National enrollment of lung cancer clinical trials is disproportionate based on race and health care access

OBJECTIVE:Despite declining lung cancer mortality in the United States, survival differences remain among racial and ethnic minorities in addition to those with limited healthcare access. Improvements in lung cancer treatment can be obtained through clinical trials, yet there are disparities in clinical trial enrollment of other cancer types. This study aims to evaluate disparities in lung cancer clinical trial enrollment to inform future enrollment initiatives. METHODS:We analyzed non-small cell lung cancer patients from the National Cancer Database (2004-2018), categorizing them as enrolled or not enrolled in clinical trials based on "rx_summ_other" data element. Clinical, demographic, and institutional factors associated with trial enrollment were assessed using bivariate and multivariate analysis, adjusting for institutional-level clustering. RESULTS:A total of 1,924 (0.12%) lung cancer patients were enrolled in clinical trials. Enrolled patients were predominantly non-Hispanic White (82%), with higher socioeconomic status, treated at academic programs (67%), and had private insurance (42%) or Medicare (44%). They also traveled further for treatment compared to unenrolled patients (56 vs 27 miles, p<0.001). After adjusting for demographic and clinical factors, lung cancer trial enrollment was significantly less likely among Blacks (OR 0.55, CI 0.5-0.7, p<0.001) and Hispanics (0.66, CI 0.5-0.9, p=0.01). Patients with Medicaid or uninsured, in the lowest socioeconomic status group, and those treated at community-based cancer programs were the least likely to enroll. CONCLUSION:Enrollment in lung cancer trials disproportionally excludes minority patients, those in the lowest socioeconomic status, community cancer programs, and the underinsured. These disparities in demographic and access for trial participation show a need for improved enrollment strategies.