peoplePerson

Joseph M. Unger

Biostatistician who showed most patients are excluded from trials by structural barriers, not by unwillingness to take part.

Joseph Unger led the systematic review and meta-analysis showing that more than half of cancer patients cannot enrol in trials because none is available locally or they fail eligibility, and that when offered, more than half agree to participate regardless of race, reframing under-representation as a structural problem. His SWOG analyses have quantified the survival benefits of trial participation and the effects of Medicaid expansion.

Role

Associate Professor, Public Health Sciences and SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center

Institution

Fred Hutchinson Cancer Center

Specialisms

Trial participation and accessHealth disparitiesBiostatisticsCooperative-group trials

Profiles

PubMed

Papers

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Title	Journal	Year
Systematic review and meta-analysis of the magnitude of structural, clinical, and physician and patient barriers to cancer clinical trial participation	JNCI	2019
'When offered to participate': a systematic review and meta-analysis of patient agreement to participate in cancer clinical trials	JNCI	2021

Key papers

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meta analysisJNCI: Journal of the National Cancer Institute 2019

Unger: most patients never get the chance to join a cancer trial, and when offered, half say yes

Patients are not the bottleneck; trial access is. Bringing trials to community practices, loosening restrictive eligibility criteria and reducing site burden would do more for enrolment than patient education. Trials today reflect the minority of patients who happen to be treated where trials exist.

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