Impact of sociodemographic determinants on enrollment into contemporary lymphoma clinical trials: a systematic review.
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While the incidence and survival associated with lymphoma have improved in recent years, outcome disparities related to sociodemographic factors such as age, sex, race, ethnicity, socioeconomic status (SES), and other social determinants of health (SDOH) remain prevalent in the modern era. Clinical trials are crucial for further improving outcomes, yet not all sociodemographic groups are equally represented in contemporary lymphoma trials. We conducted a systematic review of the literature evaluating the impact of SDOH on enrollment into clinical trials in the United States and identified 21 relevant studies. We confirmed that Black and Hispanic individuals are underrepresented in lymphoma clinical trials, due largely to the geographic distribution of clinical trial sites and exacerbated by globalization of cancer trials. Women may also be less appropriately represented than men, although this association is less robust and consistent. Adolescents and young adults with lymphoma who are older, treated at adult cancer centers, or managed by adult hematologists/oncologists are all less likely to be part of trials. Older adults are also excluded from most lymphoma clinical trials. There is a dearth of data on how other SDOHs including education, employment, and household income contribute to differences in clinical trial enrollment. Further research is required to explore the intersection of demographics, SES, insurance status, and enrollment into lymphoma clinical trials.