Abstract B22: Lesbian, gay, and bisexual cancer survivor's participation in cancer clinical trials: Findings from a national health survey.
Authors: Jabson Jennifer M. , Blosnich John R. 
Published: August 2014

Introduction: Clinical trials are important tools for advancing cancer treatment, prevention, and control. To identify and describe clinical effects relevant to underserved groups, representation of medically underserved cancer survivors in clinical trials is necessary. Medically underserved groups historically have been defined to include racial/ethnic minorities, under-insured or uninsured groups, those with low levels of education, and those with low socioeconomic status. The recent Institute of Medicine report on the Health of Lesbian, Gay, Bisexual, and Transgender People also describes lesbian, gay, and bisexual (i.e., LGB) people as medically underserved. Medically underserved groups are known to be underrepresented in cancer clinical trials, except in the case of LGB cancer survivors. Currently, no published research has examined LGB cancer survivor's participation in cancer trials. Given this paucity in the literature, this study aimed to test the hypothesis that prevalence of clinical trial participation would be lower among LGB cancer survivors than heterosexual cancer survivors.

Methods: Data were from the Behavioral Risk Factor Surveillance System (BRFSS), which is a health surveillance program sponsored collaboratively by the Centers for Disease Control and Prevention (CDC) and U.S. states. The BRFSS is administered annually to probability-based samples of non-institutionalized adults over 18 years of age. The Cancer Survivorship module is an optional module that states may elect to use and that assesses cancer survivor participation in cancer clinical trials. Data for this study are from five states' 2010 BRFSS surveys that included both the Cancer Survivorship module and an item asking self-identified LGB status to either their entire survey population (Massachusetts, New Mexico, Wisconsin, and Alaska) or to one or more probability-based sample splits (California) (n=4,339).

Results: Participation in cancer clinical trials was higher among LGB cancer survivors (12.5%) than among heterosexual cancer survivors (6.0%) (p = .005). In the multivariate model, adjusted by age, sex, education, race/ethnicity, and survey state, LGB cancer survivors were more than twice as likely, as heterosexual cancer survivors, to report participation in a clinical trial (AOR 2.17, 95% CI 1.21-3.90).

Conclusion: LGB cancer survivors had greater likelihood of cancer clinical trial participation than heterosexual cancer survivors, and this association was not explained by education. The finding was not expected given the historic marginalization of this group and previous reports that up to 15% of clinical trials explicitly excluded LGB participants. The finding may be explained by insurance coverage. LGB people are more likely to lack health insurance than heterosexuals. Thus, LGB cancer survivors may be more inclined to seek care through clinical trial participation. Small sample size precluded examining whether denial of insurance coverage was an explanatory factor for trial participation; however this is a logical next step for future research.

Citation Format: Jennifer M. Jabson, John R. Blosnich. Lesbian, gay, and bisexual cancer survivor's participation in cancer clinical trials: Findings from a national health survey. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B22.