Differences in Clinical Trial Availability vs Distribution of Disease Among Gynecological Cancers

Objective: Given disparities in incidence and outcomes among racial and ethnic groups, and differences in patient characteristics among the 3 main types of gynecologic cancer, we examined whether clinical trial availability at a large, high-enrolling National Cancer Institute–designated Comprehensive Cancer Center reflects the clinical volume of each cancer in the catchment area. We also assessed whether the patients who consented to the trials reflected the racial and ethnic distribution of each cancer type. Methods: Patients who consented to ovarian, uterine, and cervical cancer clinical trials at the UCLA Jonsson Comprehensive Cancer Center in Los Angeles, California, from 2013 through 2018 were included. Clinical trial and patient-level data were collected. Los Angeles County cancer incidence data were used to represent disease burden in the catchment area. χ-Square and Fisher exact tests were used to compare proportions. Results: Twenty-four gynecologic oncology clinical trials were identified: 16 (67%) ovarian, 5 (21%) uterine, and 3 (12%) cervical cancer trials. Compared with corresponding county incidence rates, respectively, the proportion of patients with ovarian (82% vs 25%), uterine (9% vs 59%), or cervical (9% vs 6%) cancer who consented for clinical trials differed significantly ( P  < .001). The racial/ethnic distribution of patients also differed for ovarian ( P  < .001) and cervical cancer trials ( P  = .005). Patients who were Black or Asian were underrepresented in ovarian and cervical cancer trials; Hispanic patients were underrepresented in ovarian trials. Conclusions: The distribution of clinical trials and patients who consented did not reflect the incidence or racial and ethnic makeup of gynecologic cancers in the catchment area. Greater efforts are needed to align trial availability and enrollment with disease burden and population diversity.