Socioeconomic Status and Clinical Trial Enrollment in Head and Neck Cancer: A Single‐Institution Retrospective Study
Isabella M. Le, Melissa F. Riedel, Subir Goyal, Jennifer H. Gross, James E. Bates, William A. Stokes, Conor E. Steuer, Dong M. Shin, Soumon Rudra, Nabil F. Saba, Nicole C. SchmittAbstract
Objectives
Cancer clinical trial (CCT) enrollment remains essential to advancing oncologic care, yet participation disparities persist. While socioeconomic status (SES) and race are associated with lower enrollment across oncology, determinants within head and neck cancer (HNC) are less defined. We evaluated whether SES and geographic distance were associated with HNC CCT enrollment.
Study Design
Retrospective cohort study.
Setting
Multidisciplinary HNC clinic at a comprehensive cancer center.
Methods
Patients evaluated between May 2023 and April 2024 with documented discussion of CCT participation were identified from a prospective database. Eligibility and enrollment status were confirmed by chart review. SES measures included insurance status and zip code–level median income. Travel distance to the trial site was calculated. Univariable and multivariable logistic regression analyses were performed.
Results
Of 192 patients screened, 169 met eligibility criteria; 59 (35%) enrolled and 110 (65%) declined. In multivariable analysis, female sex was associated with lower odds of enrollment (OR 0.34, 95% CI 0.13‐0.87, P = .025). Greater travel distance independently predicted lower enrollment (OR 0.99 per mile, 95% CI 0.99‐1.00, P = .045). Stage IV disease trended toward lower participation but was not statistically significant. No significant associations were observed for age, race/ethnicity, median income, insurance status, or comorbidity index.
Conclusions
In this single‐institution cohort, geographic distance and sex were independent predictors of HNC CCT enrollment, whereas SES was not. Structural accessibility may represent a more immediate enrollment barrier within tertiary referral populations. Prospective studies are needed to validate these findings and inform interventions to improve equitable trial participation.