2023 San Antonio Breast Cancer Symposium

Geographic Distribution and Accessibility of Clinic Trials for Advanced-Stage Breast Cancer in the United States: A Focus on Rural and Minority Health Disparities

Authors: Emily Westergard, DO; Zack Schroeder, BA; Abigail Swenson, BA; Wade Swenson, MD

San Antonio Breast Cancer Symposium 2023

Background: Our research delves into the geographical distribution and accessibility of clinical trials for metastatic breast cancer patients in the U.S., spotlighting the challenges faced by rural communities and minority groups. Prior research indicated nearly half of these patients would have to commute over an hour to reach a trial site. [1] Our study provides a refreshed perspective on this issue, offering a more comprehensive analysis.

Methods: Utilizing the ClinicalTrials.gov portal, we identified active interventional clinical trials for metastatic breast cancer patients as of November 25, 2022. We obtained distinct zip codes linked to these trials and, using 2020 census data, gauged the proportion of the U.S. populace residing within specific distances from these sites. Our analysis encompassed factors like urbanity, ethnicity, and other socio-economic parameters. We also developed illustrative maps to visually represent the U.S. clinical trial accessibility landscape.

Results: The majority of Americans diagnosed with metastatic breast cancer have clinical trials within their reach. A significant 80% of the U.S. populace resides within a 30-mile radius of a relevant clinical trial site. However, a closer look reveals pronounced disparities based on urban-rural demarcations and racial lines, with American Indians facing the most pronounced accessibility challenges.

Conclusions: While a commendable 80% of the U.S. population resides within 30 miles of a metastatic breast cancer clinical trial site, our data underscores the uneven geographical spread of these trials. This skewed distribution poses accessibility hurdles for specific demographics, especially those in rural areas and certain racial groups. Our findings underscore the pressing need for strategic initiatives to rectify these disparities, ensuring clinical trials are within reach for every individual, irrespective of their location or background.

Reference: Galsky MD, Stensland KD, McBride RB, Latif A, Moshier E, Oh WK, Wisnivesky J. Geographic accessibility to clinical trials for advanced cancer in the United States. JAMA Intern Med. 2015 Feb;175(2):293-5. doi: 10.1001/jamainternmed.2014.6300. PMID: 25437434.

Figure 1. Map of 30-, 60-, and 120-mile buffers from clinical trial sites open to patients with metastatic breast cancer. 

Table 1. The U.S. Population living within 30-, 60-, and 120-miles of an open clinical trial site for patients with metastatic breast cancer.