Examining social determinants of health and clinical trial participation among cancer survivors: A multi-state cross-sectional study

Introduction: Clinical trials are essential for advancing cancer treatment options and providing patients access to novel therapies, yet recruitment and participation among cancer patients remain low. This study examined whether social determinants of health (SDOH) were associated with clinical trial participation among cancer survivors. Methods: This cross-sectional study analyzed Behavioral Risk Factor Surveillance System data from 2022 to 2024. The sample included cancer survivors aged 18 years or older from 15 states and 2 U.S. territories. An SDOH composite score (range 0-9) was calculated by summing binary responses across nine domains: life satisfaction, social/emotional support, loneliness/isolation, employment disruption, SNAP benefits, food insecurity, housing/utility payment difficulty, threats of utility service shut-off, and transportation barriers. A higher composite score indicated greater social disadvantage. Adjusted logistic regression models identified factors associated with clinical trial participation. All analyses were weighted. Results: Of the 6,929 cancer survivors, 370 (5.34%) reported clinical trial participation as part of their treatment. Cancer survivors who participated in a clinical trial as part of their treatment were younger, more likely to be female, and from racial/ethnic minority groups compared to non-participants (all p-values <0.05). After adjusting for age, sex, race/ethnicity, marital status, income, comorbidity burden, and health insurance type, SDOH composite score was not associated with clinical trial participation.When examining individual SDOH factors, cancer survivors who had experienced threats of utility service shut-offs (electric, gas, oil, and/or water) in the past 12 months were less likely to have participated in clinical trials (aOR: 0.504, 95% CI: 0.257-0.989, p=0.046). Additionally, cancer survivors with private insurance (aOR: 1.62, 95% CI: 1.14-2.30, p=0.007) and Medicare beneficiaries (aOR: 1.69, 95% CI: 1.22-2.33, p=0.001) were more likely to participate in clinical trials compared to those with Medicaid. Conclusion: Overall SDOH burden was not associated with clinical trial participation among cancer survivors; however, insurance type and individual determinants of financial vulnerability did have a significant impact. While privately insured survivors and Medicare beneficiaries showed higher participation, those experiencing utility shut-off threats had significantly reduced participation. These findings highlight the importance of addressing financial stressors to improve clinical trial access for patients with cancer.