TY - JOUR
T1 - Inequities in Alliance Acute Leukemia Clinical Trial and Biobank Participation
T2 - Defining Targets for Intervention
AU - Hantel, Andrew
AU - Kohlschmidt, Jessica
AU - Eisfeld, Ann Kathrin
AU - Stock, Wendy
AU - Jacobson, Sawyer
AU - Mandrekar, Sumithra
AU - Larson, Richard A.
AU - Stone, Richard M.
AU - Lathan, Christopher S.
AU - Deangelo, Daniel J.
AU - Byrd, John C.
AU - Abel, Gregory A.
N1 - Funding Information:
The Supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U10CA180821, U10CA180882, and U24CA196171 (to the Alliance for Clinical Trials in Oncology).
Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - PURPOSERepresentativeness in acute leukemia clinical research is essential for achieving health equity. The National Cancer Institute's mandate for Comprehensive Cancer Centers (CCCs) to define and assume responsibility for cancer control and treatment across a geographic catchment area provides an enforceable mechanism to target and potentially remediate participatory inequities.METHODSWe examined enrollee characteristics across 15 Cancer and Leukemia Group B/Alliance cooperative group adult acute leukemia clinical trials (N = 3,734) from 1998 to 2013, including participation in optional companion biobanks. We determined enrollment odds by race-ethnicity for all participants adjusted for national incidence, and for those enrolled at CCCs adjusted for catchment area incidence. We modeled biobank participation by sociodemographics using logistic regression.RESULTSNon-Hispanic (NH)-White patients were more likely to be enrolled than NH-Black, NH-Asian, or Hispanic patients (odds ratio [OR] 0.75, 0.48, and 0.44, respectively; all P <.001), but less likely than NH-Native American patients (OR 1.91; P <.001), adjusted for national incidence. Enrollment odds were lower for NH-Black, NH-Asian, and Hispanic patients at CCCs adjusted for catchment area incidence (OR 0.57, 0.26, and 0.32, respectively; P <.001); differences were driven by overenrollment of NH-White patients from outside self-defined catchment areas (18.1% v 12.3%; χP =.01) and by CCCs with less absolute enrollee diversity (rank sum P =.03). Among all enrollees, NH-White race-ethnicity and lower neighborhood deprivation correlated with biobank participation (OR 1.81 and 1.45, respectively; P =.01 and.03). For CCC enrollees, the correlation of race-ethnicity with biobank participation was attenuated by a measure accounting for their site's degree of enrollment disparity but not neighborhood deprivation.CONCLUSIONAcute leukemia clinical research disparities are substantial and driven by structural trial enrollment barriers at CCCs. Real-time CCC access and enrollment monitoring is needed to better align research participation with local populations.
AB - PURPOSERepresentativeness in acute leukemia clinical research is essential for achieving health equity. The National Cancer Institute's mandate for Comprehensive Cancer Centers (CCCs) to define and assume responsibility for cancer control and treatment across a geographic catchment area provides an enforceable mechanism to target and potentially remediate participatory inequities.METHODSWe examined enrollee characteristics across 15 Cancer and Leukemia Group B/Alliance cooperative group adult acute leukemia clinical trials (N = 3,734) from 1998 to 2013, including participation in optional companion biobanks. We determined enrollment odds by race-ethnicity for all participants adjusted for national incidence, and for those enrolled at CCCs adjusted for catchment area incidence. We modeled biobank participation by sociodemographics using logistic regression.RESULTSNon-Hispanic (NH)-White patients were more likely to be enrolled than NH-Black, NH-Asian, or Hispanic patients (odds ratio [OR] 0.75, 0.48, and 0.44, respectively; all P <.001), but less likely than NH-Native American patients (OR 1.91; P <.001), adjusted for national incidence. Enrollment odds were lower for NH-Black, NH-Asian, and Hispanic patients at CCCs adjusted for catchment area incidence (OR 0.57, 0.26, and 0.32, respectively; P <.001); differences were driven by overenrollment of NH-White patients from outside self-defined catchment areas (18.1% v 12.3%; χP =.01) and by CCCs with less absolute enrollee diversity (rank sum P =.03). Among all enrollees, NH-White race-ethnicity and lower neighborhood deprivation correlated with biobank participation (OR 1.81 and 1.45, respectively; P =.01 and.03). For CCC enrollees, the correlation of race-ethnicity with biobank participation was attenuated by a measure accounting for their site's degree of enrollment disparity but not neighborhood deprivation.CONCLUSIONAcute leukemia clinical research disparities are substantial and driven by structural trial enrollment barriers at CCCs. Real-time CCC access and enrollment monitoring is needed to better align research participation with local populations.
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U2 - 10.1200/JCO.22.00307
DO - 10.1200/JCO.22.00307
M3 - Article
C2 - 35696629
AN - SCOPUS:85133722863
SN - 0732-183X
VL - 39
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
M1 - JCO.22.00307
ER -