By Steven Ross Johnson, Special to the Tribune
July 11, 2012
Lower-income people are less inclined to participate in cancer clinical research trials than those with higher incomes, according to a new study.
The study, which was recently presented at an annual meeting of the American Society for Clinical Oncology in Chicago, found that patients with incomes less than $50,000 a year were 27 percent less likely to participate in clinical trials than those making above that amount, and that 44 percent of patients were less likely to participate if they made $20,000 or less.
A primary concern for lower-income patients was financial, the study found. About 53 percent of those making less than $20,000 a year expressed concerns about the cost of participating in clinical trials compared with 24 percent of patients earning more than $100,000 annually.
According to Loyola University Medical Center oncologist and study co-author Dr. Kathy Albain, the findings may suggests certain factors could play a significant role in a patient's willingness to participate, such as a lack of public understanding about clinical trials as well as more indirect economic concerns like insurance co-pays, travel expenses and time off of work.
"One side of it is education and making sure the patient really understands that it's not going to be an added cost to whatever standard cancer treatment they get," said Albain, who added that more research would have to be done in order to target the reasons behind their financial concerns.
Prior research examining the issue of clinical research participation has traditionally focused on differences such as ethnicity or age, with many studies finding ethnic minorities, women and the elderly participating at lower rates than non-Hispanic white males.
"It's very, very difficult to get patients on clinical trials in general, and there are more barriers for certain populations," said Ellen Richmond, a nursing consultant with the National Cancer Institute and a former clinical trial recruitment nurse. The NCI helped fund the study.
"All the barriers that other people face are multiplied when you're in a low-income situation," Richmond said.
Albain said clinical participation based on income has not been well-studied in the past because information on what a person earns has been difficult to obtain because of privacy issues.
The findings raise concerns, according to Albain, about the overall accessibility of clinical trials to lower-income patients.
"We have a large segment of our population — the low-income group — that we have identified is not participating in our trials," Albain said. "Is that segment reaping the same benefits of treatment or not?"
Once the reasons for lower enrollment are clearly identified, Albain said, steps can be taken to help address patient concerns, such as better educating patients about the true costs involved in participating in clinical trials, or possibly providing assistance with some of the indirect costs.
The study, conducted by the NCI-funded cancer research cooperative group SWOG — formerly known as the Southwest Oncology Group — surveyed more than 5,000 patients who were newly diagnosed with breast, prostate, lung or colorectal cancer from June 2007 through July 2011, of which 9 percent said they had participated in a clinical trial.
Of those surveyed, 7.3 percent of patients with an annual income below $50,000 reported taking part in clinical trials, while 10 percent of those with incomes of $50,000 or more reported they participated.
Despite the study's findings, other factors unrelated to income or cost concerns should not be overlooked, according to Dr. Aman Buzdar, vice president of clinical research at the University of Texas Anderson Cancer Center. He said cultural and historical issues for certain groups may also have an impact in determining a patient's decision.
Buzdar cited two examples as possible reasons for why some groups tend to be hesitant to volunteer in clinical research: the Tuskegee study of the 1930s where the U.S. government intentionally injected 400 African-American men in Tuskegee, Ala., with syphilis and left them untreated to see the effects the disease, and the deliberate injection of Guatemalan subjects with the same disease during the 1940s.
"It's not one thing we can do and the problem will be fixed," Buzdar said. "It is one patient at a time we have to educate that in research today there are a number of safety checks and balances, and that it is not done in the same ways that it was done maybe 30 or 40 years ago."
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