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Peer-reviewedCC BY-NC-ND 4.0OTO Open

Socioeconomic Status and Clinical Trial Enrollment in Head and Neck Cancer: A Single‐Institution Retrospective Study

  • Isabella M. Le1
  • Melissa F. Riedel2
  • Subir Goyal2,3
  • Jennifer H. Gross2,4
  • James E. Bates2,5
  • William A. Stokes2,5
  • Conor E. Steuer2,6
  • Dong M. Shin2,6
  • Soumon Rudra2,5
  • Nabil F. Saba2,6
  • Nicole C. Schmitt2,4
6 affiliations
  1. 1Emory University School of Medicine
  2. 2Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
  3. 3Department of Biostatistics and Bioinformatics Rollins School of Public Health, Atlanta, Georgia, USA
  4. 4Department of Otolaryngology–Head and Neck Surgery Emory University, Atlanta, Georgia, USA
  5. 5Department of Radiation Oncology Emory University Atlanta Georgia USA
  6. 6Department of Hematology and Medical Oncology Emory University, Atlanta, Georgia, USA
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{le2026socioeconomic,
  title = {{Socioeconomic Status and Clinical Trial Enrollment in Head and Neck Cancer: A Single‐Institution Retrospective Study}},
  author = {Isabella M. Le and Melissa F. Riedel and Subir Goyal and Jennifer H. Gross and James E. Bates and William A. Stokes and Conor E. Steuer and Dong M. Shin and Soumon Rudra and Nabil F. Saba and Nicole C. Schmitt},
  journal = {OTO Open},
  year = {2026},
  month = oct,
  doi = {10.1002/oto2.70318},
  url = {https://doi.org/10.1002/oto2.70318},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Socioeconomic Status and Clinical Trial Enrollment in Head and Neck Cancer: A Single‐Institution Retrospective Study
AU  - Isabella M. Le
AU  - Melissa F. Riedel
AU  - Subir Goyal
AU  - Jennifer H. Gross
AU  - James E. Bates
AU  - William A. Stokes
AU  - Conor E. Steuer
AU  - Dong M. Shin
AU  - Soumon Rudra
AU  - Nabil F. Saba
AU  - Nicole C. Schmitt
PY  - 2026
DA  - 2026/10/26
JO  - OTO Open
DO  - 10.1002/oto2.70318
UR  - https://doi.org/10.1002/oto2.70318
AB  - 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.
SN  - 2473-974X
ER  -