Addressing Racial and Socioeconomic Disparities in Lymphoma Trials

A retrospective analysis of 3,897 patients with lymphoma enrolled in 32 cooperative group trials between 2005 and 2020 highlights significant disparities in racial, ethnic, and socioeconomic characteristics. The study, which was presented at the 66^th American Society of Hematology Annual Meeting & Exposition, involving the National Clinical Trials Network (NCTN) groups (Alliance for Clinical Trials in Oncology, Eastern Cooperative Oncology Group, and Southwest Oncology Group), evaluated demographic data, including race, ethnicity, insurance status, and Social Deprivation Index (SDI), in relation to lymphoma subtypes and compared findings with those in the SEER database.

Most patients had non-Hodgkin lymphoma (87.4%), including diffuse large B-cell lymphoma (48.3%), follicular lymphoma (26.6%), and mantle cell lymphoma (19.6%). Hodgkin lymphoma accounted for 12.6%. Most patients were male (58.8%) with a median age of 57 years. The racial composition was predominantly White (86.6%), with African American (6.3%), Asian (2.5%), American Indian/Alaska Native (0.3%), and Native Hawaiian/Pacific Islander (0.2%) groups underrepresented compared with their respective populations. Hispanic ethnicity was reported in 4.6% of patients, lower than the 13.9% in the SEER database.

Insurance coverage data revealed that 55.6% of patients had private insurance, 18.5% relied solely on public insurance (eg, Medicare or Medicaid), and 4.4% were uninsured. Socioeconomic disparities were evident, with non-Hispanic Black and Hispanic patients residing in areas with significantly higher SDI scores (66.4 and 65.5, respectively) compared with non-Hispanic White patients (38.8). Patients without insurance or those relying on public insurance had higher SDI scores, indicating greater social deprivation, compared with those who had private or mixed coverage.

Comparisons with SEER data showed modest differences in representation for diffuse large B-cell lymphoma. For instance, non-Hispanic Black patients comprised 9.8% of cases in NCTN trials versus 7.7% in the SEER database. However, Hispanic patients remained underrepresented across trials.

“To our knowledge, this is the largest retrospective catalog of racial, ethnic, and socioeconomic characteristics of pts with lymphoma enrolled on cooperative group therapeutic trials,” the researchers wrote. “The scope of NCTN cooperative group lymphoma studies provides a unique opportunity to assess novel therapeutic outcomes for patients representing racial, ethnic and socioeconomic subgroups with both common and rare lymphoma subtypes. From this resource, additional analyses on relationships between SDI, race/ethnicity, insurance coverage, disease subtype, and temporal trends will be presented.”

REFERENCE:

Alencar AJ, Geyer SM, Paskett ED, et al. Representation of minorities in therapeutic clinical trials – a 15-year review of lymphoma cooperative group studies (Alliance A152123). Abstract #110. Presented at the American Society of Hematology Annual Meeting; December 7-10, 2024; San Diego, California.