Institutional and Regional Variations in Access to Clinical Trials and Next-Generation Sequencing in Turkish Oncology Centers

BACKGROUND Clinical trials provide opportunities for patients with cancer to access novel treatment regimens in many developing countries. Next-generation sequencing (NGS) plays a key role in the treatment of various cancer types in today's clinical practice. The aim of this study is to investigate accessibility of clinical trials and NGS in Turkish oncology clinics. MATERIAL AND METHODS This cross-sectional survey was conducted among medical oncologists in 86 oncology centers across Turkey. Responses to a 14-item questionnaire were analyzed based on the centers. Final analyses included 86 oncology centers across 38 cities (n=86). These centers were classified as public (n=63) and private (n=23) hospitals and as those in the 3 largest metropolitan areas (n=33) or in other cities (n=53). RESULTS The median numbers of ongoing clinical trials were 1 (0-50) and 2 (0-50) in public and private hospitals, respectively (P=0.961), and clinical trials actively recruiting were 0 (0-42) and 0 (0-30) in public and private hospitals, respectively (P=0.862). Hospitals located in the largest metropolitan areas had significantly higher median numbers of ongoing clinical trials, 2 (0-50) vs 0 (0-25) (P=0.002), and actively recruiting trials, 2 (0-42) vs 0 (0-25) (P=0.008), compared with hospitals in other cities The availability of NGS was also higher in metropolitan hospitals (75.8%) than in other cities (20.8%) (P<0.001). CONCLUSIONS Geographic location creates significant inequalities in the number of clinical trials and access NGS in oncology centers, in contrast to the uniform coverage provided by general health insurance. Tailored region-specific improvements are required to enhance cancer care in Turkey.