Patient reimbursement in therapeutic cancer clinical trials: An 18-year multicenter experience.
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BACKGROUND: Clinical trials add to the financial burden of cancer care. To expand equitable access to trials, from 2006 to 2024 the Lazarex Cancer Foundation reimbursed nonmedical expenses related to therapeutic cancer clinical trial participation. METHODS: Eligible patients were enrolled in a cancer treatment trial and had a household income of ≤700% of the federal poverty level. Expense reimbursement occurred at 50%, 75%, and 100% according to income level. This study analyzed the type, timing, and amounts (in 2024 dollars) of reimbursed expenses for trial participants. Associations between patient/trial characteristics, reimbursed amounts, and distance traveled were evaluated via t-tests, analysis of variance, and multivariate linear regression. RESULTS: Overall, 2826 individuals (64% non-Hispanic White, 97% with health insurance, with a median household income of $50,948) received at least one reimbursement. Median total per-patient reimbursement was $2128, median trial participation duration was 4.3 months, and monthly reimbursed amounts declined substantially throughout trial participation. Types of reimbursement varied by patient income: internet, ground transportation, and child/elder care were more common at lower income levels, whereas lodging and airfare were more common for higher incomes. In multivariate analysis, monthly reimbursed amount was greater among middle-tier household income quartiles (p = .003), greater distance to trial site (p < .001), and phase 1 trials (p = .001). The proportion of patients participating across income levels remained stable over time. CONCLUSIONS: Reimbursement needs during cancer clinical trial participation are dynamic and closely tied to both socioeconomic status and logistical burden, particularly travel distance and trial intensity. Financial support for these expenses may enhance trial accessibility and retention.