Abstract 80P
Background
Social determinants of health inequalities (SDoH) impact patients with cancer. Early phase clinical trials in Oncology represent a subspecialised area where patients are highly selected and influenced in the UK by access to Experimental Cancer Medicine Centres (ECMCs). Northern England is more socioeconomically deprived than other areas of the UK. To examine equity of access to early phase trials, patient SDoH characteristics were explored for all referrals to two large Northern England ECMCs.
Methods
A retrospective cohort study including all patients referred to Newcastle (N) and Manchester (M) ECMCs in 2021 was completed. This stratified consent to trial screening or pre-screening against SDoH characteristics, such as: age, gender, Index of Multiple Deprivation (IMD) per quintile, ethnicity and distance to centre. Deprivation profiles of referral populations were generated from census data. Factors influencing non-enrolment to trials were explored. Univariate analysis was utilised to determine odds ratios (OR) and 95% confidence intervals (CI) for determinants, p values ≤0.05 were considered statistically significant.
Results
1,243 patients with advanced cancer were referred for consideration of trials. Median age was 62 years (range: 18 - 90), with a male predominance (n = 670, 53.9%) and multiple tumour types (n = 84). 628 (50.5%) patients were consented to trials. Quintile 1 (most deprived) patients had reduced likelihood of being referred for trials when compared to expected population models (OR, 0.67; 95% CI, 0.55 to 0.80, p = <0.0001), while quintile 5 (least deprived) had increased likelihood of referral (OR, 1.46; 95% CI, 1.17 to 1.82, p = 0.0007). Living beyond the median referral distance from M reduced the likelihood of consenting to trials (M OR, 0.72; 95% CI, 0.55 to 0.94, p = 0.015). Ethnicity data represented a White British propensity. Reasons for non-enrollment between socio-economic quintile groups did not vary significantly.
Conclusions
Inequalities in socioeconomic and geographic factors influence referral and enrolment to early phase clinical trials in Northern England. This has important implications for equity of access and generalisability of trial results internationally and warrants further study.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
C. Oing: Financial Interests, Personal, Invited Speaker, Renal Cancer Expert Panel Case Presentation: Ipsen; Financial Interests, Personal, Invited Speaker, Talk on Pain Management in GU Cancer Patients: Medac; Financial Interests, Personal, Invited Speaker, Case Presentation Soft Tissue Sarcoma: Roche; Financial Interests, Personal, Advisory Board, Ad Board on discussing novel educational events for young hematologists: Novartis; Financial Interests, Personal, Invited Speaker, Science Slam with a presentation on young professional support from oncological societies in Germany: AstraZeneca; Financial Interests, Personal, Advisory Board, Ad. Board assessing educational needs for oncology professionals regarding G-CSF use: Sandoz; Financial Interests, Personal, Invited Speaker, Presentation on Burnout and Resilience in medical oncology professionals: Asklepios Hamburg; Financial Interests, Personal, Advisory Board, Larotrectinib use in sarcoma: Bayer; Financial Interests, Personal, Advisory Board, Experiences with Cabo/Nivo as first-line treatment for metastatic RCC: Ipsen; Non-Financial Interests, Personal, Other, Clinical Advisory role in early drug discovery with a fellowship position affiliated with Astex Pharmaceuticals, Cambridge, UK: Astex Pharmaceuticals; Non-Financial Interests, Institutional, Product Samples, Cytotoxic Agent for Preclinical Experiments: PharmaMar. M.G. Krebs: Financial Interests, Personal, Advisory Board: Bayer, Roche, Janssen, Guardant Health; Financial Interests, Personal, Invited Speaker: Roche, Janssen; Financial Interests, Institutional, Expert Testimony: AstraZeneca; Financial Interests, Institutional, Advisory Board: Seattle Genetics; Financial Interests, Institutional, Invited Speaker: AstraZeneca, Blueprint, Astex, Bayer, BerGenBio, Carrick, Immutep, Janssen, Novartis, Nurix, Nuvalent, Pyramid Biosciences, Roche, Seattle Genetics, Turning Point Therapeutics; Financial Interests, Institutional, Research Grant: Roche, Novartis; Other, Personal, Other, Travel expenses for congress: Immutep, Janssen; Other, Personal, Other, Travel expenses: Roche. F. Thistlethwaite: Financial Interests, Personal, Advisory Board, Ad board: BMS; Financial Interests, Personal, Advisory Board, Ad boards: GSK; Financial Interests, Personal, Advisory Board, Adboard/consultancy: T-Knife Therapeutics; Financial Interests, Personal, Advisory Board: Adicet, Janssen, EnaraBio, Immatics, Ixaka, Scenic Biotech, F-Star, Leucid; Financial Interests, Institutional, Advisory Board: Pfizer; Financial Interests, Personal, Invited Speaker: Kite Gilead; Financial Interests, Personal, Other, Occasional individual consulting: Guidepoint; Financial Interests, Institutional, Other, iMATCH is a 12 partner consortium funded by not for profit Innovate UK (UK government body) partners include commercial, clinical and academic institutes. I am director and my salary (0.1WTE) is supported through this work as a grant to my institution (The Christie NHS foundation trust - not for profit NHS hospital) from IUK: iMATCH director; Financial Interests, Institutional, Officer, Clinical lead for this 10 partner consortium of clinical academic and commercial partners. My salary is partly supported (approx. 0.05WTE) through this by a grant paid by Innovate UK (a NFP government body) to my institution (The Christie NHS foundation trust a NFP UK hospital): SAMPLE; Financial Interests, Institutional, Invited Speaker, NCT02890069: Novartis; Financial Interests, Institutional, Research Grant, Sarcoma pathways project: GSK; Financial Interests, Institutional, Invited Speaker, NCT02493751: Pfizer; Financial Interests, Institutional, Invited Speaker, NCT03245736, NCT02988817, NCT02552121, NCT02001623: GenMab; Financial Interests, Institutional, Invited Speaker, NCT02277717: Synthon; Financial Interests, Institutional, Invited Speaker, NCT03013491: CytomX; Financial Interests, Institutional, Invited Speaker, NCT03314935: Incyte; Financial Interests, Institutional, Invited Speaker, NCT02908906: Janssen; Financial Interests, Institutional, Invited Speaker, NCT03132792, NCT04044768,: Adaptimmune; Financial Interests, Institutional, Invited Speaker, NCT03400332: BMS; Financial Interests, Institutional, Invited Speaker, NCT04262466, NCT03973333, NCT03515551: Immunocore; Financial Interests, Institutional, Invited Speaker, EudraCT Number: 2018-001005-85, 2018-003446-16: Achilles Ltd.; Financial Interests, Institutional, Invited Speaker: Agalimmune Ltd.; Financial Interests, Institutional, Invited Speaker, NCT02834247: Millennium Pharmaceuticals/Takeda; Financial Interests, Institutional, Invited Speaker, NCT02690350: Daiichi Sankyo; Financial Interests, Institutional, Invited Speaker, NCT04839991: Crescendo; Financial Interests, Institutional, Invited Speaker, NCT05104515: Oxford Vacmedix Ltd.; Financial Interests, Institutional, Invited Speaker, NCT05278975: RS Oncology LLC; Financial Interests, Institutional, Invited Speaker, NCT03697824, NCT03391778: GSK; Financial Interests, Institutional, Invited Speaker, NCT04140500, NCT04857138, NCT04826003: Roche; Financial Interests, Institutional, Invited Speaker, NCT04272203: AbbVie; Financial Interests, Personal, Invited Speaker, NCT05008913, NCT04949425, NCT0331509, NCT03313557: AstraZeneca; Financial Interests, Institutional, Invited Speaker, NCT03829501: Kymab Ltd./Sanofi; Financial Interests, Institutional, Invited Speaker, EUDRACT ID No: 2019-003329-11: Chugai; Financial Interests, Institutional, Invited Speaker, NCT05430555: T-Knife Therapeutics; Financial Interests, Institutional, Invited Speaker, NCT03621982: ADCT Therapeutics; Financial Interests, Institutional, Research Grant, IRAS Project ID: 227414: Novartis; Non-Financial Interests, Personal, Other, Panel member for a funding committee (MRC is a UK government NFP organisation): MRC DPFS panel member; Non-Financial Interests, Personal, Advisory Role, Sarcoma UK is a not-for-profit charity. I act as an advisor on their Research Strategy Committee. This role is not compensated: Sarcoma UK; Non-Financial Interests, Personal, Leadership Role, Funding is from not-for-profit government bodies. Role is not compensated: Chair of the Independent Steering Committee for NIHR Blood & Transplant Research Unit, Oxford; Non-Financial Interests, Personal, Advisory Role, Funding panel member for CRUK (not-for profit charity). Role is not compensated: CRUK New Agents Committee Member; Non-Financial Interests, Personal, Leadership Role, Chair of Cell therapy subgroup. MRC is a not-for-profit organisation. Role is not compensated: MRC Advanced Therapies Task Group. L. Carter: Financial Interests, Personal, Other, Consultancy: Bicycle Therapeutics, Boehringer Ingelheim, Athenex; Financial Interests, Personal, Full or part-time Employment, Medical Advisor: Cancer research UK Centre for Drug Development; Financial Interests, Institutional, Invited Speaker: Boehringer Ingelheim, Bicycle Therapeutics, Cellcentric, Eli Lily, Athenex, Lupin Limited, Repare Therapeutics, Cytomx therapeutics, EMD Serono/Merck KGaA, Sierra Oncology; Financial Interests, Institutional, Invited Speaker, Funding for delivering commercial trial activity: Genmab. N. Cook: Financial Interests, Institutional, Advisory Board: Roche; Financial Interests, Institutional, Invited Speaker: Taiho, Roche, AstraZeneca, RedX, Orion, Avacta, Bayer, Eisai, UCB, Starpharma, Boeringher, Stemline; Non-Financial Interests, Personal, Advisory Role: Roche. A. Greystoke: Financial Interests, Personal, Advisory Board: BMS, AstraZeneca, Boehringer Ingelheim, Takeda, Roche, Novartis; Financial Interests, Personal, Invited Speaker: Merck, MSD, Pfizer, Janssen; Financial Interests, Institutional, Invited Speaker: MSD, Pfizer, AstraZeneca, Novartis, Achilles; Non-Financial Interests, Personal, Advisory Role: National Institute for Health and Clinical Excellence; Non-Financial Interests, Personal, Leadership Role, Steering Committee member: British Thoracic Oncology Group; Other, Personal, Other, Clinical Lead for Cancer (paid position): North East Englad and Yorkshire Genomic Laboratory Hub. D.M. Graham: Financial Interests, Personal, Advisory Board, Consulting role on advisory board: clinigen; Financial Interests, Institutional, Invited Speaker, Institutional funding from study: MSD, Codiak Biosciences, Starpharma, Faron Pharmaceuticals, Synthon, Janssen, Incyte; Financial Interests, Institutional, Other, Sub-I: Institutional funding from study, Research Funding: AstraZeneca; Financial Interests, Institutional, Other, Sub-I: Institutional funding from study: Roche, BerGenBio, GSK, Bayer, Bicycle pharmaceuticals, Carrick, Taiho pharmaceuticals, CytomX Therapeutics, RedX Pharma PLC, Eisai Inc, Octimet, Orion Pharma, Kinex pharmaceuticals, Boehringer Ingelheim, BMS, Turning Point Therapeutics, Immutep, Agalimmune, Kymab, Blueprint, Astellas, Cellcentric, UCB Biopharma USL, Eli Lily, Seagen, Repare therapeutics, Timepoint Therapeutics, Astex, Stemline, Crescendo Biologics Ltd., ADC Therapeutics, Genentech, Avacta Life Sciences Ltd., Nurix Therapeutics Inc; Financial Interests, Institutional, Other, Sub-I: Institutional finding from study: Chugai Pharmaceuticals; Non-Financial Interests, Institutional, Training, Training and support of research inclusivity seminar: Gilead. R. Plummer: Financial Interests, Personal, Advisory Board: Pierre Faber, Bayer, Novartis, BMS, Cybrexa, Ellipses, CV6 Therapeutics, Astex Therapeutics, Sanofi Aventis, Immunocore, Genmab, Medivir, Onexo, Incyte; Financial Interests, Institutional, Royalties, Royalties relating to rucaparib licensing: Clovis Oncology; Financial Interests, Personal, Other, Honorarium as member of IDMC: SOTIO, Alligator Biosciences, AstraZeneca; Financial Interests, Personal, Other, Honoraria as member of IDMC: GSK. All other authors have declared no conflicts of interest.