The most socially vulnerable counties are less likely to have any cancer clinical trial, according to a research letter published online May 7 in JAMA Network Open. Black people, particularly Black women are more likely to live in these socially vulnerable counties.
Rishi Robert Sekar, M.D., from the University of Michigan in Ann Arbor, and colleagues examined the association between county-level social determinants of health (SDOH) and cancer clinical trial availability in the United States. Cross-sectional and longitudinal analyses of county-level trial availability and SDOH were performed.
The study included 3,142 counties with a mean Social Vulnerability Index (SVI) of 0.50 and median population of 10,163 people. The researchers found that 58.4 percent of the counties included in the study had any trial during the study period, while the mean number of county-level population-adjusted trials was 342.1.
The most socially vulnerable counties were less likely than the least socially vulnerable counties to have any trial in a multivariable analysis (49.6 versus 70.0 percent; odds ratio, 0.33), and they had fewer population-adjusted trials (223.4 versus 579.2; incidence rate ratio, 0.39).
Throughout the study period, these observations were seen across SVI quintiles, with stable differences noted in the proportion of counties with any trial and a relative increase in the mean number of trials for the least socially vulnerable counties.
“This study emphasizes the role of SDOH in the disparate availability of cancer clinical trials and demonstrates the need to identify socially vulnerable communities for expansion of trial opportunities toward improving representation in studies and ensuring equitable cancer care,” the authors write.
Why socially vulnerable areas need cancer clinical trials
Clinical trials are the engine driving advancements in cancer treatment. They offer patients access to potentially life-saving new therapies while providing researchers with crucial data to improve future cancer care. However, a significant disparity exists in access to these trials, with rural areas facing substantial barriers. This lack of access disproportionately impacts Black Americans, who already experience poorer cancer outcomes compared to their white counterparts.
Several factors contribute to the limited availability of clinical trials in rural communities. Geographic distance is a major hurdle. Rural residents often live far from major medical centers where most trials are conducted. The time and financial burden of travel for consultations, treatment sessions, and follow-up appointments can be a serious deterrent. Additionally, rural areas typically have fewer specialists and research institutions compared to urban centers. This lack of health care infrastructure makes it difficult to recruit and manage clinical trials effectively.
Furthermore, rural communities often have lower rates of health literacy. Limited access to information about clinical trials and a potential distrust of the medical system can further discourage participation. These challenges disproportionately impact Black Americans in rural areas. Black populations are more likely to live in rural communities compared to white populations. This geographic factor, coupled with the existing mistrust in the medical system within some Black communities, creates a significant hurdle to participation in clinical trials.
The lack of access to clinical trials in rural areas has a direct impact on Black health outcomes. Rural patients, particularly Black patients, miss out on the potential benefits of cutting-edge therapies offered in clinical trials. This can lead to poorer treatment outcomes and lower survival rates. Additionally, the lack of Black participants in rural trials means researchers have less data on how different racial groups respond to new treatments. This can lead to the development of therapies that are less effective for Black patients, further perpetuating health care disparities.
How to bring cancer clinical trials to Black rural communities
Several strategies can help bridge the rural-urban divide in cancer clinical trials and improve access for Black Americans. Integrating telehealth technologies for consultations, monitoring, and even treatment delivery can significantly reduce the burden of travel for rural patients. Bringing clinical trials directly to rural communities through mobile research units can improve access and address logistical challenges.
Building trust and increasing awareness about clinical trials within Black communities through culturally sensitive outreach programs is crucial to address historical mistrust and increase participation. Increasing funding for research specifically focused on improving access to clinical trials in rural and minority communities is essential to address these disparities.
By implementing these strategies, we can create a more equitable landscape for cancer clinical trials. Expanding access for rural Black Americans will not only improve their individual health outcomes but also contribute to the development of more effective treatments for all cancer patients.