Evaluating Minority Participation in Radiation Oncology Clinical Trials and the Impact of COVID-19 on Enrollment in a Large Integrated Academic Satellite Network

PURPOSE Social distancing and health care rationing during the COVID-19 pandemic exacerbated cancer disparities. It is important to understand the impact of ethnic representation in clinical trials. We investigated how COVID-19 disease influenced racial/ethnic representation in radiation oncology (RO) trials in a large integrated academic satellite, hypothesizing that the pandemic significantly affected minority participation. METHODS We conducted an institutional review board–approved retrospective analysis of patients 18 years and older who enrolled in RO trials from March 2018 to August 2024 in a five-campus integrated academic satellite. Chi-square testing was used to compare variables across the COVID-19 periods. Statistical significance was considered for P values <.05, and statistical trends were considered for P values of .05-.1. RESULTS A total of 1,702 patients were enrolled in RO trials: 531 (31.2%) pre–COVID-19, 843 (49.5%) during COVID-19, and 328 (19.3%) post–COVID-19. Racial/ethnic makeup was 79% White and 21% non-White. There was an increase in minority participation during COVID-19 (147 17.5%) compared with pre–COVID-19 (71 12.5%) and post–COVID-19 (46 14.0%) although this increase was not statistically significant ( P = .06). The average distance from participants' homes to the treatment centers was significantly lower during COVID-19 (122 miles) compared with pre–COVID-19 (174 miles) and post–COVID-19 (187 miles; P < .01). CONCLUSION Despite abundant literature suggesting the exacerbation of racial disparities in trials during COVID-19, we observed an increase in minority representation. Travel restrictions and regionally focused recruitment might have played a role. Future research should explore strategies focused on expanding outreach initiatives and integrating telehealth and patient education to enhance participation. By prioritizing equitable access to trials, we can improve cancer care and enhance the distribution of benefits and risks and the generalizability of research.