Regional disparities in cancer biomarker knowledge and access across Canada.

Abstract

e13547 Background: Clinical trials are essential to the advancement of cancer therapies, yet accrual rates remain low. Multiple challenges contribute to the less than 5% enrollment rate of patients onto clinical trials. The Clinical Trials Navigator (CTN) program identified a key factor as the lack of biomarker knowledge across Canada. Methods: Between May 2024 and October 2024, an electronic survey was conducted among Canadian oncologists to assess the knowledge and accessibility of biomarkers in different regions across the country. A comprehensive biomarker list approved for funding by Cancer Care Ontario was used as a reference standard. Physicians were asked to identify accessible biomarkers from this list. Results: A total of 36 physicians responded to the survey, predominantly from Ontario (21), followed by British Columbia (7), Alberta (3), Manitoba (2), Québec (1), Nova Scotia (1), and Newfoundland and Labrador (NFL) (1). Regional biomarker knowledge varied. ER, PR and HER2 for breast cancer were reliably identified by 18/18 physicians. Colorectal cancer biomarkers also displayed high levels of knowledge and accessibility, with 16/16 physicians reporting awareness of MLH1, MSH2, and MSH6. Lung, hematological, and pancreatic cancers were also well represented. In contrast, biomarker knowledge and accessibility for adrenal, penile, and stomach cancers were substantially lower. Among these three cancer types, 11 physicians only identified 1 (HPV) out of the 6 available biomarkers (EBER for stomach, HPV for penile, MLH1, MSH2/6, PMS2 for adrenal), highlighting gaps in advanced testing knowledge. Geographic disparities in biomarker knowledge and access revealed significant variability across Canada. NFL reported the highest accessibility (86%), although this was based on one physician respondent, limiting generalizability. Ontario had the largest number of respondents (21) and reported an overall knowledge rate of 60%. This reflects educational gaps rather than accessibility, as all biomarkers in the survey were accessible. British Columbia (67%), Manitoba (77%), and Nova Scotia (85%) also demonstrated notable knowledge and accessibility, albeit with smaller sample sizes. Conversely, some provinces, including Alberta (54%), displayed the least overall biomarker knowledge and accessibility. Conclusions: Our survey identified significant physician-reported regional disparities in biomarker accessibility and knowledge across Canada. While certain biomarkers, such as those for breast and colorectal cancers, are reported to be widely accessible, gaps are evident in biomarker testing for rare cancers. Our findings illustrate the need for targeted educational initiatives and improved resource allocation to ensure equitable biomarker access nationwide. Enhanced knowledge and accessibility to biomarker testing can improve clinical trial enrollment rates, ultimately advancing cancer care outcomes.