Travel Time and Distance and Participation in Precision Oncology Trials at the National Cancer Center Hospital

Abstract

ImportanceGenotype-matched trials, which are becoming increasingly important in the precision oncology era, require referrals from institutions providing comprehensive genomic profiling (CGP) testing to those conducting these trials, and the travel burden for trial participation is significant. However, it remains unknown whether travel time or distance are associated with genotype-matched trial participation.ObjectiveTo assess whether travel time or distance are associated with disparities in genotype-matched trial participation following CGP testing.Design, Setting, and ParticipantsThis retrospective cohort study from June 2020 to June 2022 included patients with advanced or metastatic solid tumors referred to the National Cancer Center Hospital for participation in genotype-matched trials following CGP testing and discussion by molecular tumor boards. Data were analyzed from June to October 2022.ExposuresTravel time and distance.Main Outcomes and MeasuresThe primary and secondary outcomes were enrollment in genotype-matched trials and all-cancer clinical trials, respectively.ResultsOf 1127 patients (mean [range] age, 62 [16-85] years; 584 women [52%]; all residents of Japan), 127 (11%) and 241 (21%) were enrolled in genotype-matched trials and all-cancer clinical trials, respectively. The overall median (IQR) travel distance and time were 38 (21-107) km and 55 (35-110) minutes, respectively. On multivariable regression with 23 covariates, travel distance (≥100 km vs <100 km) was not associated with the likelihood of genotype-matched trial participation (26 of 310 patients [8%] vs 101 of 807 patients [12%]; odds ratio [OR], 0.64; 95% CI, 0.40-1.02), whereas in patients with travel time of 120 minutes or more, the likelihood of genotype-matched trial participation was significantly lower than those with travel time less than 120 minutes (19 of 276 patients [7%] vs 108 of 851 patients [13%]; OR, 0.51; 95% CI, 0.29-0.84). The likelihood of genotype-matched trial participation decreased as travel time increased from less than 40 (38 of 283 patients [13%]) to 40 to 120 (70 of 568 patients [12%]) and 120 or more (19 of 276 patients [7%]) minutes (OR, 0.74; 95% CI, 0.48-1.17; OR, 0.41; 95% CI, 0.22-0.74, respectively). Neither travel time nor distance were associated with the likelihood of all-cancer clinical trial participation.Conclusions and RelevanceIn this cohort study of patients undergoing CGP testing, an increased travel time was associated with a decreased likelihood of genotype-matched trial participation. This warrants further research on interventions, such as decentralization of clinical trials to mitigate travel burden.

Evolving or immutable - phase I solid tumor trials in the era of precision oncology

“…Lower albumin levels have been associated with decreased survival rates in numerous studies [ 12 – 15 ]. Additionally, a previous investigation of factors associated with precision oncology trial participation has found a significant association between lower albumin levels and lesser likelihood of enrollment in genotype-matched trials [ 16 ]. Greater utilization of albumin as a study inclusion criterion may aid in appropriately excluding patients at high risk for clinical deterioration.…”

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

“…Increased travel time is associated with a reduced likelihood of clinical trial participation. 31 In addition to being patient-related barriers, travel and distance are also perceived barriers for physicians and may prevent physicians from referring patients to clinical trials in the first instance. 32 In a US study that was not specific to cancer, 33 it was found that rural residents have 77% lower odds of being invited to clinical trials compared to metropolitan residents, which the authors concluded was due to limited trial availability locally.…”

Identification of barriers to implementation of precision oncology in patients with rare cancers

“…Previous reports have demonstrated that 3.6%–12.2% of patients with advanced cancers received genomically matched therapy based on CGP testing results 2–4 . However, the clinical utility of CGP testing varies based on patient characteristics (including age, gender, and cancer type) and the treatment options available at different hospitals 5 . We previously reported that the proportion of patients treated using genomically matched therapy was significantly higher for common cancers than noncommon cancers 2 …”