title: Effect of patient socioeconomic status on access to early-phase cancer trials.
abstract: OBJECTIVE
  Little is known about the influence of socioeconomic factors on patient access to cancer trials. Differences should be considered to ensure generalizability of trial results and equality of access.
  
  
  METHODS
  Phase I trials unit referrals at our center over 5 years, from 2007 to 2012, were reviewed. Socioeconomic status was defined by the Index of Multiple Deprivation (IMD; 1, least deprived; 5, most deprived). Multivariate analysis was performed comparing incident cancer cases with referred patients and those ultimately enrolled onto a trial.
  
  
  RESULTS
  Four hundred thirty patients were referred (median age, 62 years). Compared with 10,784 incident cases, referral was less likely for patients in the more-deprived quintiles compared with the least deprived (IMD 5: odds ratio [OR], 0.53; 95% CI, 0.38 to 0.74). Once reviewed in the unit, enrollment onto a trial was not affected (IMD 5: OR, 0.81; 95% CI, 0.40 to 1.63). Ethnicity analysis showed the nonwhite population was less likely to be recruited (OR, 0.48; 95% CI, 0.26 to 0.88). This relationship was lost with adjustment for age, sex, cancer type, and deprivation index.
  
  
  CONCLUSIONS
  We show for the first time to our knowledge that socioeconomic status affects early-phase cancer trial referrals. The least-deprived patients are almost twice as likely to be referred compared with the most deprived. This may be because more-deprived patients are less suitable for a trial-as a result of comorbidities, for example-or because of inequalities that could be addressed by patient or referrer education. Once reviewed at the unit, enrollment onto a trial is not affected by deprivation.
authors.affiliation: King’s College London, United Kingdom.
authors.forename: Aisyah
authors.initials: A
authors.lastname: Mohd Noor
authors.forename: Debashis
authors.initials: D
authors.lastname: Sarker
authors.forename: Suzanne
authors.initials: S
authors.lastname: Vizor
authors.forename: Blair
authors.initials: B
authors.lastname: McLennan
authors.forename: Sarah
authors.initials: S
authors.lastname: Hunter
authors.forename: Aneta
authors.initials: A
authors.lastname: Suder
authors.forename: Henrik
authors.initials: H
authors.lastname: Moller
authors.forename: James F
authors.initials: JF
authors.lastname: Spicer
authors.forename: Sophie
authors.initials: S
authors.lastname: Papa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic / Q000191:economics* / Q000706:statistics & numerical data; D017321:Clinical Trials, Phase I as Topic / Q000191:economics*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D012923:Social Class; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult