Millions of U.S. patients with cancer may face barriers to accessing some of the most advanced treatments being tested in clinical trials for their disease, according to a recent study published by Kirkwood et al in JCO Oncology Practice.
Background
“We need to support bringing clinical trials to where the patients live and receive their care, as opposed to leaving them with no choice but to travel for a trial,” stressed co–study author Ishwaria Subbiah, MD, MS, Executive Director of Cancer Care Equity & Professional Wellness at the Sarah Cannon Research Institute. “Clinical trials provide [patients] with access to new, novel treatments. Yet, whether someone can access a potentially life-saving trial is often determined by where they live rather than if they’d be a good fit and could benefit. We need to bridge this divide and ensure more [patients] with cancer can consider all the treatment choices available without being shut out because of location,” she continued.
Study Findings
In the 2023 State of Cancer Care in America Snapshot and accompanying infographic, investigators found that 70% of U.S. counties lacked a single active cancer treatment trial. About 25% of adults over 55 years—the age group most diagnosed with cancer—would have to travel over 2 hours round trip to access a trial site with wide cancer offerings.
Further, 90% of adult patients did not participate in clinical trials at all and only about 50% of all patients nationwide had access to a trial at their cancer care facility. Patients in rural areas, where just 10% of the nation’s oncologists practice, faced particular challenges accessing cancer clinical trials.
In addition to geographic disparities, the infographic also assessed the diversity of the oncology workforce—a critical element to reducing disparities in cancer care. The investigators noted that there are nearly 16,000 oncologists actively engaged in patient care in the United states, 50% of whom are White, 30% of whom are Asian, 5% of whom are Hispanic or Latino, and 3% of whom are Black. The workforce data also showed that 36% of oncologists are female.
Conclusions
"This information highlights the need for increasing workforce diversity. A diverse workforce is more likely to increase cultural humility and the ability to deliver high-quality care to a broad patient population,” underscored co–study author David M. Waterhouse, MD, MPH, Director of Early Phase Clinical Trials at the Oncology Hematology Care/Sarah Cannon Research Institute. “We need to introduce more students/early careers to oncology as early as possible so that more of them choose it as a career in the future," he concluded.
ASCO is committed to expanding access to clinical trials and diversifying the oncology workforce. An ASCO Task Force recently issued a call to action detailing practical steps to allow patients to participate in trials closer to their homes. Furthermore, the fourth year of ASCO’s Oncology Summer Internship program—a paid internship designed to introduce rising second-year medical students from populations underrepresented in medicine to the field of oncology—will launch in the spring of 2025.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
