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Oncologist. 2018 Oct;23(10):1242-1249. doi: 10.1634/theoncologist.2017-0628. Epub 2018 Apr 26.

At What Cost to Clinical Trial Enrollment? A Retrospective Study of Patient Travel Burden in Cancer Clinical Trials.

Author information

1
Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California, USA hala.borno@ucsf.edu.
2
Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California, USA.
3
Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA.

Abstract

BACKGROUND:

Recent literature suggests that living in a rural setting may be associated with adverse cancer outcomes. This study examines the burden of travel from home to cancer center for clinical trial (CT) enrollees.

MATERIALS AND METHODS:

Patients from the University of California San Francisco Clinical Trial Management System database who enrolled in a cancer CT for a breast, genitourinary, or gastrointestinal malignancy between 1993 and 2014 were included. Cancer type, household zip code, race/ethnicity, phase of study, study sponsor, and year of signed consent were exported. Distance traveled from home to center was calculated using a GoogleMaps application programming interface. The relationships of distance with phase of CT, household income, and race/ethnicity were examined.

RESULTS:

A total of 1,600 patients were enrolled in breast (55.8%), genitourinary (29.4%), or gastrointestinal (14.9%) cancer CTs. The overall median unidirectional distance traveled from home to study site was 25.8 miles (interquartile range [IQR] 11.5-75.3). Of the trial sponsors examined, principal investigator (56.4%), industry (22.2%), cooperative group (11.6%), and National Institutes of Health (NIH; 9.8%), the longest distance traveled was for NIH-sponsored trials, with a median of 39.4 miles (p < .001). Phase I (8.4%) studies had the longest distance traveled, with a median of 41.2 miles (IQR 14.5-101.0 miles; p = .001). White patients (83%) traveled longer compared with black patients (4.4%), with median distances of 29.9 and 13.9 miles, respectively (p < .001). Patients from lower-income areas (n = 799) traveled longer distances compared with patients from higher-income areas (n = 773; 58.3 vs. 17.8 miles, respectively; p < .001). A multivariable linear model where log10 (distance) was the outcome and adjusting for the exported variables and income revealed that cancer type, year of consent, race/ethnicity, and income were significantly associated with distance traveled.

CONCLUSION:

This study found that the burden of travel is highest among patients enrolled in NIH-sponsored trials, phase I studies, or living in low-income areas. These data suggest that travel burden for cancer CT participants may be significant.

IMPLICATIONS FOR PRACTICE:

This study is one of the first to measure travel distance for patients in cancer clinical trials using a real-world GoogleMaps calculator. Out-of-pocket expenses such as travel are not typically covered by health care payers; therefore, patients may face considerable cost to attend each study visit. Using a single-center clinical trials enrollment database, this study found that the burden of travel is highest for patients enrolled in National Institutes of Health-sponsored trials and phase I studies, as well as for patients living in low-income areas. Results suggest that a significant proportion of patients enrolled in clinical trials face a substantial travel burden.

KEYWORDS:

Cancer clinical trial disparities; Health care costs; Recruitment science; Representativeness in clinical trials; Travel distance

PMID:
29700209
PMCID:
PMC6263122
[Available on 2019-10-01]
DOI:
10.1634/theoncologist.2017-0628

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

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