Patients With Lower Income Less Likely to Participate in Clinical Trials
Patients with newly diagnosed cancer were less likely to participate in clinical trials if their annual household income was less than $50 000, according to an article published online by JAMA Oncology (2015; doi:10.1001/jamaoncol.2015.3924).
Joseph M. Unger, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, Washington, and coauthors used data from a survey of adult patients with new diagnoses of breast, lung, or colorectal cancer. All patients were enrolled prior to making a treatment decision and then followed for 6 months to assess whether they participated in a clinical trial.
Of the 1581 patients who were eligible, 1262 (80%) with annual income data were available for the analysis. Patients were predominantly younger than 65 years, female, and not African American.
The authors report patients with annual household incomes less than $50 000 had 32% lower odds of trial participation than higher-income patients (12% vs 17%). Trial participation decreased as annual household income decreased from $50 000 or more, to $20 000 to $49 999, and to less than $20 000 (17% vs 13% vs 11%, respectively).
“The identification of patient income level as an independent predictor of trial participation is important for multiple reasons. If income is associated with health status, then improving representativeness of lower-income patients in trials would improve the generalizability of study outcomes. Also, greater participation of lower-income patients would allow trials to be conducted more quickly, speeding the development of new treatments. Crucially, since clinical trial treatments represent the newest available treatments, access to this vital resource should be available to individuals of all income levels,” the authors concluded.
The authors mentioned the possibility of incentives or reimbursements; however, they should not be coercive to patients. Incentives might provide coverage of the excess costs of participation, including copayments and coinsurance.