Age, Diagnosis are Predictors of Patient Participation in NHL Clinical Trials

Age and diagnosis were the key predictors of whether a patient with non-Hodgkin lymphoma (NHL) would participate in a clinical trial—not race and gender, according to a study presented at the 2022 American Society of Hematology Annual Meeting.

“In a large academic cohort, age and diagnosis not race, gender, insurance type, or neighborhood level socioeconomic status were independent predictors of trial participation,” the investigators, led by Chijioke Nze, MD, MPH, of the University of Texas MD Anderson Cancer Center, noted.

Dr. Nze and colleagues performed a retrospective analysis of patients with NHL seen at the University of Texas MD Anderson Cancer Center between January 2017 and December 2020. Using patient addresses, they ascertained neighborhood level socioeconomic status (SES) variables, including educational attainment, neighborhood median income, poverty, crowding, race composition, and home values using geolocation software and American Community Survey (2015-2020) and 2020 census data available through the site data.Census.gov.

The final study cohort comprised 2,943 patients, of which 59% were male, 74.6% were non-Hispanic white, 13.2% were Hispanic, 6.1% were Black, and 3.7% were Asian. The most common insurance was managed care (47%) and Medicare (45.7%); 2.5% of patients were self-pay, 1.2% had Medicaid, and 2.1% had other government insurance. The cohort was also categorized by NHL subtypes (see TABLE 1).

There was a high overall clinical trial participation rate of 30.5%, with 20.9% enrolled in therapeutic trials. In univariate analyses, participation in NHL clinical trials differed significantly by diagnosis (P<.0005).

In terms of demographics, lower participation rates were associated with lower neighborhood level SES, including living below poverty level, living in crowded households, being older than 25 years with less than high school diploma, and lower median household income.

Racial composition of census tract was not associated with differences in clinical trial participation, and participation did not differ by insurance type.

The investigators cautioned that a major limitation to the generalizability of their results is the fact that the patient population seen at their institution is relatively well insured. “Examination of multicenter datasets including community practices when underinsured patients received care and evaluation of interventions to influence access to clinical trials are needed,” they wrote.

Reference

Nze C, Andersen CR, Ayers A, et al. Impact of patient demographics and neighborhood socioeconomic variables on clinical trial participation patterns for non-Hodgkin lymphoma at a major academic institution. Abstract #3544. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.