{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:30:50Z","timestamp":1790253050093,"version":"4.1.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi241346-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Disparities in minoritized racial and ethnic populations\u2019 participation in gynecologic cancer clinical trials are well documented despite the high rates of endometrial cancer in these populations. Geographic proximity to trials is a critical component to ensure equitable trial access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241346-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the geographic distribution of gynecological cancer trials across the US and identify disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241346-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This study is a cross-sectional analysis of trials first posted on ClinicalTrials.gov from January 1, 2013, through January 10, 2024. This study involved a state-level analysis of clinical trials located in the US. Enrollment criteria of clinical trials for ovarian, uterine, cervical, endometrial, vaginal and\/or vulvar, and other gynecological cancers were reviewed to exclude nongynecological cancers (1643 trials) or noninvasive gynecological conditions (224 trials).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241346-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>The number of gynecological trials per 100\u202f000 persons in each state.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241346-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>A state-level analysis was performed to determine whether gynecologic cancer clinical trial availability in the US is associated with other state-level characteristics to identify areas of increased need. Census data, state-level total population size, percentage of non-Hispanic White persons, and the Federal Emergency Management Agency expected annual loss per state as a measure of social vulnerability were aggregated. The association between these variables and the number of gynecological trials per 100\u202f000 persons was measured using Spearman rank correlation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241346-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 1561 invasive gynecological cancer trials that met the inclusion criteria, most cancer trials were ovarian (911 trials [58.4%]), followed by cervical (438 trials [28.1%]), and endometrial (385 trials [24.7%]). Predominantly minoritized population\u2013serving states (ie, those with &amp;amp;lt;50% non-Hispanic White persons) had fewer than 4 trials per 100\u202f000 persons, but this was not significant nationally (\u03c1\u2009=\u20090.20; 95% CI, \u22120.08 to 0.45;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.16). States with higher Federal Emergency Management Agency expected annual loss had lower numbers of gynecological trials per 100\u202f000 persons, which was significant nationally (\u03c1\u2009=\u2009\u22120.53; 95% CI, \u22120.70 to \u22120.29;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241346-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cross-sectional study of female gynecological cancer trials by state, states with particularly high economic vulnerability and minoritized populations had low clinical trial availability. Further efforts are needed to address disparities identified in this study to ensure equitable trial access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.47635","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T11:03:28Z","timestamp":1732619008000},"page":"e2447635","source":"Crossref","is-referenced-by-count":14,"title":["Geographic Disparities in Gynecologic Oncology Clinical Trial Availability in the US"],"prefix":"10.1001","volume":"7","author":[{"given":"Mary Regina","family":"Boland","sequence":"first","affiliation":[{"name":"Department of Data Science in Mathematics, Herbert W. Boyer School of Natural Sciences, Mathematics, and Computing, Saint Vincent College, Latrobe, Pennsylvania"},{"name":"Department of Marketing, Analytics and Global Commerce, Saint Vincent College, Latrobe, Pennsylvania"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Tubridy","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian Spataro","family":"Solorzano","sequence":"additional","affiliation":[{"name":"Department of Biosciences, Rice University, Houston, Texas"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Population Aging Research Center, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Simpkins","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Jo Bodurtha","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Population Aging Research Center, University of Pennsylvania, Philadelphia"},{"name":"Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Population Aging Research Center, University of Pennsylvania, Philadelphia"},{"name":"Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"issue":"1","key":"zoi241346r1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3322\/caac.21763","article-title":"Cancer statistics, 2023.","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"zoi241346r2","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.ygyno.2013.12.039","article-title":"Gynecologic cancer disparities: a report from the Health Disparities Taskforce of the Society of Gynecologic Oncology.","volume":"133","author":"Collins","year":"2014","journal-title":"Gynecol Oncol"},{"issue":"1","key":"zoi241346r4","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.ygyno.2017.12.006","article-title":"Racial and ethnic disparities over time in the treatment and mortality of women with gynecological malignancies.","volume":"149","author":"Rauh-Hain","year":"2018","journal-title":"Gynecol Oncol"},{"issue":"18","key":"zoi241346r6","doi-asserted-by":"publisher","first-page":"4210","DOI":"10.1002\/cncr.24482","article-title":"Race does not impact outcome for advanced ovarian cancer patients treated with cisplatin\/paclitaxel: an analysis of Gynecologic Oncology Group trials.","volume":"115","author":"Farley","year":"2009","journal-title":"Cancer"},{"issue":"2","key":"zoi241346r7","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.ygyno.2008.08.013","article-title":"Does equal treatment yield equal outcomes? the impact of race on survival in epithelial ovarian cancer.","volume":"111","author":"Terplan","year":"2008","journal-title":"Gynecol Oncol"},{"issue":"12","key":"zoi241346r8","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1200\/JCO.20.02602","article-title":"Persistent disparity: socioeconomic deprivation and cancer outcomes in patients treated in clinical trials.","volume":"39","author":"Unger","year":"2021","journal-title":"J Clin Oncol"},{"issue":"12","key":"zoi241346r11","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.46494","article-title":"Racial and ethnic disparities in clinical trial enrollment among women with gynecologic cancer.","volume":"6","author":"Khadraoui","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi241346r12","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1097\/GRF.0000000000000765","article-title":"Enrollment of racial and ethnic minoritized groups in gynecologic oncology clinical trials: a review of the scope of the problem, contributing factors, and strategies to improve inclusion.","volume":"66","author":"Barry","year":"2023","journal-title":"Clin Obstet Gynecol"},{"issue":"2","key":"zoi241346r13","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.cct.2014.08.004","article-title":"Strategies addressing barriers to clinical trial enrollment of underrepresented populations: a systematic review.","volume":"39","author":"Heller","year":"2014","journal-title":"Contemp Clin Trials"},{"key":"zoi241346r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2022.106936","article-title":"Race\/ethnicity matching boosts enrollment of black participants in clinical trials.","volume":"122","author":"Segre","year":"2022","journal-title":"Contemp Clin Trials"},{"issue":"4","key":"zoi241346r15","doi-asserted-by":"publisher","first-page":"373","DOI":"10.4155\/cli.14.21","article-title":"Geographic distribution of clinical trials may lead to inequities in access.","volume":"4","author":"Seidler","year":"2014","journal-title":"Clin Invest"},{"issue":"2","key":"zoi241346r21","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.ygyno.2021.08.013","article-title":"A look at the gynecologic oncologist workforce: are we meeting patient demand?","volume":"163","author":"Ackroyd","year":"2021","journal-title":"Gynecol Oncol"},{"key":"zoi241346r22","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.gore.2017.11.006","article-title":"Geographic disparities in the distribution of the U.S. gynecologic oncology workforce: a Society of Gynecologic Oncology study.","volume":"22","author":"Ricci","year":"2017","journal-title":"Gynecol Oncol Rep"},{"issue":"1","key":"zoi241346r23","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.ygyno.2015.04.025","article-title":"Geographic access to gynecologic cancer care in the United States.","volume":"138","author":"Shalowitz","year":"2015","journal-title":"Gynecol Oncol"},{"key":"zoi241346r24","doi-asserted-by":"publisher","first-page":"S260","DOI":"10.1016\/S0090-8258(21)01144-6","article-title":"Referral patterns for gynecologic oncology consultation.","volume":"162","author":"Shalowitz","year":"2021","journal-title":"Gynecol Oncol"},{"key":"zoi241346r25","doi-asserted-by":"publisher","first-page":"49S","DOI":"10.1097\/01.AOG.0000558985.80976.2a","article-title":"Referral patterns for gynecologic oncology consultation.","volume":"133","author":"Madeka","year":"2019","journal-title":"Obstet Gynecol"},{"key":"zoi241346r3","unstructured":"The White House. Fact sheet: President Biden issues executive order and announces new actions to advance women\u2019s health research and innovation. March 18, 2024. Accessed October 21, 2024. https:\/\/www.whitehouse.gov\/briefing-room\/statements-releases\/2024\/03\/18\/fact-sheet-president-biden-issues-executive-order-and-announces-new-actions-to-advance-womens-health-research-and-innovation\/"},{"key":"zoi241346r5","unstructured":"US Food and Drug Administration. Enhancing the diversity of clinical trial populations\u2014eligibility criteria, enrollment practices, and trial designs guidance for industry: FDA-2019-D-1264. November 2020. Accessed October 21, 2024. https:\/\/www.fda.gov\/regulatory-information\/search-fda-guidance-documents\/enhancing-diversity-clinical-trial-populations-eligibility-criteria-enrollment-practices-and-trial"},{"key":"zoi241346r9","unstructured":"Scully? JA. Eugenics, women of color and reproductive health: the saga continues. 2004. Accessed October 21, 2024. https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=1649704"},{"key":"zoi241346r10","unstructured":"Alsheikh? B. Reproductive abuse and the sterilization of women of color: history in the making. 2023. Accessed October 21, 2024. https:\/\/scholarworks.lib.csusb.edu\/cgi\/viewcontent.cgi?article=1282&context=history-in-the-making"},{"key":"zoi241346r16","unstructured":"US Department of Commerce. Change in resident population of the 50 states, the District of Columbia, and Puerto Rico: 1910 to 2020. Accessed February 2024. https:\/\/web.archive.org\/web\/20210426202412\/https:\/\/www2.census.gov\/programs-surveys\/decennial\/2020\/data\/apportionment\/population-change-data-table.pdf"},{"key":"zoi241346r17","unstructured":"US Census Bureau. Race and ethnicity in the United States: 2010 Census and 2020 Census. August 12, 2021. Accessed February 2024. https:\/\/www.census.gov\/library\/visualizations\/interactive\/race-and-ethnicity-in-the-united-state-2010-and-2020-census.html"},{"key":"zoi241346r18","unstructured":"Wikipedia. List of U.S. states by non-Hispanic white population. Accessed February 2024. https:\/\/en.wikipedia.org\/wiki\/List_of_U.S._states_by_non-Hispanic_white_population#cite_note-8"},{"key":"zoi241346r19","unstructured":"Federal Emergency Management Agency. Expected annual loss. Accessed February 2024. https:\/\/hazards.fema.gov\/nri\/expected-annual-loss"},{"key":"zoi241346r20","unstructured":"Boland Lab. GitHub. Accessed October 25, 2024. https:\/\/github.com\/bolandlab\/Boland_GynOncTrials_JAMAOpen"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2827064\/boland_2024_oi_241346_1732034370.65274.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T11:03:34Z","timestamp":1732619014000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2827064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,26]]},"references-count":25,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11,4]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.47635","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,26]]}}}