An evaluation of biobanking and therapeutic clinical trial representation among adult glioma patients from rural and urban Utah

Emma R Earl; Howard Colman; Joe Mendez; Randy L Jensen; Michael Karsy

doi:10.1093/nop/npad026

An evaluation of biobanking and therapeutic clinical trial representation among adult glioma patients from rural and urban Utah

Neurooncol Pract. 2023 May 13;10(5):472-481. doi: 10.1093/nop/npad026. eCollection 2023 Oct.

Authors

Emma R Earl¹, Howard Colman^{1

2}, Joe Mendez^{1

2}, Randy L Jensen^{1

2}, Michael Karsy¹

Affiliations

¹ School of Medicine, University of Utah, Salt Lake City, Utah, USA.
² Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.

Abstract

Background: Social determinants of health (SDOHs)-specifically those related to rurality, health care accessibility, and income-may play as-yet-unidentified roles in prognosis for glioma patients, and their impact on access to clinical trials is important to understand. We examined SDOHs of patients enrolled in glioma clinical trials and evaluate disparities in trial participation and outcomes between rural and urban patients.

Methods: We retrospectively identified patients enrolled in glioma clinical trials at Huntsman Cancer Institute (HCI) from May 2012 to May 2022 to evaluate clinical trial participation. We used multivariable models to evaluate SDOHs and geographic information system mapping to assess representation across Utah's counties. We utilized the most recent 10-year datasets of patients treated for glioma at HCI and from the Utah Cancer Registry to analyze survival and incidence, respectively.

Results: A total of 570 participants (68 trials) resided in Utah, 84.4% from urban counties, 13.5% from rural counties, and 2.1% from frontier (least-populous) counties. Nineteen counties (65.5%) were underrepresented in trials (enrolled participants vs. eligible), 1 (3.5%) was represented in a near-1:1 ratio, and 9 (31.0%) were overrepresented. Counties with greater enrollment had greater population densities, highest per-capita income, and proximity to HCI. Among patients treated at HCI, patients from rural/frontier counties had equivalent survival with urban patients across nearly all glioma types, including glioblastomas, despite underrepresentation in clinical trials.

Conclusions: By highlighting disparities in clinical trial enrollment, our results can support efforts to improve recruitment in underrepresented regions, which can assist providers in delivering equitable care for all patients.

Keywords: clinical trials; glioma; population density; rurality; social determinants of health.

© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.