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Disparities in Surgical Oncologic Care

P18: Association between Minority-Serving Hospitals and Disparities in Clinical Trial Enrollment among Patients with Gastrointestinal Cancer

Introduction: To account for the diverse lived experiences and exposures of various populations, clinical research should be appropriately inclusive of racial and ethnic minority groups, as well as other populations experiencing health disparities. We sought to assess the association between receiving care at a minority-serving hospital (MSH) and clinical trial enrollment among patients with gastrointestinal (GI) cancer.

Methods: Adult patients with a GI cancer (i.e., gastric, liver, bile duct, pancreatic, and colon) who underwent oncologic surgery and were enrolled in institutional/National Cancer Institute (NCI)-funded clinical trials between 2012-2019 were identified in the National Cancer Database (NCDB). Top decile facilities treating the highest proportion of minority patients were defined as minority-serving hospitals (MSH). Multivariable regression was used to assess the relationship between trial enrollment and MSH.

Results: Among 1,112,594 patients, 993,981 (89.4%) patients were treated at a non-MSH, while 117,613 (10.6%) were treated at an MSH. Patients treated at MSH were more likely to be Black (MSH 36.8% vs. non-MSH 13.2%), lack insurance (MSH 7.4% vs. non-MSH 2.7%), and be younger (MSH 65 years vs. non-MSH 68 years) (all p< 0.05). Overall, only 1,857 (0.2%) patients were enrolled in a clinical trial; the vast majority received care at a non-MSH (n=1,787, 96.2%). On multivariable analysis, odds of enrollment in a clinical trial were markedly lower among patients treated at an MSH versus non-MSH. (OR 0.39, 95%CI 0.28-0.52). In addition, even after controlling for receipt of care at MSH, Black patients remained at lower odds of enrollment in a clinical trial versus White patients (OR 0.61, 95%CI 0.48–0.78).

Conclusions: Overall clinical trial participation among patients with a GI cancer was extremely low. Patients treated at MSH, as well as Black individuals, were much less likely to be enrolled in a clinical trial. Efforts should be made to improved clinical trial enrollment, as well as address disparities in clinical trials representation.

Learning Objectives:

  • Upon completion the participants will be able to assess the overall clinical trail participation among patients with gastrointestinal malignancy.
  • Upon completion the participants will be able to identify the trends and disparities in clinical trail enrollment among patients with gastrointestinal malignancy.
  • Upon completion the participants will be able to assess the association between minority-serving hospitals and disparities in clinical trial enrollment among patients with gastrointestinal malignancy.