Annual Meeting Proceedings II - Newly Released Abstracts for

CRA6009 Clinical Science Symposium, Sun, 8:00 AM-9:30 AM
Patterns of decision making about cancer clinical trial participation among the
online cancer treatment community: A collaboration between SWOG and NexCura.
Joseph M Unger, Dawn L. Hershman, Kenda Burg, Carol Moinpour, Kathy S. Albain, Judith A. Petersen,
John Crowley; SWOG Statistical Center, Seattle, WA; Columbia University Medical Center, New York, NY;
Nexcura, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Loyola University Medical
Center, Maywood, IL; Cancer Research and Biostatistics, Seattle, WA
Background: Studies have shown an association between socioeconomic status (SES) and quality of
oncology care, but less is known about the impact of SES on decision-making about CT participation.
Methods: We assessed patterns of CT treatment decision-making according to important SES and
demographic factors (age, sex, race, income, education) in a large sample of patients surveyed via a
web-based treatment decision tool (NexCura, The Woodlands, TX). Eligible patients had a new diagnosis
of breast, lung, colorectal, or prostate cancer, and were �18. Logistic regression (conditioning on type of
cancer) was used. Reasons for non-participation in CTs were assessed using pre-specified items about
treatment, family, cost, and logistics. All data were self-reported. Results: 5,499 patients were surveyed
from 2007-2011. 40% discussed CTs with their physician; this differed by age (42% �65 v. 29% �65),
income (42% �$50k/yr v. 36% �$50k/yr), and education (42% �college degree (CD) v. 37% �CD). 45%
of discussions led to offers of CT participation, and 51% of offers led to CT participation. The overall CT
participation rate was 9%, differing by age, income, and education (see table below). In a multivariate model
including all SES and demographic factors (plus covariates comorbidity status and “distance to clinic”, a
surrogate for convenience), income remained a predictor of CT participation (OR 0.73, 95% CI, 0.57-0.94,
p�.01). Even in patients �65, who are nearly universally covered by Medicare, lower income predicted
reduced CT participation (age by income interaction test, p�.05). Cost concerns were much more evident
among lower income patients (p�.0001). Conclusions: Lower income patients were less likely to
participate in CTs, even when considering age group.A better understanding of why income is a barrier may
help identify ways to make CTs better available to all patients, and would increase the generalizability of
CT study results across all levels of SES.
Factor Category (code) % Enrolled in CT
Age �65 (0)
�65 (1)
Income �$50k (0)
�$50k (1)
Education �CD (0)
�CD (1)
10.0
5.4
10.0
7.6
9.6
7.9
HEALTH SERVICES RESEARCH
Odds ratio (OR)
95% CI p value
0.64
0.48-0.85
0.68
0.54-0.86
0.78
0.64-0.96
© 2012 American Society of Clinical Oncology. Reprinted with permission.
.002
.001
.02