Evaluating Worldwide Disparities in Bladder Cancer Clinical Trial Availability.
Simple Summary: Bladder cancer affects patients worldwide, but access to clinical trials that test new treatments is not evenly distributed. Many trials are conducted in wealthier countries, even though a large share of the disease burden occurs in lower-resource settings. In this study, we examined...
| Publicado en: | Cancers Vol. 18; no. 11; pp. 1730 - 1743 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
MDPI
Jun2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194779277&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194779277 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20726694 B74B jtl: Cancers issn: 20726694 maglogo: N pubinfo: dt: Jun2026 vid: 18 iid: 11 pid: 97109 pub: MDPI artinfo: ui: 194779277 194779277 194779277 10.3390/cancers18111730 194779277 ppf: 1730 ppct: 13 formats: tig: atl: Evaluating Worldwide Disparities in Bladder Cancer Clinical Trial Availability. aug: au: Shah, Koral U. Castro, Daniela V. Li, Xiaochen Zugman, Miguel Jaime-Casas, Salvador Abreu de Goes, Vitor Zang, Peter D. Reid, Skylar Paul, Teebro Goud, Jaya Dickter, Samuel Dickter, Lea Lau, Lily Agarwal, Ruchi Lee, Aaron Chaudhary, Nasr Ebrahimi, Hedyeh Mercier, Benjamin Dizman, Nazli Bergerot, Cristiane D. affil: Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA sug: subj: Bladder Neoplasms Therapy Clinical Trials Research Subjects Healthcare Disparities Evaluation Diversity, Equity, Inclusion Human World Health Retrospective Design Record Review Descriptive Statistics Fisher's Exact Test Kruskal-Wallis Test Multiple Logistic Regression Analysis of Variance Multiple Linear Regression Data Analysis Software Confidence Intervals Health Expenditures Income Bladder Neoplasms Mortality Overall Survival ab: Simple Summary: Bladder cancer affects patients worldwide, but access to clinical trials that test new treatments is not evenly distributed. Many trials are conducted in wealthier countries, even though a large share of the disease burden occurs in lower-resource settings. In this study, we examined where bladder cancer trials are being conducted globally and how this aligns with need. We found that most trials take place in high-income countries, with very limited access in lower-income countries and none in the lowest-income countries. Trials that included multiple countries tended to offer broader access but were often led by wealthier nations. These gaps may limit access to new therapies and reduce the extent to which results apply to diverse populations. Expanding trials to underrepresented regions could improve equity, strengthen global research, and ensure that advances in care benefit patients everywhere. Background: Bladder cancer disproportionately affects non-high-income countries, yet clinical trials underrepresent global diversity. We assessed global availability of bladder cancer trials, their alignment with disease burden, and barriers to equitable care. Methods: We queried ClinicalTrials.gov for adult bladder cancer trials from June 2019 to June 2024, excluding observational and non-oncologic trials. Trial characteristics were summarized descriptively, and country data came from the Global Cancer Observatory. Countries were classified per World Bank Ranking (WBR) into high-income (HICs), upper middle-income (UMICs), lower middle-income (LMICs), and low-income countries (LICs). Trials were categorized as HIC-only, non-HIC, or mixed-income trials. Fisher's exact and Kruskal–Wallis tests compared groups. Multivariable logistic regression assessed associations between trial availability and WBR, national health expenditure, and gross national income (GNI). Univariable linear regression and ANOVA assessed the association between the mortality-to-incident ratio and WBR. Results: Of 611 trials, 75.1% were HIC-only, 16.9% non-HIC, and 8.0% mixed-income trials. Non-HIC trials were mainly academic-sponsored (80.6%), while all mixed-income trials had pharmaceutical sponsorship (p < 0.001). Non-HIC trials had lower enrollment, less pharmaceutical funding, fewer multinational collaborations, and fewer basket, multi-arm, early-phase designs (all p < 0.001). Mixed-income trials were larger, led by HICs, had broader eligibility criteria, more novel therapies, and more frequent use of overall survival endpoints. Trial availability was lower in UMICs (p = 0.011), LMICs (p = 0.024), and absent in LICs, and positively associated with higher national health expenditure (p = 0.007) and GNI (p = 0.001). Conclusions: Bladder cancer trials remain concentrated in HICs. Mixed-income trials expand access in non-high-income countries, but are exclusively led by HICs and require balanced sponsorship, early-phase research, and lasting local benefits. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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