Several groups of patients are underrepresented in non-small cell lung cancer (NSCLC) clinical trials, according to research presented at the American Association for Thoracic Surgery (AATS) Annual Meeting.

Patients belonging to racial or ethnic minority groups, patients with the lowest socioeconomic status, and uninsured or underinsured patients are among those who are disproportionally excluded from enrollment in NSCLC trials, researchers found.

The researchers analyzed data on patients from the National Cancer Database who were diagnosed with NSCLC from 2004 to 2018. Of the 1.7 million patients identified, 7813 (0.5%) enrolled in clinical trials. 

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In a univariate analysis, patients were more likely to enroll in trials if they had stage IV NSCLC, were treated at an academic or research center, traveled shorter distances to receive care, and had private insurance. Patients were less likely to enroll in trials if they were older, were Hispanic or non-Hispanic Black, had a higher comorbidity score, and had lower socioeconomic status.

In a multivariable analysis, patients were less likely to enroll in trials if they were non-Hispanic Black (odds ratio [OR], 0.80; 95% CI, 0.74-0.87; P <.001) or Hispanic (OR, 0.83; 95% CI, 0.72-0.96; P =.014) than if they were White.

Patients were less likely to enroll in trials if they had Medicaid (OR, 0.85; 95% CI, 0.77-0.94; P =.001) or no insurance (OR, 0.70; 95% CI, 0.60-0.81; P <.001), compared with private insurance. There was no significant difference in enrollment between patients with Medicare and those with private insurance (OR, 0.97; 95% CI, 0.90-1.03; P =.35).

Patients treated outside of academic or research programs were less likely to enroll in trials. This included patients treated in community cancer programs (OR, 0.50; 95% CI, 0.45-0.55; P <.001), comprehensive community cancer programs (OR, 0.56; 95% CI, 0.53-0.59; P <.001), and integrated network cancer programs (OR, 0.61; 95% CI, 0.57-0.65, P <.001).

Patients with the lowest socioeconomic status (group 1) were less likely to enroll in trials than patients with mid-level socioeconomic status (group 4; OR, 0.82; 95% CI, 0.74-0.90; P <.001). There were no other significant differences across the 7 socioeconomic groups.  

These disparities suggest a need to improve enrollment strategies for NSCLC clinical trials, according to researchers.


Kwak M, Bassiri A, Jiang B, et al. National enrollment of lung cancer clinical trials is disproportionate based on race and health care access. AATS 2023. May 6-9, 2023. Abstract 47.