A Simple Way to Close Racial Gaps in Cancer Trial Enrollment

TOPLINE:

In a single-center survey, patients with breast cancer from different racial and ethnic backgrounds were equally likely to discuss and participate in clinical trials when given the opportunity. Among patients who declined to participate, ineligibility and time commitment emerged as key barriers.

METHODOLOGY:

• Clinical trials are crucial for advancing breast cancer care, but enrollment among Black and Hispanic women remains disproportionately low, resulting in study populations that do not reflect the diversity of patients with breast cancer. Some studies suggest that when given the opportunity, Black and Hispanic patients are just as willing to participate in clinical trials as their White counterparts.
• To better understand discussions, participation as well as patient attitudes surrounding clinical trials, researchers analyzed survey responses from 1150 patients with breast cancer who were enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort and responded to a survey between July and September 2022. Among them, 4.4% were Asian, 19.5% Black, 3.1% Hispanic, and 73.0% White individuals; mean age at diagnosis was just under 54 years.
• Compared with White patients, Black patients had increased proportions of triple-negative breast cancer (TNBC; 14.6% vs 25.0%) and grade 3 tumors (36.9% vs 55.5%).
• Outcomes of interest were discussions of clinical trials, actual participation, and barriers to participation.

TAKEAWAY:

• Among survey respondents, 447 (38.9%) reported discussing trial participation with healthcare practitioners, with no significant differences between different racial/ethnic groups (adjusted odds ratios, 0.75 for Asian, 1.31 for Black, 0.73 for Hispanic patients compared to White patients).
• Of the 443 patients who were offered trials, 64.3% participated. Patients who were younger, had more advanced disease, or were diagnosed with TNBC or high-grade cancer were more likely to be offered a clinical trial. While there were differences in trial participation rates across racial and ethnic groups, they were not significantly different after adjusting for sociodemographic and clinical factors.
• Among 158 patients who declined to participate, the primary reasons were ineligibility and lack of interest in trials (23.4% for both) as well as concerns about receiving placebo (10.8%) and the time requirement (10.1%).
• Patients with an annual household income below $150,000 were also significantly less likely to participate than those with an income of $150,000 or more but this association varied by income bracket, suggesting that financial barriers are more nuanced than annual income alone.

IN PRACTICE:

The study adds to evidence that patients from racial minority groups are just as willing to enroll in clinical trials when given the chance, according to an invited commentary by Joseph M. Unger, PhD, MS, Fred Hutch Cancer Center, Seattle. The results also “lend crucial validation” to prior findings showing that structural and clinical barriers — not patient refusal — are the main reasons for trial non-participation, according to Unger.

“Reducing barriers to enrollment of clinical trials is a scientific and ethical imperative for the cancer community,” the study authors said. 

SOURCE:

This study, led by Nan Chen, MD, University of Chicago, Illinois, was published online in JAMA Network Open.

LIMITATIONS:

The study population may not have fully represented the broader population of patients with breast cancer in the US. The analysis also lacked sufficient statistical power to detect significant differences in clinical trial discussion and participation between Asian or Hispanic patients and White patients given limited sample sizes. Additionally, survey-based data collection may have introduced selection bias as respondents were likely healthier or had positive experiences with clinical trial discussion or participation.

DISCLOSURES:

This study was supported partly by grants from the Breast Cancer Research Foundation, National Cancer Institute, Susan G. Komen Breast Cancer Foundation, and National Institute on Aging. Two authors reported receiving personal fees or grants from various sources, outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.