title: Patient income level and cancer clinical trial participation.
abstract: OBJECTIVE
  Studies have shown an association between socioeconomic status (SES) and quality of oncology care, but less is known about the impact of patient SES on clinical trial participation.
  
  
  METHODS
  We assessed clinical trial participation patterns according to important SES (income, education) and demographic factors in a large sample of patients surveyed via an Internet-based treatment decision tool. Logistic regression, conditioning on type of cancer, was used. Attitudes toward clinical trials were assessed using prespecified items about treatment, treatment tolerability, convenience, and cost.
  
  
  RESULTS
  From 2007 to 2011, 5,499 patients were successfully surveyed. Forty percent discussed clinical trials with their physician, 45% of discussions led to physician offers of clinical trial participation, and 51% of offers led to clinical trial participation. The overall clinical trial participation rate was 9%. In univariate models, older patients (P = .002) and patients with lower income (P = .001) and education (P = .02) were less likely to participate in clinical trials. In a multivariable model, income remained a statistically significant predictor of clinical trial participation (odds ratio, 0.73; 95% CI, 0.57 to 0.94; P = .01). Even in patients age ≥ 65 years, who have universal access to Medicare, lower income predicted lower trial participation. Cost concerns were much more evident among lower-income patients (P < .001).
  
  
  CONCLUSIONS
  Lower-income patients were less likely to participate in clinical trials, even when considering age group. A better understanding of why income is a barrier may help identify ways to make clinical trials better available to all patients and would increase the generalizability of clinical trial results across all income levels.
authors.affiliation: SWOG Statistical Center, Fred Hutchinson Cancer Research Center, M3-C102, 1100 Fairview Ave, Seattle, WA 98109, USA. junger@fhcrc.org
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Unger
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Kathy S
authors.initials: KS
authors.lastname: Albain
authors.forename: Carol M
authors.initials: CM
authors.lastname: Moinpour
authors.forename: Judith A
authors.initials: JA
authors.lastname: Petersen
authors.forename: Kenda
authors.initials: K
authors.lastname: Burg
authors.forename: John J
authors.initials: JJ
authors.lastname: Crowley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000628:therapy; D003661:Decision Support Techniques; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D016015:Logistic Models; D008175:Lung Neoplasms / Q000628:therapy; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D016017:Odds Ratio; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data; D010361:Patients; D011471:Prostatic Neoplasms / Q000628:therapy; D035842:Research Subjects / Q000191:economics / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States