title: Clinical trial participation among ethnic/racial minority and majority patients with advanced cancer: what factors most influence enrollment?
abstract: BACKGROUND
  Studies using administrative data report that racial/ethnic minority patients enroll in clinical trials less frequently than white patients. We studied a cohort of terminally ill cancer patients to determine a) if racial/ethnic minority patients have lower rates of drug trial enrollment than white patients once socioeconomic characteristics are accounted for and b) what factors most influence drug trial enrollment among patients with advanced canceroverall.
  
  
  METHODS
  Coping with Cancer (CwC) is a National Cancer Institute/National Institute of Mental Health (NCI/NIMH)-funded multisite, prospective, longitudinal study of patients with advanced cancer. Baseline interviews assessed drug trial enrollment as well as socioeconomic characteristics. Logistic regression models estimated associations between drug trial enrollment and baseline characteristics. Stepwise, backward, and subset model selection was applied to select the final model where characteristics significant at α=0.05 remained in the model.
  
  
  RESULTS
  At a median of 4.4 months prior to death, 35 of 358 patients (9.8%) were enrolled in a drug trial. In unadjusted analyses, race/ethnicity, health insurance, performance status, recruitment site, cancer type, preference for life-extending care, and lack of end-of-life care planning were associated (p<0.05) with enrollment. In multivariable analysis, patient race/ethnicity was not significantly associated with enrollment. Patients who reported not having an end-of-life discussion (adjusted odds ratio [AOR], 0.18; 95% confidence interval [CI] 0.04-0.83) and those not wanting to discuss life expectancy (AOR, 0.31; 95%CI 0.12-0.79) were more likely to be trial enrollees.
  
  
  CONCLUSIONS
  Patient race/ethnicity was not associated with clinical trial enrollment after adjustment for socioeconomic covariates. Patients with advanced cancer endorsing less engagement in end-of-life planning were more likely to be enrolled in a clinical trial.
authors: Department of Radiation Oncology, Harvard Radiation Oncology Program, Boston, Massachusetts, USA.
authors: Rachel
authors: R
authors: Jimenez
authors: Baohui
authors: B
authors: Zhang
authors: Steven
authors: S
authors: Joffe
authors: Matthew
authors: M
authors: Nilsson
authors: Lorna
authors: L
authors: Rivera
authors: Jan
authors: J
authors: Mutchler
authors: Christopher
authors: C
authors: Lathan
authors: M Elizabeth
authors: ME
authors: Paulk
authors: Holly G
authors: HG
authors: Prigerson
mesh_terms: D002986:Clinical Trials as Topic / Q000523:psychology*; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000208:ethnology*; D010358:Patient Participation; D057240:Patient Preference; D010817:Physician-Patient Relations; D011446:Prospective Studies; D019452:Terminally Ill
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