Clinical trial access in patients with pancreatic cancer (PC): A Pancreatic Cancer Action Network (PanCAN) patient survey.

Abstract

e23174 Background: PC is the third leading cause of cancer-related deaths in the US with a five-year survival rate of only 13%. Limited data suggest low rates of accrual among PC clinical trials, which are crucial avenues for advancing care and outcomes with this highly lethal malignancy. We sought to study clinical trial participation and identify potential impediments to trial access using a large patient survey. Methods: We partnered with PanCAN to administer this HIPAA-compliant survey electronically to patients and caregivers. Logistic regression was used to determine the association between patient-reported demographic and clinical characteristics and the odds of being offered and participating in a clinical trial. A multivariate model was built to include all characteristics that were statistically significant on univariate analysis (p < 0.05). Results: A total of 1,046 patients were included, of which, 284 (27.2%) were offered and 204 (19.5%) participated in clinical trials. On univariate analysis of age, gender, race, rural/urban residence, insurance status, stage and treatment facility type, only stage, treatment facility type and age were significant. On multivariate analysis, stage (p < 0.01), facility Type (p < 0.01), and age (p = 0.03) were significantly associated with odds of being offered a trial. Patients with stage II/III (OR = 1.50, 95% CI 1.04-2.18) and stage IV PC (OR = 2.36, 95% CI 1.56-3.53) had higher odds of being offered trials (compared to stage I). Compared to stage IV, patients with stage II/III PC had lower odds of being offered a trial (OR = 0.64, 95% CI 0.46-0.90). Patients at large community practices were also less likely to be offered trials than those at academic hospitals (OR = 0.47, 95% CI 0.34-0.64). A 1-year increase in age decreased the odds of being offered a trial by 2% (OR = 0.98, 95% CI 0.97-1.00). When analyzing trial participation, stage (p < 0.01) and facility Type (p < 0.01) emerged as significant predictors. Patients with stage IV PDAC patients had higher odds of participating in a trial compared to stage I (OR = 2.21, 95% CI 1.40-3.49), while stage II/III had lower odds of participating on a clinical trial compared to patients with stage IV PC (OR = 0.65, 95% CI 0.45-0.94). Patients at large community practices had lower odds of participating in a trial than those at academic hospitals (OR = 0.38, 95% CI 0.27-0.55). Conclusions: The current analysis highlights low rates of clinical trial availability among patients with PC, emphasizing the need for strategies to enhance access and enrollment. Stage of cancer and facility type were significantly associated with both the likelihood of being offered and participating in clinical trials. These findings underscore the need for improved trial access, especially for patients at community practices and those with earlier-stage disease.