Abstract B095: Factors associated with adolescent and young adult cancer clinical trial enrollment at a minority underserved NCI community oncology research program

Abstract Background: Adolescents and young adults (AYA; 15-39 years), particularly non-Hispanic Black (NHB) and Hispanic AYAs, are historically under-enrolled on cancer clinical trials. Proposed hypotheses for under-enrollment include structural, system, and individual-level barriers. We examine patterns of AYA clinical trial enrollment (CTE) at an academic medical center within a highly diverse catchment area. Objective: To evaluate rates and predictors of therapeutic CTE amongst AYAs treated for cancer at Columbia University Irving Medical Center (CUIMC). Design /Method: Therapeutic trial enrollment was measured among patients aged 18 – 39 treated for cancer at CUIMC between 1/1/2010 – 12/31/2020. Demographic and clinical data were abstracted from electronic health records. Yost index (a metric of neighborhood socioeconomic status) was determined by linking residential address to U.S. Census Bureau data. Trial enrollment was defined as a binary variable (yes/no), regardless of enrollment on multiple trials. Logistic regression analyses, adjusted for sex, race/ethnicity, insurance, diagnosis, and Yost index, explored factors associated with cancer CTE and are presented as odds ratios (OR) with 95% confidence intervals (CI). Results: Among 3,098 AYAs, 50% (N= 1,549) were non-Hispanic White (NHW), 19% (N= 595) Hispanic, 10% (N= 299) NHB, and 8% (N= 243) NH Asian/Pacific Islander. NHB and Hispanic patients were more likely than NHW patients to be publicly insured (p< 0.001) and to live in socioeconomically disadvantaged neighborhoods (p<0.001). The overall rate of CTE in this cohort was 9% (N= 276). In multivariable analyses, Hispanic (v. NHW) ethnicity (OR=1.5, CI 1.1 – 2.2) and hematologic (OR=1.7, CI 1.1 – 2.4), breast (OR=2.5, CI 1.6 – 3.8), and sarcoma (OR=2.0, CI 1.2 – 3.4) diagnoses (v. CNS) increased odds of enrollment. Public (v. private) insurance (OR=0.7, CI 0.4 – 1.0) was associated with lower odds of CTE. Patient sex and Yost index were not associated with enrollment. Conclusion: Among a diverse cohort of AYAs, Hispanic patients had the highest rates of CTE. Odds of CTE differed by cancer type and insurance, possibly reflecting trial availability for certain tumors at our center, and costs associated with participating. That Hispanic and NHB (vs. NHW) AYAs had similar or higher rates of CTE, respectively, is perhaps the result of concerted efforts at the institutional level to engage the more socially vulnerable patients in our catchment area. This said, AYA CTE overall can still be improved, and efforts to expand outreach, education, and research participation in this under-studied group are needed. Surveys to better characterize barriers and facilitators to CTE among AYAs at our center are ongoing. Acknowledgment: Supported by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme LLC; the opinions reflected herein are those of the authors only. Citation Format: Kathryn McHenry, Rohit Raghunathan, Sarah Kleinknecht, Katherine MacNeil, Claire Chanatry, Dawn Hershman, Melissa Beauchemin, Justine Kahn. Factors associated with adolescent and young adult cancer clinical trial enrollment at a minority underserved NCI community oncology research program [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B095.