# Determinants of first-line clinical trial enrollment among Black and White gynecologic cancer patients

## TL;DR

This study finds that Black gynecologic cancer patients are less likely to enroll in clinical trials compared to White patients, with few differences in the factors influencing enrollment between the two groups.

## Contribution

The study is one of the few to examine racial differences in clinical trial enrollment predictors for gynecologic cancer patients.

## Key findings

- Black patients had significantly lower clinical trial enrollment rates compared to White patients.
- Cervical cancer diagnosis was associated with higher enrollment odds for Black patients, while cervical and ovarian cancers were linked to higher odds for White patients.
- Most predictors were associated with clinical trial enrollment among White patients but not Black patients.

## Abstract

Disparities in gynecologic cancer clinical trial enrollment exist between Black and White patients; however, few examine racial differences in clinical trial enrollment predictors. We examined whether first-line clinical trial enrollment determinants differed between Black and White gynecologic cancer patients.

We used the National Cancer Database to identify Black and White gynecologic cancer (cervix, ovarian, uterine) patients diagnosed in 2014–2020. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between clinical trial enrollment (yes vs no) and sociodemographic, facility, tumor, and treatment characteristics stratified by race. We included a multiplicative interaction term between each assessed predictor and race to test whether associations differed by race.

We included 703,022 gynecologic cancer patients (mean [SD] age at diagnosis, 60.9 [13.1] years). Clinical trial enrollment was lower among Black (49/86,058, 0.06%) vs. White patients (710/616,964, 0.11%). Only cancer site differed by race: among Black patients, a cervical vs. uterine cancer diagnosis (OR = 4.63, 95% CI = 1.67–12.88) was associated with higher clinical trial enrollment odds, while among White patients, both cervical (OR = 2.21, 95% CI = 1.48–3.29) and ovarian (OR = 3.40, 95% CI = 2.58–4.47) cancer diagnoses (vs. uterine cancer) were associated with higher enrollment odds. Most predictors were associated with clinical trial enrollment odds among White but not Black patients.

Few differences in first-line clinical trial enrollment predictors exist between Black and White gynecologic cancer patients. Although small numbers of Black patients and low clinical trial prevalence are limitations, this descriptive analysis is important in understanding racially disparate clinical trial enrollment.

The online version contains supplementary material available at 10.1007/s10552-025-01963-y.