Disp-15. disparities in the availability of neuro-oncology clinical trial supporting infrastructure in the united states

Abstract BACKGROUND Barriers to clinical trial access have significant implications for patient care and disproportionally impact rural and socioeconomically disadvantaged populations. Expanding on reported disparities in neuro-oncology trial availability, we assessed whether existing networks of clinical providers and collaboratives, including NCI’s National Clinical Trials Network (NCTN) and Community Oncology Research Program (NCORP), can effectively bridge these disparities. METHODS Locations of adult neuro-oncology trial sites, UCNS-certified neuro-oncologists, NCTN Main Members, NCORP Community Affiliates, and general oncologists reporting to Centers for Medicare/Medicaid Services were obtained, mapped to zip code tabulation areas (ZCTAs), and annotated with US Census population and geography data and the Neighborhood Atlas Area Deprivation Index (ADI). Regression and spatial analyses were conducted assessing the role of geography, socioeconomic disadvantage, and population on infrastructure accessibility. RESULTS We identified 1976 neuro-oncology trials, 586 NCTN institutions, 962 NCORP sites, 306 neuro-oncologists, and 863 general oncologists located in just 8% of all ZCTAs, inhabited by 19% of the US population. All trial-supporting infrastructure components were more likely to exist in more populated, geographically neighboring regions (OR >1, p< 0.00001). Trial sites, NCTN institutions, and neuro-oncologists served ZCTAs with less disadvantage (OR=0.99, p=0.03958; OR=0.99, p< 0.00001; OR=0.98, p< 0.00001), while NCORP served more disadvantaged areas (OR=1.01, p=0.00102) and general oncologists were distributed similarly across ADI (OR=1.00, p=0.94317). Investigating potentially underutilized infrastructure, 2 neuro-oncologists, 8 NCTN institutions, 10 NCORP sites, and 107 general oncologists were located more than 25 miles from utilized trial sites. CONCLUSION The identified disparities in neuro-oncologists and trial-supporting institutions reflect disparities in trial-site access and point to broader disparities in neuro-oncology care access. NCORP sites reach more socioeconomically disadvantaged populations, but the overall sparsity of trial-supporting networks indicates that the existing infrastructure cannot effectively bridge trial-access barriers and novel approaches including telehealth and decentralized trial designs may be necessary to promote equity.