IntroductionDisparities in clinical trials (CTs) enrollment perpetuate inequities in treatment access and outcomes, but there is a paucity of Canadian data. The objective of this study was to examine disparities in cancer CT enrollment at a large Canadian comprehensive cancer center.MethodsRetrospective study of CT enrollment among new patient consultations from 2006 to 2019, with follow‐up to 2021 (N = 154,880), with the primary outcome of enrollment as a binary variable. Factors associated with CT enrollment were evaluated using multivariable Bayesian hierarchical logistic regression with random effects for most responsible physician (MRP) and geography, adjusted for patient characteristics (sex, age, language, geography, and primary care provider [PCP]), area‐level marginalization (residential instability, material deprivation, dependency, and ethnic concentration), disease (cancer site and stage), and MRP (department, sex, language, and training). A sensitivity analysis of the cumulative incidence of enrollment was conducted to account for differences in disease type and follow‐up length.ResultsCT enrollment was 11.2% overall, with a 15‐year cumulative incidence of 18%. Lower odds of enrollment were observed in patients who were female (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.78–0.86), ≥65 years (AOR vs. <40, 0.61; 95% CI, 0.56–0.66), non‐English speakers (0.72; 95% CI, 0.67–0.77), living ≥250 km away (AOR vs. <15 km, 0.71; 95% CI, 0.62–0.80), and without a PCP. Disease characteristics accounted for the largest proportion of observed variation (20.8%), with significantly greater odds of enrollment in patients with genitourinary cancers and late‐stage disease.ConclusionSignificant sociodemographic disparities were observed, suggesting the need for targeted strategies to increase diversity in access to cancer CTs in Canada.

中文翻译：

---

加拿大综合癌症中心临床试验注册的差异：一项 15 年回顾性研究

简介临床试验（CT）入组的差异导致治疗获取和结果方面的不平等长期存在，但加拿大的数据却很少。本研究的目的是调查加拿大一家大型综合癌症中心癌症 CT 入组的差异。方法对 2006 年至 2019 年新就诊患者的 CT 入组进行回顾性研究，并随访至 2021 年（氮= 154,880），注册的主要结果作为二元变量。使用多变量贝叶斯分层逻辑回归对与 CT 入组相关的因素进行评估，并对最负责任的医生 (MRP) 和地理位置进行随机效应，并根据患者特征（性别、年龄、语言、地理位置和初级保健提供者 [PCP]）、地区进行调整。水平边缘化（居住不稳定、物质匮乏、依赖性和种族集中）、疾病（癌症部位和阶段）和 MRP（部门、性别、语言和培训）。对入组累积发生率进行敏感性分析，以考虑疾病类型和随访时间长度的差异。结果 CT 入组率为 11.2%，15 年累积发生率为 18%。女性患者（调整后比值比 [AOR]，0.82；95% 置信区间 [CI]，0.78–0.86）、≥65 岁（AOR 对比 <40，0.61；95% CI， 0.56–0.66）、非英语人士（0.72；95% CI，0.67–0.77）、居住距离 ≥250 公里（AOR 与 <15 公里，0.71；95% CI，0.62–0.80），并且没有 PCP。疾病特征在观察到的变异中所占比例最大（20.8%），泌尿生殖系统癌症和晚期疾病患者的入组几率显着更高。结论观察到显着的社会人口统计学差异，表明需要采取有针对性的策略来增加获取途径的多样性加拿大的癌症CT。