Researchers recently sought to better understand the factors and barriers for veteran enrollment in blood cancer clinical trials—a population that comprises 3% of the nation’s total cancer diagnoses.

Clinical trial enrollment and participation is critical to improve care; however, patients who identify as minorities, live in rural areas, or are low-income are often underrepresented and veterans tend to fall into this population. Blood cancers are specifically more prevalent among the veteran population in part due to military exposures.

Researchers presented data at the 63rd ASH Annual Meeting & Exposition in which the Leukemia & Lymphoma Society’s (LLS) Clinical Trial Support Center (CTSC), a clinical trial nurse navigation service for patients with blood cancers and their oncologists, analyzed clinical trial databases to assess the impact of geography and rurality on the availability of clinical trials across 13 VA facilities (6 urban, 7 rural), 6 blood cancer centers, and two disease statuses (new diagnosis, relapsed/refractory). In addition, the researchers examined referral patterns of VA hematologist/oncologists and veterans treatment choices at 4 VA facilities from September 2020 through May 2021.

Based on the findings, researchers found that clinical trials were significantly more available to veterans in urban locations, as well as on the west and east coasts compared with the Midwest. This held true across all cancer and disease types or status.

A total of 48 veterans with blood cancers at Durham, NC; Salem, VA; Sioux Falls, SD; and Clarksburg, WV, VA facilities “had consideration of clinical trials as a treatment option by oncology providers over a 9-month period.” These patients were: all men; white (33) African American (15); non-Hispanic (47); Hispanic (1); aged 41 to 93 years; living 0.2-186 miles from their VA facility; and represented diverse diseases and stages.

Fourteen patients were not asked if they wanted clinical trial information with the most cited reasons being the need for immediate therapy, comorbidity, and individual patient circumstances.

Of the remaining included 34 patients, 14 did not agree to a CTSC referral due to preference for immediate therapy, wanting care in the VA, desire for standard therapy, and a lack of available transportation.

Only 2 of the 20 patients referred actually enrolled in clinical trials outside of the VA—for trials for chronic lymphocytic leukemia and primary myelofibrosis—with investigational therapy provided by the study sponsors.

“When offered information about clinical trials, the majority of patients agreed to an LLS CTSC referral, suggesting that patients are generally willing to receive education and information about trial participation if given the opportunity,” concluded researchers.

The researchers added that nurse navigators would be able to combat barriers to clinical trial enrollment with increased education and research into geographic area availability. There is also a need for increased trial creation in rural areas and within the VA system.

Reference:
Friedman DR, Rodgers TD, Szumita L, Weiss ES. Identifying and overcoming barriers in clinical trial enrollment for veterans with blood cancers. Poster presented at: 63rd ASH Annual Meeting & Exposition; December 11-14, 2021; Atlanta, GA.