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. 2024:46:e2024006.
doi: 10.4178/epih.e2024006. Epub 2023 Dec 11.

Regional disparities in the availability of cancer clinical trials in Korea

Jieun Jang  1 , Wonyoung Choi  2   3   4 , Sung Hoon Sim  5   6 , Sokbom Kang  1   7
Affiliations

Regional disparities in the availability of cancer clinical trials in Korea

Jieun Jang et al. Epidemiol Health. 2024.

Abstract

Objectives: Unequal access to cancer clinical trials is an important issue, given the potential benefits of participation for cancer patients. We evaluated regional disparities in access to cancer clinical trials in Korea.

Methods: From the Ministry of Food and Drug Safety database, we extracted 2,465 records of all cancer clinical trials approved between January 2012 and April 2023. To measure disparities in cancer clinical trial access, we calculated the ratio of clinical trials open to non-capital areas relative to those open to capital areas. We then analyzed temporal trends in this ratio, which we termed the trial geographical equity index (TGEI).

Results: Disparities in access to cancer clinical trials, as indicated by the TGEI, did not significantly improve during the study period (regression coefficient, 0.002; p=0.59). However, for phase II/III trials sponsored by global pharmaceutical companies, the TGEI improved significantly (regression coefficient, 0.021; p<0.01). In contrast, the TGEI deteriorated for trials initiated by investigators or those testing domestically developed therapeutics (regression coefficient, -0.015; p=0.05). Furthermore, the increasing trend of TGEI for phase II/III trials sponsored by global companies began to reverse after 2019, coinciding with the outbreak of coronavirus disease 2019 (COVID-19).

Conclusions: Over the past decade, access to cancer clinical trials has improved in Korea, particularly for phase II/III trials evaluating therapeutics from global companies. However, this increase in accessibility has not extended to trials initiated by investigators or those assessing domestically developed therapeutics. Additionally, the impact of COVID-19 on disparities in clinical trial access should be closely monitored.

Keywords: Clinical trial; Health inequities; Health services accessibility; Healthcare disparities; Neoplasms.

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Conflict of interest statement

Conflict of interest

The authors have no conflicts of interest to declare for this study.

Figures

Figure 1.
Figure 1.
Temporal trend in the trial geographical equity index (TGEI) from 2012 to 2023 in Korea.
Figure 2.
Figure 2.
Temporal trend in the trial geographical equity index (TGEI) from 2012 to 2023 in Korea, considering the type of developer for the therapeutic. (A) Phase II/III trials. (B) Phases other than II/III.
Figure 3.
Figure 3.
Disparity in temporal trends of the trial geographical equity index (TGEI) before and after onset of the coronavirus disease 2019 pandemic in Korea. (A) Overall cancer clinical trials. (B) Phase II/III trials evaluating cancer therapeutics developed by global companies.
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