(UroToday.com) The 2024 GU ASCO annual meeting featured a prostate cancer session and a presentation by Dr. Rishi Sekar discussing disparities in prostate cancer mortality and clinical trial availability across vulnerable populations. Clinical trials provide high-level evidence and test novel therapies that have significantly improved cancer outcomes. However, disparities in clinical trial participation and cancer mortality persist across race/ethnicity and vulnerable populations, notably in patients with prostate cancer. Adverse social determinants of health and systemic barriers may underlie these disparities. Identifying and overcoming these barriers may improve access to and representation in clinical trials, thereby promoting equitable advancement and applicability of science. For these reasons, Dr. Sekar and colleagues evaluated the association between clinical trial availability, cancer mortality, and population-level social determinants of health in prostate cancer.
Using custom data linkage from ClinicalTrials.gov, Surveillance Epidemiology and End Results (SEER) Registry, and the Centers for Disease Control and Prevention Social Vulnerability Index, Dr. Sekar performed a cross-sectional analysis of county-level prostate cancer clinical trial data, cancer incidence and mortality rates, and population-level social determinants of health. They included phase 2 and phase 3 interventional prostate cancer clinical trials with start dates from 2007 to 2022. The total number of clinical trials over the study period was calculated per county and population-adjusted for 100,000 residents. Counties were then stratified into quintiles based on Social Vulnerability Index (for example, the least vulnerable to most vulnerable). Population-adjusted clinical trial availability, cancer incidence, and cancer mortality were compared across Social Vulnerability Index quintiles. Multivariable logistic and linear regression analyses were performed to evaluate the association between Social Vulnerability Index and clinical trial availability and cancer mortality, respectively.
Only 40.9% of counties had at least one prostate cancer clinical trial. The mean number of prostate cancer trials per 100,000 residents was 25.6, with the most vulnerable counties having fewer clinical trials compared to the least vulnerable counties (mean 18.1 vs. 50.0, p < 0.05). As follows is the probability of having any prostate cancer trial by Social Vulnerability Index quintile:
Moreover, the most vulnerable counties had a lower prostate cancer incidence rate per 100,000 residents (mean 393.8 vs. 411.7, p < 0.05), but a higher prostate cancer mortality rate per 100,000 residents (mean 85.7 vs. 72.0, p < 0.05):
On multivariable regression analysis, the most vulnerable counties were associated with significantly decreased odds of having any prostate cancer clinical trial (OR 0.30, 95% CI 0.20 – 0.40), and significantly increased prostate cancer mortality (10.8, 95% CI 7.4 – 14.3), while the presence of any prostate cancer clinical trial was associated with significantly decreased prostate cancer mortality (-6.9, 95% CI -9.1 – -4.7).
Dr. Sekar concluded his presentation by discussing disparities in prostate cancer mortality and clinical trial availability across vulnerable populations with the following take-home points:
- Significant geographic disparities in prostate cancer clinical trial availability exist in the United States
- The most vulnerable counties were far less likely to have any prostate cancer clinical trials despite having a significantly higher prostate cancer mortality rate
- The presence of a prostate cancer clinical trial was associated with a reduction in prostate cancer mortality
- These vulnerable counties represent scientifically underserved populations that may benefit from equity-driven clinical trial enrollment and cancer care infrastructure expansion
Presented by: Rishi Sekar, MD, University of Michigan, Ann Arbor, MI
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, San Francisco, CA, January 25th – January 27th, 2024