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Analysis of Maryland Cancer Patient Participation in National Cancer Institute–Supported Cancer Treatment Clinical Trials

Claudia R. Baquet, Gary L. Ellison, Shiraz I. Mishra

From the Department of Internal Medicine, Office of Policy and Planning, the University of Maryland Comprehensive Center for Health Disparities Research, Outreach, and Training; and Department of Family and Community Medicine, Center for Health Policy/Health Services Research, University of Maryland School of Medicine, Baltimore, MD

Corresponding author: Claudia R. Baquet, MD, MPH, University of Maryland School of Medicine, 685 West Baltimore St, Suite 618, Baltimore, MD 21201; e-mail: cbaquet{at}som.umaryland.edu

Purpose We examined the relationship of sociodemographic factors, urban/rural residence, and county-level socioeconomic factors on accrual of Maryland patients with cancer to National Cancer Institute (NCI) –sponsored cancer treatment clinical trials.

Patients and Methods Data were analyzed for the period 1999 to 2002 for 2,240 Maryland patients with cancer accrued onto NCI-sponsored treatment trials. The extent to which Maryland patients with cancer and patients residing in lower socioeconomic and/or rural areas were accrued to cancer trials and were representative of all patients with cancer in Maryland was determined. Data were obtained from several sources, including NCI's Cancer Therapy Evaluation Program for Maryland patients with cancer in Cooperative Group therapeutic trials, Maryland Cancer Registry data on cancer incidence, and United States Census and the Department of Agriculture.

Results For Maryland patients with cancer accrued onto NCI-sponsored treatment trials between 1999 and 2002, subgroups accrued at a higher rate included pediatric and adolescent age groups, white patients, female patients (for sex-specific tumors), patients with private health insurance, and patients residing in the Maryland National Capitol region. Moreover, between 1999 and 2002, there was an estimated annual decline (8.9% per year; P < .05) in the percentage of black patients accrued onto cancer treatment trials. Logistic regression models uncovered different patterns of accrual for female patients and male patients on county-level socioeconomic factors.

Conclusion Results highlight disparities in the accrual of Maryland patients with cancer onto NCI-sponsored treatment trials based on patient age, race/ethnicity, geography of residence, and county-level socioeconomic factors. Findings provide the basis for development of innovative tailored and targeted educational efforts to improve trial accrual, particularly for the underserved.

Supported by grants from the National Center for Minority Health and Health Disparities (Grant No. P60MD000532) and National Cancer Institute (Grants No. U01CA114650 and 5U01CA86249). The National Cancer Institute Cancer Therapy Evaluation Program provided patient data based on a freedom of information request by C.R.B.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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