Differences in cancer clinical trial activity and trial characteristics at metropolitan and rural trial sites in Victoria, Australia

Abstract

ObjectiveCancer clinical trials (CCTs) provide access to emerging therapies and extra clinical care. We aimed to describe the volume and characteristics of CCTs available across Victoria, Australia, and identify factors associated with rural trial location.MethodsQuantitative analysis of secondary data from Cancer Council Victoria's Clinical Trials Management Scheme dataset.DesignA cross‐sectional study design was used.SettingCCTs were available Victoria‐wide in 2018.ParticipantsThere were 1669 CCTs and 5909 CCT participants.Main Outcome MeasuresRural CCT location was assessed as a binary variable with categories of ‘yes’ (modified Monash [MM] categories 2–7) and ‘no’ (MM category 1). MM categories were determined from postcodes. The highest (‘least rural’) MM category was used for postcodes with multiple MM categories.ResultsOf 1669 CCTs, 168 (10.1%) were conducted in rural areas. Of 5909 CCT participants, 315 (5.3%) participated in rural CCTs. There were 526 CCTs (31.5%) with 1907 (32.3%) newly enrolled participants. Of 1892 newly enrolled participants with postcode data, 488 (25.8%) were rural residents. Of them, 368 (75.4%) participated in metropolitan CCTs. In a multivariable logistic regression analysis for all 1669 CCTs, odds of a rural rather than metropolitan CCT location were significantly (p‐value <0.05) lower for early‐phase than late‐phase trials and non‐solid than solid tumour trials but significantly (p‐value <0.05) higher for non‐industry than industry‐sponsored trials.ConclusionsIn Victoria, 10% of CCTs are at rural sites. Most rural‐residing CCT participants travel to metropolitan sites, where there are more late‐phase, non‐solid‐tumour and industry‐sponsored trials. Approaches to increase the volume and variety of rural CCTs should be considered.

Health equity in clinical trials for regional, rural and First nations communities: Need for networked clinical trial system, through a values and purpose‐aligned system culture

“…This is a key challenge highlighted by the accompanying commentary (Walsh et al) 7 and specifically emphasised in the accompanying research paper (McPhee et al). 7,8 Alarmingly, an MJA study recently described particularly poor representation of First nations communities in trials (exemplified in trials of parenting programs). 9 Many of the challenges and barriers to health services in regional, rural and First nations communities are apparent (or even more pronounced) in the case of clinical trials.…”