June 3, 2012 in CancerCancer patients with annual
household incomes below $50,000 were less likely to participate in clinical
trials than patients with annual incomes of $50,000 or higher, and were more
likely to be concerned about how to pay for clinical trial participation. This
is the conclusion of a large study by the SWOG cancer research cooperative group
that will be presented at the annual meeting of the American Society for
Clinical Oncology (ASCO) in Chicago
this week. X-tremeGENE Transfection - Highly efficient Roche Reagents – Request
your free sample today! - www.roche-applied-science.comThe study was a
collaboration between SWOG, supported largely by the National Cancer Institute
(NCI), and NexCura, which until the recent sale of that company had run an
online treatment decision tool that many cancer advocacy organizations made
available to patients via their websites. Led by Joseph M. Unger, M.S., Ph.C.,
of the SWOG Statistical
Center and the Fred
Hutchinson Cancer
Research Center
in Seattle , the
study surveyed 5,499 patients who registered with NexCura's treatment decision
tool. In the end, 7.6 percent of survey takers with an annual income below
$50,000 reported participating in clinical trials, while 10.0 percent of those
with incomes of $50,000 or more said they took part. Lower levels of
participation are concerning on at least two fronts, says Unger. "From the
patient perspective, since clinical trials offer state of the art therapy,
lower income patients may not have equal access to this important medical
resource." On a broader scientific level, Unger argues that increasing
participation rates of lower income patients in clinical trials would give
doctors and researchers greater confidence that the results of those trials
apply to patients across the income spectrum. In addition, with more patients
participating in clinical trials, trials could be done more quickly, ultimately
speeding the development of new treatments for cancer patients. The researchers
found that lower income patients were more likely to be concerned about how to
pay for the care they would receive as part of a clinical trial. Unger proposes
that although past research has shown that patient care costs for clinical
trials are not appreciably higher than for non-trial treatments, lower income
patients may still be more concerned about co-pays and co-insurance than higher
income patients. Also, lower income patients may be more affected by the
indirect or hidden costs of clinical trial participation, such as having to
take time off work to go to a clinic visit. The researchers suggest that
further research is needed to identify the specific cost concerns that may be
limiting participation for lower income patients. Because income data are not
generally collected from patients when they start treatment, previous studies
that looked at socioeconomic status and trial participation often included
surrogate measures to infer income level; for example, median income level from
the patient's zip code region was used to estimate individual patient income.
Those earlier studies hinted at this correlation, but tended to be less
reliable as evidence. Unger notes that, "This is the biggest study to use
patient-level income on a national level that also accounts for patient medical
conditions." He emphasizes the importance of the comorbidity factor
because lower income patients are more likely to suffer from a range of health
conditions that might limit their eligibility for trials. This study was able
to control for these differences in health status, yet the difference in
participation rates by income level remained.
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