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Breast cancer clinical trial participation among diverse patients at a comprehensive cancer center
This study was designed to determine the enrollment patterns in breast cancer clinical trials (CCTs) of patients with diverse backgrounds in an equal access setting and to evaluate the factors contributing to low rates of clinical trial accrual in patients of low socioeconomic status (SES). We perfo...
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Published in: | NPJ breast cancer 2024-08, Vol.10 (1), p.70-5, Article 70 |
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description | This study was designed to determine the enrollment patterns in breast cancer clinical trials (CCTs) of patients with diverse backgrounds in an equal access setting and to evaluate the factors contributing to low rates of clinical trial accrual in patients of low socioeconomic status (SES). We performed a retrospective review of a prospectively maintained database of new patients seen at the Dan L. Duncan Comprehensive Cancer Center dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCTs. We compared the rate of CCT availability, eligibility, and enrollment between two patient populations: Smith Clinic, where most patients are of low SES and uninsured, and Baylor St. Luke’s Medical Center (BSLMC) with mostly predominantly insured, higher income patients. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the differences in CCT enrollment. More patients were eligible for CCTs at Smith Clinic (53.7% vs 44.7%,
p
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p
< 0.001). However, Smith Clinic patients were more likely to decline CCT enrollment compared to BSLMC (61.3% declined vs 39.4%,
p
< 0.001). On multivariate analysis, Black patients had a significantly higher rate of CCT refusal overall (OR = 0.26, 95% CI 0.12–0.56,
p
< 0.001) and BSLMC only (OR = 0.20, 95% CI 0.060–0.60,
p
= 0.006). Our data shows that it is likely an oversimplification to assume that equal access will lead to the elimination of CCT disparities. Efforts to diversify CCTs must include consideration of structural and institutional inequities as well as social needs.</description><identifier>ISSN: 2374-4677</identifier><identifier>EISSN: 2374-4677</identifier><identifier>DOI: 10.1038/s41523-024-00672-0</identifier><identifier>PMID: 39097576</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/4028/67/1347 ; 692/700/478 ; Biomedical and Life Sciences ; Biomedicine ; Breast cancer ; Cancer Research ; Cell Biology ; Clinical trials ; Human Genetics ; Oncology</subject><ispartof>NPJ breast cancer, 2024-08, Vol.10 (1), p.70-5, Article 70</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c422t-f23f13e06f067639a4401c97baecc0e438490966976ebc96ee1295ff92e95aa73</cites><orcidid>0000-0002-9700-3616</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/3087617351/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3087617351?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25751,27922,27923,37010,37011,44588,53789,53791,74896</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39097576$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Podany, Emily L.</creatorcontrib><creatorcontrib>Bulsara, Shaun</creatorcontrib><creatorcontrib>Sanchez, Katherine</creatorcontrib><creatorcontrib>Otte, Kristen</creatorcontrib><creatorcontrib>Ellis, Matthew J.</creatorcontrib><creatorcontrib>Kinik, Maryam</creatorcontrib><title>Breast cancer clinical trial participation among diverse patients at a comprehensive cancer center</title><title>NPJ breast cancer</title><addtitle>npj Breast Cancer</addtitle><addtitle>NPJ Breast Cancer</addtitle><description>This study was designed to determine the enrollment patterns in breast cancer clinical trials (CCTs) of patients with diverse backgrounds in an equal access setting and to evaluate the factors contributing to low rates of clinical trial accrual in patients of low socioeconomic status (SES). We performed a retrospective review of a prospectively maintained database of new patients seen at the Dan L. Duncan Comprehensive Cancer Center dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCTs. We compared the rate of CCT availability, eligibility, and enrollment between two patient populations: Smith Clinic, where most patients are of low SES and uninsured, and Baylor St. Luke’s Medical Center (BSLMC) with mostly predominantly insured, higher income patients. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the differences in CCT enrollment. More patients were eligible for CCTs at Smith Clinic (53.7% vs 44.7%,
p
< 0.001). However, Smith Clinic patients were more likely to decline CCT enrollment compared to BSLMC (61.3% declined vs 39.4%,
p
< 0.001). On multivariate analysis, Black patients had a significantly higher rate of CCT refusal overall (OR = 0.26, 95% CI 0.12–0.56,
p
< 0.001) and BSLMC only (OR = 0.20, 95% CI 0.060–0.60,
p
= 0.006). Our data shows that it is likely an oversimplification to assume that equal access will lead to the elimination of CCT disparities. Efforts to diversify CCTs must include consideration of structural and institutional inequities as well as social needs.</description><subject>692/4028/67/1347</subject><subject>692/700/478</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Breast cancer</subject><subject>Cancer Research</subject><subject>Cell Biology</subject><subject>Clinical trials</subject><subject>Human Genetics</subject><subject>Oncology</subject><issn>2374-4677</issn><issn>2374-4677</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9kk1v1DAQhiMEolXpH-CAInHhEhh_xI5PCCo-KlXiAmdr4ky2XiX2Ymcr8e_xbsrScuBiWzOvH89rvVX1ksFbBqJ7lyVruWiAywZAad7Ak-qcCy0bqbR--uB8Vl3mvAUAJlVnWva8OhMGjG61Oq_6j4kwL7XD4CjVbvLBO5zqJfmy7jAt3vkdLj6GGucYNvXg7yhlqg9FCkuucamxdnHeJbqlkEv7RCt9Si-qZyNOmS7v94vqx-dP36--NjffvlxffbhpnOR8aUYuRiYI1FjsKGFQSmDO6B7JOSApOlmmVspoRb0ziohx046j4WRaRC0uquuVO0Tc2l3yM6ZfNqK3x0JMG3u0M5E12Pa8o04o5FIzMohMQu9aPQwwdFBY71fWbt_PNByMJJweQR93gr-1m3hnWRlKG-gK4c09IcWfe8qLnX12NE0YKO6zFdBpZYxUqkhf_yPdxn0K5a9WFdOiZUXFV5VLMedE42kaBvYQCbtGwpZI2GMk7MHHq4c-Tlf-BKAIxCrIpRU2lP6-_R_sb7Ljwio</recordid><startdate>20240803</startdate><enddate>20240803</enddate><creator>Podany, Emily L.</creator><creator>Bulsara, Shaun</creator><creator>Sanchez, Katherine</creator><creator>Otte, Kristen</creator><creator>Ellis, Matthew J.</creator><creator>Kinik, Maryam</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><general>Nature Portfolio</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-9700-3616</orcidid></search><sort><creationdate>20240803</creationdate><title>Breast cancer clinical trial participation among diverse patients at a comprehensive cancer center</title><author>Podany, Emily L. ; Bulsara, Shaun ; Sanchez, Katherine ; Otte, Kristen ; Ellis, Matthew J. ; Kinik, Maryam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-f23f13e06f067639a4401c97baecc0e438490966976ebc96ee1295ff92e95aa73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>692/4028/67/1347</topic><topic>692/700/478</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Breast cancer</topic><topic>Cancer Research</topic><topic>Cell Biology</topic><topic>Clinical trials</topic><topic>Human Genetics</topic><topic>Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Podany, Emily L.</creatorcontrib><creatorcontrib>Bulsara, Shaun</creatorcontrib><creatorcontrib>Sanchez, Katherine</creatorcontrib><creatorcontrib>Otte, Kristen</creatorcontrib><creatorcontrib>Ellis, Matthew J.</creatorcontrib><creatorcontrib>Kinik, Maryam</creatorcontrib><collection>SpringerOpen</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>NPJ breast cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Podany, Emily L.</au><au>Bulsara, Shaun</au><au>Sanchez, Katherine</au><au>Otte, Kristen</au><au>Ellis, Matthew J.</au><au>Kinik, Maryam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Breast cancer clinical trial participation among diverse patients at a comprehensive cancer center</atitle><jtitle>NPJ breast cancer</jtitle><stitle>npj Breast Cancer</stitle><addtitle>NPJ Breast Cancer</addtitle><date>2024-08-03</date><risdate>2024</risdate><volume>10</volume><issue>1</issue><spage>70</spage><epage>5</epage><pages>70-5</pages><artnum>70</artnum><issn>2374-4677</issn><eissn>2374-4677</eissn><abstract>This study was designed to determine the enrollment patterns in breast cancer clinical trials (CCTs) of patients with diverse backgrounds in an equal access setting and to evaluate the factors contributing to low rates of clinical trial accrual in patients of low socioeconomic status (SES). We performed a retrospective review of a prospectively maintained database of new patients seen at the Dan L. Duncan Comprehensive Cancer Center dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCTs. We compared the rate of CCT availability, eligibility, and enrollment between two patient populations: Smith Clinic, where most patients are of low SES and uninsured, and Baylor St. Luke’s Medical Center (BSLMC) with mostly predominantly insured, higher income patients. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the differences in CCT enrollment. More patients were eligible for CCTs at Smith Clinic (53.7% vs 44.7%,
p
< 0.001). However, Smith Clinic patients were more likely to decline CCT enrollment compared to BSLMC (61.3% declined vs 39.4%,
p
< 0.001). On multivariate analysis, Black patients had a significantly higher rate of CCT refusal overall (OR = 0.26, 95% CI 0.12–0.56,
p
< 0.001) and BSLMC only (OR = 0.20, 95% CI 0.060–0.60,
p
= 0.006). Our data shows that it is likely an oversimplification to assume that equal access will lead to the elimination of CCT disparities. Efforts to diversify CCTs must include consideration of structural and institutional inequities as well as social needs.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>39097576</pmid><doi>10.1038/s41523-024-00672-0</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-9700-3616</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | 692/4028/67/1347 692/700/478 Biomedical and Life Sciences Biomedicine Breast cancer Cancer Research Cell Biology Clinical trials Human Genetics Oncology |
title | Breast cancer clinical trial participation among diverse patients at a comprehensive cancer center |
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