Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 1;116(7):1178-1184.
doi: 10.1093/jnci/djae067.

Racial and ethnic associations with comprehensive cancer center access and clinical trial enrollment for acute leukemia

Andrew Hantel  1 , Andrew M Brunner  2 , Jesse J Plascak  3 , Hajime Uno  1 , Juan C Varela  4 , Marlise R Luskin  1 , Timothy R Rebbeck  1   5 , Richard M Stone  1 , Christopher S Lathan  1 , Daniel J DeAngelo  1 , Gregory A Abel  1
Affiliations

Racial and ethnic associations with comprehensive cancer center access and clinical trial enrollment for acute leukemia

Andrew Hantel et al. J Natl Cancer Inst. .

Abstract

Background: Clinical trial participation at Comprehensive Cancer Centers (CCC) is inequitable for minoritized racial and ethnic groups with acute leukemia. CCCs care for a high proportion of adults with acute leukemia. It is unclear if participation inequities are due to CCC access, post-access enrollment, or both.

Methods: We conducted a retrospective cohort study of adults with acute leukemia (2010-2019) residing within Massachusetts, the designated catchment area of the Dana-Farber/Harvard Cancer Center (DF/HCC). Individuals were categorized as non-Hispanic Asian (NHA), Black (NHB), White (NHW), Hispanic White (HW), or Other. Decomposition analyses assessed covariate contributions to disparities in (1) access to DF/HCC care and (2) post-access enrollment.

Results: Of 3698 individuals with acute leukemia, 85.9% were NHW, 4.5% HW, 4.3% NHB, 3.7% NHA, and 1.3% Other. Access was lower for HW (age- and sex-adjusted OR = 0.64, 95% CI = 0.45 to 0.90) and reduced post-access enrollment for HW (aOR = 0.54, 95% CI =0.34 to 0.86) and NHB (aOR = 0.60, 95% CI = 0.39 to 0.92) compared to NHW. Payor and socioeconomic status (SES) accounted for 25.2% and 21.2% of the +1.1% absolute difference in HW access. Marital status and SES accounted for 8.0% and 7.0% of the -8.8% absolute disparity in HW enrollment; 76.4% of the disparity was unexplained. SES and marital status accounted for 8.2% and 7.1% of the -9.1% absolute disparity in NHB enrollment; 73.0% of the disparity was unexplained.

Conclusions: A substantial proportion of racial and ethnic inequities in acute leukemia trial enrollment at CCCs are from post-access enrollment, the majority of which was not explained by sociodemographic factors.

PubMed Disclaimer

Conflict of interest statement

Dr Hantel reports receiving personal fees (advisory boards) from AstraZeneca and AbbVie outside the submitted work. Dr Brunner receiving personal fees (consulting) from Agios, Acceleron, BMS/Celgene, Gilead, Keros Therapeutics, Novartis, and Takeda and BMS (advisory board) outside the submitted work. Dr Varela reports receiving personal fees (speakers bureau) from Gilead outside the submitted work and having stock options in NexImmune. Dr Luskin reports receiving personal fees (advisory boards) from Novartis and AbbVie outside the submitted work. Dr Stone reports receiving personal fees (consulting, advisory boards, steering committees, and/or data safety monitoring board participation) for GSK, Hermavant, Takeda, AMGEN, Aptevo, AvenCell, BerGenBio, Cellularity, CTI Pharma, Epizyme, Jazz, Kura Onc, Rigel, and Syntrix outside the submitted work. Dr Lathan reports receiving personal fees (advisory boards) from BMS outside the submitted work. Dr DeAngelo reports receiving research funding from Abbvie, Novartis, Blueprint, and Glycomimetrics and personal fees (consulting) from Amgen, Autolus, Blueprint, Gilead, Incyte, Jazz, Kite, Novartis, Pfizer, Servier, and Takeda outside the submitted work. Dr Abel reports receiving personal fees (consultancy) from Novartis and Geron outside of the submitted work.

Figures

Figure 1.
Figure 1.
Absolute differences in access and enrollment by race/ethnic group. Bars show the absolute percentage difference in access and enrollment between the race/ethnic group listed and the non-Hispanic White group. NHA = non-Hispanic Asian; NHB = non-Hispanic Black; HW = Hispanic White; OTH = Other; NHW = non-Hispanic White; DF/HCC = Dana-Farber/Harvard Cancer Center.
Figure 2.
Figure 2.
Decomposition analyses of access to DF/HCC care. Black bars show the absolute percentage difference in access between minoritized race/ethnic groups and non-Hispanic White patients. Multicolored bars show factors contributing to that overall difference. NHW = non-Hispanic White; NHA = non-Hispanic Asian; NHB = non-Hispanic Black; HW = Hispanic White; OTH = Other; SES = socioeconomic status; DF/HCC = Dana-Farber/Harvard Cancer Center.
Figure 3.
Figure 3.
Decomposition analyses of DF/HCC enrollment among individuals with access to DF/HCC care. Black bars show the absolute percentage difference in access between minoritized race/ethnic groups and non-Hispanic White patients. Multicolored bars show factors contributing to that overall difference. NHW = non-Hispanic White; NHA = non-Hispanic Asian; NHB = non-Hispanic Black; HW = Hispanic White; OTH = Other; SES = socioeconomic status; DF/HCC = Dana-Farber/Harvard Cancer Center.
See this image and copyright information in PMC

References

    1. Murthy VH, Krumholz HM, Gross CP.. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 2004;291(22):2720-2726. doi:10.1001/jama.291.22.2720 - DOI - PubMed
    1. Williams PA, Zaidi SK, Sengupta R.. AACR cancer disparities progress report 2022. Cancer Epidemiol Biomarkers Prev. 2022;31(7):1249-1250. doi:10.1158/1055-9965.EPI-22-0542 - DOI - PubMed
    1. Nipp RD, Hong K, Paskett ED.. Overcoming barriers to clinical trial enrollment. Am Soc Clin Oncol Educ Book. 2019;39:105-114. doi:10.1200/EDBK_243729 - DOI - PubMed
    1. Ho G, Wun T, Muffly L, et al.Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California. Cancer. 2018;124(9):1938-1945. doi:10.1002/cncr.31296 - DOI - PMC - PubMed
    1. Hantel A, Luskin MR, Garcia JS, Stock W, DeAngelo DJ, Abel GA.. Racial and ethnic enrollment disparities and demographic reporting requirements in acute leukemia clinical trials. Blood Adv. 2021;5(21):4352-4360. doi:10.1182/bloodadvances.2021005148 - DOI - PMC - PubMed