Socioecological Factors Associated With Lung Cancer Clinical Trial Participation: Real-world California Cancer Registry Data.

[INTRODUCTION] Racial/ethnic minority enrollment in oncological clinical trials (CT) remains a persistent priority. Using a population-based cancer registry, we identify whether modifiable policy-, health system-, and patient-domains are associated with CT enrollment.

[PATIENT AND METHODS] We analyzed retrospective data from the Los Angeles Cancer Surveillance Program between 2002 and 2021 to identify lung cancer cases and receipt of treatment in a cancer protocol (CT enrollment vs. not enrolled). We assessed patient- (eg, Charlson comorbidity score, socioeconomic status, and insurance type), health system- (facility designated cancer center status), and policy- (2014 FDA guideline to report demographic CT enrollment data) domain levels of influence. We used a multivariable logistic regression model to identify these associations.

[RESULTS] Only 0.88% (n = 599/68,245) of our cohort enrolled in a CT protocol. Individuals who were seen at cancer-designated facilities (CoC, NCI, NCCN) were significantly more likely to be enrolled in CT (OR = 5.57[3.69, 8.33]) compared to those not seen at a cancer-designated facility. We also found an inverse association between comorbidity categories and CT enrollment (OR: 1 vs. 0 = 0.72 [0.59, 0.88], 2 vs. 0 = 0.51 [0.37, 0.69], 3 + vs. 0 = 0.25 [0.16, 0.37]). Among Black individuals, those on Medicaid had lower odds of being enrolled in CT compared to those on Medicare (OR: 0.05 [95% CI, 0.01, 0.68]). This pattern was similar across all race/ethnicity groups (interaction P < .03).

[CONCLUSION] Using population-based data, our findings underscore that racial/ethnic disparities in CT enrollment could be mitigated by addressing where individuals get cancer care, broadening comorbidity restrictions, and expanding cancer care research facilities in underserved areas.