Charting the geographic footprint of federally funded cancer treatment trials: An ASCO State of Cancer Care in America analysis.

134 Background: Geography is a barrier to patient participation in cancer treatment trials. A 2024 ASCO analysis found that 70% of US counties lacked cancer trials, with 22% of counties also lacking trials in adjacent counties. To identify factors associated with geographic access, we characterize the relationship between federal investment in research and geographic availability of US trials. Methods: Site and sponsor information for phase I-III cancer treatment trials in the US were extracted from clinicaltrials.gov as of 9/30/2024. Active trials were identified as those initiated in 2015 or later with a status of not yet recruiting, recruiting, active not recruiting, and enrolling by invitation. Trial sites were geocoded and trials were tabulated by county. Counties were classified as follows: 1) only trials sponsored by federal agencies; 2) trials sponsored by federal agencies and trials sponsored by others; 3) only trials sponsored by others; and 4) no trials. To characterize areas with sustained federal research investment through infrastructure awards, we identified counties with NCI-designated cancer centers and/or NCORP sites. We calculated odds ratios to compare counties with presence of trials vs. presence of NCI-supported sites. Having analyzed population data for all 3144 counties, no uncertainty estimates were evaluated. County-level trial data were also linked to age-adjusted all-cancer mortality rates from State Cancer Profiles (in the top quartile across all counties) and rural status using Rural-Urban Continuum Codes. Results: 7780 active phase I-III cancer treatment trials across 1940 US sites were included in the analysis. Of all US counties, 485 (15%) had NCI-supported trial sites. Compared to counties without NCI-supported sites, counties with sites had 72 times the odds of hosting any trials, 9 times the odds of having industry-sponsored trials, and ~12 times the odds of having other-sponsored trials. Geographic availability of cancer treatment trials varied by presence of federal sponsorship and county characteristics, with most rural and high cancer mortality counties with trials having only federally sponsored trials (Table). Conclusions: Federal sponsorship greatly expands patient access to cancer treatment trials, especially in rural counties and counties with high cancer mortality rates. Additionally, trials sponsored by industry and others routinely locate in areas with NCI-supported sites. Thus, federal funding—both direct sponsorship of trials and funding for sites—is associated with greater geographic reach of clinical research conducted by all sponsors. All counties(%), N=3144 Rural counties (%), N=1958 High cancer mortality counties (%), N=772 Only federal trials 237 (8%) 141 (7%) 47 (6%) Both federal and other trials 559 (18%) 80 (4%) 42 (5%) Only other trials 107 (3%) 36 (2%) 17 (2%) No trials 2241 (71%) 1701 (87%) 666 (80%)