Temporal Trends and Predictors for Cancer Clinical Trial Availability for Medically Underserved Populations

Background. Lackofaccesstoavailablecancerclinicaltrialshas been cited as a key factor limiting trial accrual, particularly among medically underserved populations.We examined the trendsandfactorsinclinicaltrialavailabilitywithinamajorU.S. safety-net hospital system. Materials and Methods.We identified cancer clinical trials activatedattheHaroldC.SimmonsCancerfrom1991to2014 and recorded the characteristics of the trials that were and were not activated at the Parkland Health and Hospital System satellite site. We used univariate and multivariate logistic regression to determine the association between trialcharacteristicsandnonactivationstatus,andchi-square analysis to determine the association between the trial characteristics and the reasons for nonactivation. Results. Atotalof773trialswereidentified,ofwhich152(20%) were not activated at Parkland. In multivariable analysis, nonactivationatParklandwasassociatedwithtrialyear,sponsor,and phase. Compared with the 1991–2006 period, clinical trials in the 2007–2014 period were almost eightfold more likely not to be activated at Parkland. The most common reasons for nonactivationatParklandwereaninabilitytoperformthestudy procedures (27%) and the startup costs (15%). Conclusion. Overtime,inthissingle-centersetting,adecreasing proportionofcancerclinicaltrialswereavailabletounderserved populations.Trial complexity and costs appeared to account for muchofthistrend.Effortstoovercomethesebarrierswillbekey to equitable access to clinical trials, efficient accrual, and the generalizabilityof the results.TheOncologist2015;20:674–682