Abstract PR07: Can the Affordable Care Act result in increasing enrollment of minority patients into therapeutic clinical trials at NCI-designated Cancer Centers?
Authors: Lalonde Chloe , Unkart Jonathan , Wallace Anne , Blair Sarah , Perez Giovanna , Nodora Jesse , Martinez Maria Elena 
Published: March 2017

Introduction

The Affordable Care Act (ACA) in California has resulted in the substantial reduction of uninsured individuals, including among Hispanics. The UC San Diego Moores Cancer Center (MCC) is located in a predominantly affluent, non-Hispanic white (NHW) region of San Diego County, resulting in challenges in providing care for underserved, low-income patients as well as in recruitment of under-represented cancer patients into clinical trials. Despite both the large Hispanic population in San Diego County (~35%) and proportion of cancer patients (17%), Hispanics are under-represented among clinical trial patients. This study assesses the potential effect of the ACA on the proportion of Hispanic women among total breast cancer patients cared for at MCC, and among women enrolled in the ISPY2 (Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging and molecular Analysis 2) clinical trial, a phase II neoadjuvant chemotherapy trial for women with locally advanced breast cancer.

Methods

We assessed the relative proportion of Hispanic women receiving care for a new breast cancer diagnosis at the MCC before and after January 2014, when implementation of the ACA began in California, using 2x2 chi square contingency tables. The specific time periods examined were January 2010 through December 2013 and January 2014 through December 2015. We also conducted analyses on the cohort of patients who signed screening consent for the ISPY2 clinical trial (n=236) during the same time periods, to compare Hispanic enrollment prior to and following January 2014.

Results

We observed a significant increase in the proportion of Hispanic women with breast cancer presenting to the MCC for care after implementation of the ACA. From January 2010 until January 2014, Hispanic women made up 10.1% of total breast cancer diagnoses, with no annual increase over this time period. Following January 2014, Hispanic women accounted for 13.7% of breast cancer diagnoses (p=0.002), with evidence of an increasing trend over this time period (11.5% in 2014 and 16.0% in 2015). The proportion of Hispanic women in the clinical trial group also increased significantly after January 2014, from 11.7% to 22.2% (p=0.030). Of interest, there was a near 6-fold increase between the two time periods in the proportion of consents provided by Hispanics who were Spanish-speaking (2.3% to 13.9%; p=0.0009).

Discussion/Conclusions

Our findings show that for NCI-designated Comprehensive Cancer Centers that are not located in or near underserved communities, implementation of the ACA might result in an increase of their patient population who was previously uninsured. If those patients represent a racial/ethnic minority group, this could result in increased participation in therapeutic clinical trials, another beneficial consequence of the ACA. We encourage other NCI-designated Cancer Centers to examine their data for such effects, and to explore language, culture, and related preparations to better serve these patients.

Citation Format: Chloe Lalonde, Jonathan Unkart, Anne Wallace, Sarah Blair, Giovanna Perez, Jesse Nodora, Maria Elena Martinez. Can the Affordable Care Act result in increasing enrollment of minority patients into therapeutic clinical trials at NCI-designated Cancer Centers? [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR07.