DURHAM, NC – Participation in clinical trials (CTs) remains low among cancer patients in general, but, in veterans, that issue is exacerbated because of the higher percentage of rural residents, according to a new study.
“The barrier of rural residence is relevant to veterans, who more commonly live in rural areas than non-veterans,” according to researchers from the Durham, NC, Healthcare System and colleagues. In an exploratory study, the investigative team sought to examine geographic factors that could impede CT enrollment and improve access to CTs for veterans. Results were published in the Journal of Rural Health.1
To measure the influence of rurality on the availability of CTs, researchers performed simulated searches using The Leukemia & Lymphoma Society’s Clinical Trial Support Center (LLS CTSC) database. The authors noted that LLS CTSC provides free CT education and navigation.
In the second part of this study, veterans with blood cancers who received care at the Durham; Salem, VA; Clarksburg, WV; Sioux Falls, SD, and Houston VAMCs were offered referral to the LLS CTSC.
“In simulated searches, we found significantly lower numbers of CTs open to enrollment in rural areas, compared to urban areas, the researchers explained. “In actual referrals, 33 veterans were referred to the LLS CTSC, of which 15 (45%) lived in rural areas. Three veterans enrolled in CTs. Patients declined referral or did not enroll in CTs for various reasons, including a desire to maintain care within the VA and/or to initiate therapy quickly.”
The authors said they identified “clinical trial deserts which might hinder access and reduce CT participation for rural Veterans. Referral to the LLS CTSC promoted CT education and enrollment among a highly rural cohort of veterans receiving care in the VA system.”
Background information in the articles pointed out that rural residence not only is linked to lower enrollment in clinical trials but also is associated with higher rates of cancer diagnoses and inferior cancer outcomes. “The rural-urban divide in cancer is attributed to various factors, including oncology infrastructure, insurance, geographic access and transportation, health behaviors, access to medical providers, health literacy, and access to clinical trials (CTs),” they advised.1
That especially affects veterans who receive their medical care in the VHA, according to the study, because they are more likely to live in rural areas, compared to the general population. They also tend to have higher levels of comorbidities, and often find that transportation is a barrier to accessing health care, according to the researchers, who added, “Reaching out to and providing high-quality health care to rural veterans is a priority to the VA, for example, using tele-oncology services to care for Veterans with cancer.”
Noting that cancer CTs “offer high-quality care while collecting essential data that advances medical knowledge,” the authors wrote that only 2%-8% of cancer patients in the United States participate in CTs, with those rates even lower among ethnic and racial minorities.
“Specific factors associated with lower CT enrollment that are most applicable to the veteran population who receive care in the VA include rurality, racial and ethnic minority status, lower education, insufficient transportation, lower income, and/or presence of comorbidities that render them ineligible to participate due to restrictive eligibility criteria,” according to the article.
- Friedman DR, Rodgers TD, Kovalick C, Yellapragada S, Szumita L, Weiss ES. Veterans with blood cancers: Clinical trial navigation and the challenge of rurality. J Rural Health. 2023 Jun 30. doi: 10.1111/jrh.12773. Epub ahead of print. PMID: 37389421.