Nonmetropolitan residence and other factors affecting clinical trial enrollment for adolescents and young adults with cancer in a US population-based study

Erin M Mobley; Mary E Charlton; Marcia M Ward; Charles F Lynch

doi:10.1002/cncr.32038

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Nonmetropolitan residence and other factors affecting clinical trial enrollment for adolescents and young adults with cancer in a US population-based study

Journal article

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Peer reviewed

Nonmetropolitan residence and other factors affecting clinical trial enrollment for adolescents and young adults with cancer in a US population-based study

Erin M Mobley, Mary E Charlton, Marcia M Ward and Charles F Lynch

Cancer, Vol.125(13), pp.2283-2290

07/01/2019

DOI: 10.1002/cncr.32038

PMCID: PMC6755069

PMID: 30901085

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https://www.ncbi.nlm.nih.gov/pmc/articles/6755069View

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Abstract

Cancer survival rates in adolescents and young adults (AYAs) have shown slow improvements in comparison with other age groups, and this may be due to lower participation in clinical trials. Little evidence has been provided regarding how nonmetropolitan residence may influence clinical trial enrollment for AYAs with cancer. This study sought to determine whether AYAs from nonmetropolitan areas have lower rates of clinical trial enrollment than their urban counterparts and to examine factors associated with enrollment variation. Data from the National Cancer Institute's 2006 and 2013 Surveillance, Epidemiology, and End Results Patterns of Care AYA cohorts were analyzed. Patients with acute lymphoblastic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, and sarcoma were included (n = 3155). Urban influence codes were used to measure the rurality of the county of residence at diagnosis, which was categorized as large metropolitan, small metropolitan, or nonmetropolitan. Logistic regression compared trial participants and nonparticipants while adjusting for patient and provider factors. Compared with AYAs from large metropolitan counties, AYAs from small metropolitan (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.57-2.64) or nonmetropolitan counties (OR, 1.86; 95% CI, 1.23-2.81) experienced greater trial enrollment. AYAs treated at a hospital with a residency program (OR, 2.27; 95% CI, 1.63-3.16) or by a pediatric oncologist (OR, 4.02; 95% CI, 3.03-5.32) were associated with greater enrollment. There was a significant interaction between rurality and hospital size, which had the greatest impact on nonmetropolitan enrollment. Clinical trial enrollment was higher among AYAs from nonmetropolitan counties than those from metropolitan counties, predominantly when they were treated at large hospitals.

United States - epidemiology

Rural Population - statistics & numerical data

Urban Population - statistics & numerical data

Prognosis

Clinical Trials as Topic - statistics & numerical data

Follow-Up Studies

Patient Participation - trends

Humans

Male

Neoplasms - diagnosis

Young Adult

Research Subjects - psychology

Research Subjects - statistics & numerical data

Adolescent

Adult

Female

Patient Participation - psychology

Child

Population Surveillance

Neoplasms - epidemiology

Details

Title: Subtitle: Nonmetropolitan residence and other factors affecting clinical trial enrollment for adolescents and young adults with cancer in a US population-based study
Creators: Erin M Mobley - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
Mary E Charlton - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Marcia M Ward - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
Charles F Lynch - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: Cancer, Vol.125(13), pp.2283-2290
DOI: 10.1002/cncr.32038
PMID: 30901085
PMCID: PMC6755069
NLM abbreviation: Cancer
ISSN: 1097-0142
eISSN: 1097-0142
Publisher: United States
Grant note: P30 ES005605 / NIEHS NIH HHS HHSN261201300020C / NCI NIH HHS HHSN261201300020I / NCI NIH HHS P30 CA086862 / NCI NIH HHS
Language: English
Date published: 07/01/2019
Academic Unit: Health Management and Policy; Epidemiology
Record Identifier: 9983996190202771

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