Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Adolesc Young Adult Oncol. 2022 Feb;11(1):104-110. doi: 10.1089/jayao.2021.0008. Epub 2021 May 19.
Adolescents and young adults (AYAs) have experienced inferior improvements in cancer survival outcomes. One potential explanation is the low rate of enrollment in cancer clinical trials. While the reasons behind this are multifactual, sociodemographic factors are probably contributory. We examined the impact of factors such as insurance type and race/ethnicity on clinical trial enrollment among AYAs treated for cancer at an academic medical center. We identified AYAs (ages 15-39 years) treated for cancer at the University of North Carolina between April 2014 and April 2019. Cancer registry data were linked to electronic health record data to associate treatment and sociodemographic factors with clinical trial enrollment. A multivariable log-binomial model was used to estimate adjusted risk ratios. In a 5-year period, 1574 AYA patients were identified, 59% female, 21% non-Hispanic Black and 9% Hispanic. Overall, 37% of AYAs participated in any clinical trial and 14% enrolled on a therapeutic trial. When compared to publicly insured AYAs, those with private insurance [adjusted RR: 1.52, 95% CI: 1.05-2.22] or with no insurance [adjusted RR: 2.12, 95% CI: 1.34-3.33] were more likely to enroll in a therapeutic clinical trial. Hispanic AYAs were less likely to enroll [adjusted RR: 0.50, 95% CI: 0.27-0.93] when compared to non-Hispanic White patients. Rates of clinical trial enrollment among AYAs vary based on health insurance type and race/ethnicity, suggesting possible disparities in access. Attention to resource, cultural, and language barriers may improve trial enrollment and cancer outcomes among vulnerable AYA subpopulations.
青少年和年轻成年人（AYAs）在癌症生存结果方面的改善程度较低。一个潜在的解释是他们参与癌症临床试验的比例较低。尽管造成这种情况的原因有很多，但社会人口因素可能是促成因素。我们研究了保险类型和种族/民族等因素对在学术医疗中心接受癌症治疗的 AYA 参与临床试验的影响。我们确定了在北卡罗来纳大学接受癌症治疗的 AYA（年龄在 15-39 岁之间），时间从 2014 年 4 月至 2019 年 4 月。癌症登记数据与电子健康记录数据相关联，将治疗和社会人口因素与临床试验的参与情况联系起来。使用多变量二项式模型来估计调整后的风险比。在 5 年期间，确定了 1574 名 AYA 患者，其中 59%为女性，21%为非西班牙裔黑人，9%为西班牙裔。总体而言，37%的 AYA 参与了任何临床试验，14%的 AYA 参加了治疗性临床试验。与公共保险的 AYA 相比，有私人保险的 AYA [调整后的 RR：1.52，95%可信区间：1.05-2.22]或没有保险的 AYA [调整后的 RR：2.12，95%可信区间：1.34-3.33]更有可能参加治疗性临床试验。与非西班牙裔白人患者相比，西班牙裔 AYA 参加临床试验的可能性较低 [调整后的 RR：0.50，95%可信区间：0.27-0.93]。AYA 参与临床试验的比率因健康保险类型和种族/民族而异，这表明在获得机会方面可能存在差异。关注资源、文化和语言障碍可能会改善弱势 AYA 亚群的试验参与率和癌症结局。
