Study Links High Travel Burden, Clinical Trial Participation

Patients with cancer who enroll into clinical trials (CT) for treatment experience high levels of travel burden, according to a study published in The Oncologist.

For this study, researchers evaluated the data of 1600 patients from the University of California San Francisco Clinical Trial Management System database who enrolled in a clinical trial between 1993 and 2014. Investigators measured the distance traveled by patients using a Google Maps calculator, and evaluated the relationship of distance with various factors including household income, race/ethnicity, and phase of trial.

Analysis showed that 55.8%, 29.4%, and 14.9% of patients were enrolled in clinical trials for breast, genitourinary, and gastrointestinal cancers, respectively, and of the study sponsor types, 56.4% were sponsored by principal investigator studies, 22.2% by industry sponsored, 11.6% by cooperative groups, and 9.8% by the National Institutes of Health (NIH).

The overall median unidirectional distance traveled by patients from home to study site was 25.8 miles, and patients traveled the greatest distances (39.4 miles) to reach NIH-sponsored studies. Patients went farther for phase 1 studies more than any other type of study, traveling a median 41.2 miles.

White patients (83%) were more likely to travel longer distances to participate in trials compared with black (4.4%) or Asian patients (11.6%), and traveled median unidirectional distances of 22.9, 13.9, and 13.4 miles, respectively.

Patients from lower-income areas traveled a median 58.3 miles compared with 17.8 miles for patients from high income areas.

Further analysis adjusted for income and other demographic information showed that cancer type, year of consent, income, race/ethnicity, were significantly associated with distance traveled by these patients.

The authors concluded that “a significant proportion of patients enrolled in clinical trials face a substantial travel burden; however, this relationship will need to be explored further. Future work will need to examine the total out-of-pocket expenses assumed by patients across multiple academic medical centers to account for regional and geographic variability of trial participation.”

Reference

Borno HT, Zhang L, Siegel A, Chang E, Ryan CJ. At what cost to clinical trial enrollment? A retrospective study of patient travel burden in cancer clinical trials[published online April 26, 2018]. Oncologist. doi: 10.1634/theoncologist.2017-0628