Enrollment Trends and Disparity Among Patients With Lung Cancer in National Clinical Trials, 1990 to 2012.

TitleEnrollment Trends and Disparity Among Patients With Lung Cancer in National Clinical Trials, 1990 to 2012.
Publication TypeJournal Article
Year of Publication2016
AuthorsPang, Herbert H., Xiaofei Wang, Thomas E. Stinchcombe, Melisa L. Wong, Perry Cheng, Apar Kishor Ganti, Daniel J. Sargent, Ying Zhang, Chen Hu, Sumithra J. Mandrekar, Mary W. Redman, Judith B. Manola, Richard L. Schilsky, Harvey J. Cohen, Jeffrey D. Bradley, Alex A. Adjei, David Gandara, Suresh S. Ramalingam, and Everett E. Vokes
JournalJ Clin Oncol
Volume34
Issue33
Pagination3992-3999
Date Published2016 11 20
ISSN1527-7755
KeywordsAge Factors, Aged, Carcinoma, Non-Small-Cell Lung, Clinical Trials as Topic, Female, Healthcare Disparities, Humans, Lung Neoplasms, Male, Patient Selection, SEER Program, Sex Factors, Socioeconomic Factors, United States
Abstract

Purpose Under-representation of elderly, women, and racial/ethnic minority patients with cancer in clinical trials is of national concern. The goal of this study was to characterize enrollment trends and disparities by age, sex, and race/ethnicity in lung cancer trials. Methods We analyzed data for 23,006 National Cancer Institute cooperative group lung cancer trial participants and 578,476 patients with lung cancer from the SEER registry from 1990 to 2012. The enrollment disparity difference (EDD) and enrollment disparity ratio (EDR) were calculated on the basis of the proportion of each subgroup in the trial population and the US lung cancer population. Annual percentage changes (APCs) in the subgroup proportions in each population were compared over time. Results Enrollment disparity for patients ≥ 70 years of age with non-small-cell lung cancer improved from 1990 to 2012 (test of parallelism, P = .020), with a remaining EDD of 0.22 (95% CI, 0.19 to 0.25) and EDR of 1.65 (95% CI, 1.51 to 1.82) in 2010 to 2012. No improvement was seen for elderly patients with small-cell lung cancer (SCLC), with an APC of 0.20 ( P = .714) among trial participants, despite a rising proportion of elderly patients with SCLC in the US population (APC, 0.32; P = .020). Enrollment disparity for women with lung cancer improved overall, with the gap closing by 2012 (EDD, 0.03 [95% CI, 0.00 to 0.06]; EDR, 1.07 [95% CI, 1.00 to 1.16]). Enrollment disparities persisted without significant improvement for elderly women, blacks, Asians/Pacific Islanders, and Hispanics. Conclusion Under-representation in lung cancer trials improved significantly from 1990 to 2012 for elderly patients with non-small-cell lung cancer and for women, but ongoing efforts to improve the enrollment of elderly patients with SCLC and minorities are needed. Our study highlights the importance of addressing enrollment disparities by demographic and disease subgroups to better target under-represented groups of patients with lung cancer.

DOI10.1200/JCO.2016.67.7088
Alternate JournalJ Clin Oncol
Original PublicationEnrollment trends and disparity among patients with lung cancer in national clinical trials, 1990 to 2012.
PubMed ID27646951
PubMed Central IDPMC5477832
Grant ListR21 AG042894 / AG / NIA NIH HHS / United States
U10 CA180846 / CA / NCI NIH HHS / United States
T32 AG000212 / AG / NIA NIH HHS / United States
U10 CA180833 / CA / NCI NIH HHS / United States
P01 CA142538 / CA / NCI NIH HHS / United States
U10 CA180838 / CA / NCI NIH HHS / United States
U10 CA180888 / CA / NCI NIH HHS / United States
U10 CA180819 / CA / NCI NIH HHS / United States