Disparities reported in gynecological cancer trial access
In a recent study, the prevalence of gynecological cancer trials was reduced in states with high economic vulnerability and minoritized populations.
Disparities reported in gynecological cancer trial access | Image Credit: © toeytoey - © toeytoey - stock.adobe.com.
Clinical trial availability for female gynecological cancer trials is low in states with high economic vulnerability and minoritized populations, according to a recent study published in JAMA Network Open.1
Experts expect over 110,000 new gynecologic cancer cases to be diagnosed per year in the United States as of 2024, leading to over 30,000 estimated deaths. Patients from marginalized communities are disproportionately impacted by gynecologic cancer, experiencing higher rates and reduced odds of access to treatment.2
Health outcomes may be improved through better access to oncologic clinical trials that can bridge disparities in cancer treatment.1 Data has indicated patients from different racial groups receive the same treatment when enrolled in a clinical trial.
Barriers often prevent marginalized populations from enrolling in clinical trials in the United States. Additionally, there may be geographic disparities related to clinical trial access.
To evaluate geographic and social disparities in gynecological oncology trial access across the United States, investigators conducted a cross-sectional study. Trials published between January 1, 2013, and January 10, 2024, were identified through searches of the ClinicalTrials.gov database.
Relevant cancer types included uterine, ovarian, endometrial, cervical, uterine stromal, gynecological, uterine sarcoma, ovarian germ cell, vulvar, vaginal, primary peritoneal, and fallopian tube. These trials were grouped into 6 categories: ovarian, uterine, cervical, endometrial, vaginal or vulvar, and gynecological cancer.
Pan-cancer trials were those investigating nongynecological cancers and gynecological cancers simultaneously. Those only investigating nongynecological cancers were excluded from the analysis. Trials were considered genetic if they investigated genetic traits.
There were 1561 clinical trials included in the final analysis, 58.4% of which were ovarian cancer trials, 28.1% cervical, 24.7% endometrial, 10.1% uterine, and 5% vulvovaginal. Explicit investigation of a genetic factor was reported by 7.6%, and 42.2% were broad and inclusive of multiple cancer types. Nine percent of trials were gynecologic cancer not-specified trials.
Five hundred and one trials were performed in Texas, 454 in California, and 427 in New York, making these the states with the highest number of trials. This was expected because of these states’ population sizes.
South Dakota and Rhode Island had the highest population-adjusted number of trials, at 8.60 trials per 100,000 persons and 8.40 per 100,000, respectively. California, Mississippi, and Puerto Rico had the lowest numbers at 1.10, 0.98, and 0.47 trials per 100,000 persons, respectively.
The number of gynecological trials per 100,000 individuals in a given state was not linked to trial rates among female non-Hispanic White individuals. However, states with more than 4 trials per 100,000 individuals had populations comprised of over 50% non-Hispanic White individuals.
A positive but non-statistically significant correlation was found between state-levels prevalence of non-Hispanic White individuals and the number of trials per 100,000 persons in 2020. A strong negative correlation was reported among states with higher Federal Emergency Management Agency expected annual loss.
Less than 4 gynecological cancer trials per 100,000 persons was reported in states with high minority populations. No states with a significant population of minoritized individuals had a high number of gynecological trials per 100,000 persons.
These results indicated significant gaps in gynecological cancer trial availability in states with high minoritized populations. Investigators concluded efforts should be implemented to address these disparities.
References
- Boland MR, Tubridy E, Solorzano SS, Simpkins F, Smith AJB, Ko EM. Geographic disparities in gynecologic oncology clinical trial availability in the US. JAMA Netw Open. 2024;7(11):e2447635. doi:10.1001/jamanetworkopen.2024.47635
- Rauh-Hain JA, Melamed A, Schaps D, et al. Racial and ethnic disparities over time in the treatment and mortality of women with gynecological malignancies.Gynecol Oncol. 2018;149(1):4-11. doi:10.1016/j.ygyno.2017.12.006
