The broad long-term objective is to reduce cancer health disparities in women of color (WOC) through increased participation in clinical trials. Cost concerns are a known barrier to trial participation that disproportionately affect WOC. The personal and state- and local-level economic consequences of COVID-19 may disproportionately affect WOC, intensifying financial hardship and widening the gap in trial participation between WOC and non-WOC.
The specific aims of this study are to compare 1) the proportion of WOC who experience COVID-related financial hardship (income/employment/insurance loss) vs non-WOC, in a population of women who decline participation in Tomosynthesis Mammographic Imaging Screening Trial (TMIST), a randomized controlled trial of digital mammography (DM) vs tomosynthesis (TM) to evaluate stage shift in screen-detected cancers; 2) the effects of other sociodemographics, and state- or local-level COVID-19 factors on TMIST participation, between WOC and non-WOC. The proposed study is an observational cohort of women who decline to participate in TMIST.
In Aim 1, decliners will be surveyed regarding COVID-19 related financial hardship and distress. Among decliners, the proportion of WOC vs non-WOC who experience COVID-related financial hardship will be compared, accounting for patient-, practice-, local- and state-level COVID- related factors.
In Aim 2, the observational cohort of decliners will be combined with an observational cohort of agree-ers during the same time period. The effects of sociodemographics, and state- and local-level COVID-19 on trial participation will be compared between WOC vs non-WOC. The COVID-19 specific survey in Aim 1 will not be administered to agree-ers and patient-level COVID-19 financial hardship and distress will not be incorporated into AIM 2 analyses.
Breast cancer claims more African-American lives compared to White and Asian-Americans and is the most frequent cause of cancer deaths in Latinx. Participation in clinical trials by women of color (WOC) is needed to improve outcomes, reduce health inequity and increase trial generalizability. This study will assist development of interventions to reduce the participation cost for WOC and decrease disparities.
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