to compare sociodemographic characteristics. Results: We identified 1,341 patients who were enrolled onto interventional clinical trials and compared them to 97,764 patients diagnosed with cancer over the study period. Patients enrolled on interventional trials were younger (mean age 60.2 vs 62.9 years, p < 0.001), more likely to have Stage IV disease (22.7% vs 11.2%, p < 0.001), more likely to reside in high-socioeconomic status neighborhoods (27.7 vs 23.8%, p < 0.001), and less likely to speak a language other than English (4.7 vs 7.1%, p < 0.001). There were no differences in race, ethnicity or sex distributions between the trial population and overall population. Conclusions: Across a large NCORP-designated community oncology trials program, the racial and ethnic makeup of patients enrolled on trials was similar to the broader cancer population within KPNC. These findings suggest that the trial infrastructure provided by NCORP may surmount the structural barriers that drive low access to trials among racial/ethnic minorities. Small differences in enrollment based on age, language and socioeconomic factors persisted. Efforts to bolster clinical trial portfolios in community oncology settings may address existing barriers to enrollment.