Disparities in clinical trial participation in ovarian cancer: A real-world analysis

• Published in: Gynecologic oncology 2023-08, Vol.175, p.25-31
• Main Authors: Smith, Anna Jo Bodurtha, Alvarez, Rafael, Heintz, Jonathan, Simpkins, Fiona, Ko, Emily M.
• Format: Article
• Language: English
• Subjects: Aged; Black or African American; Cohort Studies; Female; Healthcare Disparities; Humans; Medicare; Ovarian Neoplasms - therapy; Retrospective Studies; United States
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2023.05.066

Significant disparities exist in clinical trial participation in non-gynecologic cancers, but little is known about disparities in ovarian cancer trial participation. Our objective was to examine patient, sociodemographic (race/ethnicity, insurance), cancer, and health system factors associated with clinical trial participation in ovarian cancer. We conducted a retrospective cohort study of patients with epithelial ovarian cancer diagnosed from 2011 to 2021, using a real-world electronic health record derived database, representing around 800 sites of care in US academic and community practices. We used multivariable Poisson regression modeling to analyze the association of ever participating in an ovarian cancer clinical drug trial with patient, sociodemographic, health system, and cancer factors. Of the 7540 patients with ovarian cancer, 5.0% (95% CI 4.5–5.5) ever participated in a clinical drug trial. Patients of Hispanic or Latino ethnicity were 71% less likely to participate in clinical trials (RR 0.29, 95% CI 0.13–0.61) than non-Hispanic patients, and patients whose race was unknown or other than Black or White were 40% less likely to participate in clinical trials (RR 0.68, 95% CI 0.52–0.89). Patients who had Medicaid insurance were 51% less likely (RR 0.49, 95% CI 0.28–0.87) and those with Medicare were 32% (RR 0.48–0.97) less likely to participate in clinical trials than privately-insured patients. In this national cohort study, only 5% of patients with ovarian cancer participated in clinical drug trials. Interventions are needed to decrease race, ethnicity, and insurance disparities in clinical trial participation. •In a national cohort of 7540 patients with ovarian cancer, only 5.0% ever participated in a clinical drug trial.•Hispanic or Latino patients were 71% less likely to participate in ovarian cancer clinical trials.•Patients with Medicaid were 51% less likely and patients with Medicare 32% less likely to participate in clinical trials than privately-insured patients.