"We were surprised that the percentage of patients who are Black was not much lower than the census in terms of raw percentages, given the disparities and barriers that Black patients face in regard to clinical trials," said senior author William A. Hall, MD, an associate professor of radiation oncology and surgery at the Medical College of Wisconsin. "There is still work to do in this regard, however, especially because some types of cancer disproportionately affect Black patients."
Incidence rates for prostate, colon, stomach, cervical and other cancers are higher for Black populations than for non-Hispanic white populations, and Black men have the highest cancer incidence rate of any group. African Americans also face the highest cancer death rates of any racial/ethnic group for all cancers combined and for many of the most common cancers.
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The underrepresentation of Asian American patients was also surprising, said Dr. Hall. "Asian Americans have not been discussed extensively in research on disparities in clinical trial participation, but our findings signal that these discussions are needed."
Researchers also examined racial diversity across different types of clinical trials. Female-specific trials—those for breast and gynecological cancers—and male-specific trials—those for prostate, penile and testicular cancers—had the most diverse racial composition (both p< 0.001; female-specific trials: 81% white, 13% Black, 5% Asian American, <1% other; male-specific trials: 80% white, 18% Black, 1% Asian American, 0% other). The trials involving proton therapy, an advanced but expensive type of radiation therapy, were the least diverse (p<0.001; 94% white, 6% Black, <1% Asian American, 0% other).
An important limitation of this study is that is does not account for potential differences in how commonly cancer is diagnosed in different racial groups, explained Ms. Bero. "Racial differences in incidence for certain types of cancer may explain the larger proportions of Black women and men in female-specific and male-specific radiation therapy trials," she said. "This should also raise the consideration, however, that given these disparities in incidence, should the enrollment rates be even higher?"
Next steps for the researchers include expanding their focus to additional reasons behind the disparity, such as socioeconomic status or characteristics of the trials themselves. "There is a complex interplay of systemic barriers and other factors in clinical trial enrollment and participation," explained Ms. Bero. "The choices individuals and institutions make when designing clinical trials can also exacerbate or mitigate disparities—issues such as how rigid a trial's inclusion criteria are, where patients can find information about the trial and whether there is financial support for participation, as well as the implicit biases that shape these choices."