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Umaefulam V, Kleissen T, Barnabe C. The representation of Indigenous peoples in chronic disease clinical trials in Australia, Canada, New Zealand, and the United States. Clin Trials 2022; 19:22-32. [PMID: 34991361 PMCID: PMC8847750 DOI: 10.1177/17407745211069153] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Indigenous peoples are overrepresented with chronic health conditions and experience suboptimal outcomes compared with non-Indigenous peoples. Genetic variations influence therapeutic responses, thus there are potential risks and harm when extrapolating evidence from the general population to Indigenous peoples. Indigenous population-specific clinical studies, and inclusion of Indigenous peoples in general population clinical trials, are perceived to be rare. Our study (1) identified and characterized Indigenous population-specific chronic disease trials and (2) identified the representation of Indigenous peoples in general population chronic disease trials conducted in Australia, Canada, New Zealand, and the United States. METHODS For Objective 1, publicly available clinical trial registries were searched from May 2010 to May 2020 using Indigenous population-specific terms and included for data extraction if in pre-specified chronic disease. For identified trials, we extracted Indigenous population group identity and characteristics, type of intervention, and funding type. For Objective 2, a random selection of 10% of registered clinical trials was performed and the proportion of Indigenous population participants enrolled extracted. RESULTS In total, 170 Indigenous population-specific chronic disease trials were identified. The clinical trials were predominantly behavioral interventions (n = 95). Among general population studies, 830 studies were randomly selected. When race was reported in studies (n = 526), Indigenous individuals were enrolled in 172 studies and constituted 5.6% of the total population enrolled in those studies. CONCLUSION Clinical trials addressing chronic disease conditions in Indigenous populations are limited. It is crucial to ensure adequate representation of Indigenous peoples in clinical trials to ensure trial data are applicable to their clinical care.
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Affiliation(s)
- Valerie Umaefulam
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tessa Kleissen
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Profit versus Quality: The Enigma of Scientific Wellness. J Pers Med 2022; 12:jpm12010034. [PMID: 35055349 PMCID: PMC8779909 DOI: 10.3390/jpm12010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
The “best of both worlds” is not often the case when it comes to implementing new health models, particularly in community settings. It is often a struggle between choosing or balancing between two components: depth of research or financial profit. This has become even more apparent with the recent shift to move away from a traditionally reactive model of medicine toward a predictive/preventative one. This has given rise to many new concepts and approaches with a variety of often overlapping aims. The purpose of this perspective is to highlight the pros and cons of the numerous ventures already implementing new concepts, to varying degrees, in community settings of quite differing scales—some successful and some falling short. Scientific wellness is a complex, multifaceted concept that requires integrated experimental/analytical designs that demand both high-quality research/healthcare and significant funding. We currently see the more likely long-term success of those ventures in which any profit is largely reinvested into research efforts and health/healthspan is the primary focus.
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Pounders AJ, Rushing GV, Mahida S, Nonyane BAS, Thomas EA, Tameez RS, Gipson TT. Racial differences in the dermatological manifestations of tuberous sclerosis complex and the potential effects on diagnosis and care. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221140125. [PMID: 37180419 PMCID: PMC10032467 DOI: 10.1177/26330040221140125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/17/2022] [Indexed: 05/16/2023]
Abstract
Background Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder of non-malignant tumor growths throughout major organ systems and neurological, neuropsychiatric, renal, and pulmonary co-morbidities. Skin manifestations are readily visible, often develop early in life, and are major features that contribute to TSC diagnosis. Medical photographs of such manifestations are commonly shown as examples from White individuals creating a potential barrier to accurately identifying these features in darker skinned individuals. Objectives The aim of this report is to raise awareness of dermatological manifestations associated with TSC, compare their appearance by race, and consider how recognition of these features could impact diagnosis and treatment of TSC. Design and Methods We conducted a retrospective chart review at the TSC Center of Excellence (TSCOE) at the Kennedy Krieger Institute, which included all patients in the center from 2009 (inception) through the end of the calendar year 2015 and analyzed data from the TSC Alliance Natural History Database (NHD). Results Among TSCOE patients, 50% of Black patients were diagnosed before the age of 1 year, compared with 70% of White patients. NHD data corroborated this trend showing a significant difference with only 38% of Blacks as compared with 50% of Whites were diagnosed at age ⩽1 year. A significant difference was observed where White participants had higher odds of having received genetic testing in both data sets. While no differences in the total number of TSC features was observed in either data set, shagreen patches and cephalic fibrous plaques were more frequently recorded in the NHD for Black individuals. Conclusion We highlight a disparity in the representation of Black participants within the NHD, TSCOE, and TSC trials, in addition to differences in utilization of molecular testing and topical mechanistic target of rapamycin (mTOR) inhibitor therapy between Black and White individuals. We show a trend toward later diagnosis age in Black individuals. These differences between races warrant further study across additional clinical sites and other minority groups.
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Affiliation(s)
| | | | - Sonal Mahida
- Department of Neurology, Boston Children’s
Hospital, Boston, MA, USA
| | | | - Emily A. Thomas
- Department of International Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Tanjala T. Gipson
- TSC Center of Excellence, Le Bonheur Children’s
Hospital, 50 N. Dunlap Street, Memphis, TN 38105, USA
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Anaba U, Ishola A, Alabre A, Bui A, Prince M, Okafor H, Kola-Kehinde O, Joseph JJ, Mitchell D, Odei BC, Uzendu A, Williams KP, Capers Q, Addison D. Diversity in modern heart failure trials: Where are we, and where are we going. Int J Cardiol 2021; 348:95-101. [PMID: 34920047 DOI: 10.1016/j.ijcard.2021.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022]
Abstract
Over the last three decades, increased attention has been given to the representation of historically underrepresented groups within the landscape of pivotal clinical trials. However, recent events (i.e., coronavirus pandemic) have laid bare the potential continuation of historic inequities in available clinical trials and studies aimed at the care of broad patient populations. Anecdotally, cardiovascular disease (CVD) has not been immune to these disparities. Within this review, we examine and discuss recent landmark CVD trials, with a specific focus on the representation of Blacks within several critically foundational heart failure clinical trials tied to contemporary treatment strategies and drug approvals. We also discuss solutions for inequities within the landscape of cardiovascular trials. Building a more diverse clinical trial workforce coupled with intentional efforts to increase clinical trial diversity will advance equity in cardiovascular care.
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Affiliation(s)
- Uzoma Anaba
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA
| | - Abiodun Ishola
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiology, St. Elizabeth Heart and Vascular Institute, Edgewood, KY, USA
| | - Alisha Alabre
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA
| | - Albert Bui
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Marloe Prince
- Division of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Henry Okafor
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University College of Medicine, USA
| | - Darrion Mitchell
- Deparment of Radiation Oncology, Ohio State University Medical Center, Columbus, OH, USA
| | - Bismarck C Odei
- Deparment of Radiation Oncology, Ohio State University Medical Center, Columbus, OH, USA
| | - Anezi Uzendu
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Quinn Capers
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA
| | - Daniel Addison
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA.
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Goel S, Negassa A, Acuna-Villaorduna A. Comparative Effectiveness of Biologic Agents Among Black and White Medicare Patients in the US With Metastatic Colorectal Cancer. JAMA Netw Open 2021; 4:e2136378. [PMID: 34910154 PMCID: PMC8674750 DOI: 10.1001/jamanetworkopen.2021.36378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/03/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Randomized clinical trials have defined the survival benefit provided by the addition of biologic drugs to chemotherapy in patients with metastatic colorectal cancer (mCRC). However, Black patients may be underrepresented in trial populations, and outcomes in this group remain poorly defined. Objective To determine whether the real-world benefit of biologic drugs in Black patients is consistent with the real-world benefit of biologic drugs in White patients using a comparative effectiveness research approach. Design, Setting, and Participants Population-based retrospective comparative effectiveness analysis of a cohort of patients aged 65 years or older with mCRC diagnosed between 2004 and 2011 who had received at least 1 dose of chemotherapy and had complete Medicare claims data using the Surveillance, Epidemiology, and End Result (SEER)-Medicare linked database. Data were analyzed from August 1, 2020, to March 31, 2021. Interventions Patient data were classified according to whether patients received chemotherapy (oxaliplatin, irinotecan, and 5-fluorouracil or capecitabine) or biochemotherapy (bevacizumab, cetuximab, panitumumab, ramucirumab, or aflibercept, started within 3 months of chemotherapy). Main Outcomes and Measures Overall survival (OS) defined as the time from starting chemotherapy to death or last follow-up. A weighted Cox regression model was used to assess differences in survival. Results A total of 5617 patients with mCRC were identified in the SEER-Medicare linked database, and 4542 patients were included in the main analysis. Of the 5617 patients, 3969 (70.7%) received biologic agents at any point between 2004 and 2011; biologic agent therapy was started within 3 months of chemotherapy in 2894 patients (72.9%). Among 4542 patients with data on race and ethnicity, the median age was 72 years (IQR, 68-78 years), 2365 (52.0%) were female, 3445 (75.8%) had colon as the primary site, 552 (12.2%) were Black patients, and 3990 (87.8%) were White patients. There was no difference in the receipt of 1 (76.7% and 74.8%) vs 2 or more (23.3% and 25.2%: P = .92) lines of therapy, and in the receipt of biologic agents (63.6% vs 64.3% P = .33), among White patients and Black patients, respectively. Biochemotherapy was associated with a significant survival benefit compared with chemotherapy alone in the overall population (biochemotherapy median OS, 17.9 [95% CI, 17.3-18.7] months vs chemotherapy median OS, 8.3 [95% CI, 9.1-9.9] months; P < .001). The survival benefit was similar among White patients (17.8 vs 9 months; average hazard ratio, 0.59; 95% CI, 0.55-0.64; P < .001) and Black patients (18.6 vs 9.9; average hazard ratio, 0.58; 95% CI, 0.47-0.71; P < .001). Conclusions and Relevance In this comparative effectiveness analysis of a cohort of Medicare recipients with mCRC, biochemotherapy was associated with an improvement in OS with a similar rate of reduction in mortality among Black and White patients. Clinicians may offer biochemotherapy therapy to all patients to maximize clinical benefit, factoring in clinical variables, but not their race.
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Affiliation(s)
- Sanjay Goel
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Abdissa Negassa
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Ana Acuna-Villaorduna
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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106
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Johnston A, Tseung V, Dancey SR, Visintini SM, Coutinho T, Edwards JD. Use of Race, Ethnicity, and National Origin in Studies Assessing Cardiovascular Risk in Women With a History of Hypertensive Disorders of Pregnancy. CJC Open 2021; 3:S102-S117. [PMID: 34993440 PMCID: PMC8712581 DOI: 10.1016/j.cjco.2021.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022] Open
Abstract
Women with a history of hyperBtensive disorders of pregnancy (HDP) are at particularly high risk for cardiovascular disease (CVD) and CVD-related death, and certain racial and ethnic subpopulations are disproportionately affected by these conditions. We examined the use of race, ethnicity, and national origin in observational studies assessing CVD morbidity and mortality in women with a history of HDP. A total of 124 studies, published between 1976 and 2021, were reviewed. We found that white women were heavily overrepresented, encompassing 53% of all participants with HDP. There was limited and heterogeneous reporting of race and ethnicity information across studies and only 27 studies reported including race and/or ethnicity variables in at least 1 statistical analysis. Only 2 studies mentioned the use of these variables as a strength; several others (k = 18) reported a lack of diversity among participants as a study limitation. Just over half of included articles (k = 68) reported at least 1 sociodemographic variable other than race and ethnicity (eg, marital status and income); however, none investigated how they might have worked synergistically or antagonistically with race and/or ethnicity to influence participants' risk of CVD. These findings highlight significant areas for improvement in cardiovascular obstetrics research, including the need for more robust and standardized methods for collecting, reporting, and using sociodemographic information. Future studies of CVD risk in women with a history of HDP should explicitly examine racial and ethnic differences and use an intersectional approach.
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Affiliation(s)
- Amy Johnston
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Victrine Tseung
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sonia R. Dancey
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah M. Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jodi D. Edwards
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- IC/ES, Ottawa, Ontario, Canada
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Jayakrishnan T, Aulakh S, Baksh M, Nguyen K, Ailawadhi M, Samreen A, Parrondo R, Sher T, Roy V, Manochakian R, Paulus A, Chanan-Khan A, Ailawadhi S. Landmark Cancer Clinical Trials and Real-World Patient Populations: Examining Race and Age Reporting. Cancers (Basel) 2021; 13:cancers13225770. [PMID: 34830924 PMCID: PMC8616211 DOI: 10.3390/cancers13225770] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/25/2021] [Accepted: 11/12/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Food and Drug Administration (FDA) drug approvals from July 2007 to June 2019 were reviewed to identify oncology approvals, and trials with age details were reviewed for the study. We hypothesized that the clinical trials that do not report race are likely to suffer from a higher degree of age disparity. The study demonstrated that a significant number of clinical trials leading to cancer drug approvals suffer from racial and age disparity when compared to real-world populations and that the two factors may be interrelated. Age discrepancy between the clinical trial population and the real-world population was higher for studies that did not report race (mean difference −8.8 years (95% CI −12.6 to −5.0 years)) vs. studies that did report it. We recommend continued efforts to recruit diverse populations in clinical trials and make concerted efforts to implement national strategies in order to realize healthcare equity. In the meantime, detailed reporting of patient demographic characteristics in publications should be considered standard. Abstract Background: Concern exists that the clinical trial populations differ from respective cancer populations in terms of their age distribution affecting the generalizability of the results, especially in underrepresented minorities. We hypothesized that the clinical trials that do not report race are likely to suffer from a higher degree of age disparity. Methods: Food and Drug Administration (FDA) drug approvals from July 2007 to June 2019 were reviewed to identify oncology approvals, and trials with age details were selected. The outcomes studied were the weighted mean difference in age between the clinical trial population and real-world population for various cancers, the prevalence of race reporting and association of age and race reporting with each other. Results: Of the 261 trials, race was reported in 223 (85.4%) of the trials, while 38 trials (14.6%) had no mention of race. Race reporting improved minimally over time: 29 (85.3%) in 2007–2010 vs. 49 (80.3%) in 2011–2014 vs. 145 (85.4%) during the period 2015–2019 (p-value = 0.41). Age discrepancy between the clinical trial population and the real-world population was higher for studies that did not report race (mean difference −8.8 years (95% CI −12.6 to −5.0 years)) vs. studies that did report it (mean difference −5.1 years, (95% CI −6.4 to −3.7 years), p-value = 0.04). Conclusion: The study demonstrates that a significant number of clinical trials leading to cancer drug approvals suffer from racial and age disparity when compared to real-world populations, and that the two factors may be interrelated. We recommend continued efforts to recruit diverse populations.
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Affiliation(s)
- Thejus Jayakrishnan
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, OH 44106, USA;
| | - Sonikpreet Aulakh
- Departments of Internal Medicine and Neurosciences, West Virginia University, Morgantown, WV 26506, USA;
| | - Mizba Baksh
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Kianna Nguyen
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA;
| | - Meghna Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Ayesha Samreen
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Ricardo Parrondo
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Taimur Sher
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Vivek Roy
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Rami Manochakian
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Aneel Paulus
- Division of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Asher Chanan-Khan
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
- Division of Hematology-Oncology, St. Vincent’s Cancer Center, Jacksonville, FL 32224, USA
| | - Sikander Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
- Division of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224, USA;
- Correspondence: ; Tel.: +1-9049532000; Fax: +1-9049532315
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Bero EH, Rein LE, Banerjee A, Straza MW, Lawton CAF, Schultz CJ, Erickson BA, Siker ML, Hall WA. Characterization of Underrepresented Populations in Modern Era Clinical Trials Involving Radiation Therapy. Pract Radiat Oncol 2021; 11:453-459. [PMID: 34742459 DOI: 10.1016/j.prro.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE The demographic composition of modern radiation therapy (RT) clinical trials is incompletely studied. Understanding and minimizing disparities in clinical trials is critical to ensure health equity and the generalizability of research findings. METHODS AND MATERIALS Clinicaltrials.gov was searched to identify RT clinical trials that occurred from 1996 to 2019. A total of 1242 trials were reviewed for patient characteristics. The demographic composition of the studies was summarized by the frequency and percentage of patients by race, gender, and ethnicity. The racial composition of the study population was compared with the 2018 US Census using a 1-sample χ2 test. Subgroup racial composition was compared using χ2 tests of independence. Analyses used a complete case approach. RESULTS A total of 122 trials met the inclusion criteria, and 121 of these (99.1%) reported race. Trial subgroups included 63 trials in the United States (51.6%), 9 proton therapy trials (7.4%), 34 RT toxicity mitigation or prevention trials (27.9%), 24 trials for female cancer (19.7%), and 17 trials for male cancer (13.9%). US clinical trials overall, US RT toxicity mitigation or prevention trials, US trials for female cancer, and US trials for male cancer had significantly different racial compositions compared with the 2018 US Census data (P < .001 for all). Compared with all clinical trials, those for proton therapy had the largest magnitude of significantly lower enrollment of participants who identified their race as Black, Asian, or other (P < .001). CONCLUSIONS This study characterized the racial composition of prospective RT clinical trials in a modern cohort. The racial population represented across multiple categories in the United States differed significantly from US census data and was most pronounced in trials evaluating proton therapy. This is a benchmark study for future efforts to characterize and balance the participation of underrepresented populations in RT clinical trials.
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Affiliation(s)
| | | | | | | | | | | | - Beth A Erickson
- Departments of Radiation Oncology; Surgery, Medical College of Wisconsin
| | | | - William A Hall
- Departments of Radiation Oncology; Surgery, Medical College of Wisconsin
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Jones R, Hirschey R, Campbell G, Cooley ME, Lally R, Somayaji D, Rueter EK, Gullatte MM. Update to 2019-2022 ONS Research Agenda: Rapid Review to Address Structural Racism and Health Inequities. Oncol Nurs Forum 2021; 48:589-600. [PMID: 34673760 PMCID: PMC8674842 DOI: 10.1188/21.onf.589-600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The Oncology Nursing Society (ONS) formed a team to develop a necessary expansion of the 2019-2022 ONS Research Agenda, with a focus on racism and cancer care disparities. METHODS A multimethod consensus-building approach was used to develop and refine the research priorities. A panel of oncology nurse scientists and equity scholars with expertise in health disparities conducted a rapid review of the literature, consulted with experts and oncology nurses, and reviewed priorities from funding agencies. RESULTS Critical gaps in the literature were identified and used to develop priority areas for oncology nursing research, practice, and workforce development. SYNTHESIS This is the first article in a two-part series that discusses structural racism and health inequities within oncology nursing. In this article, three priority areas for oncology nursing research are presented; in the second article, strategies to improve cancer disparities and equity and diversity in the oncology workforce are described. IMPLICATIONS FOR RESEARCH Research priorities are presented to inform future research that will provide methods and tools to increase health equity and reduce structural racism in oncology nursing practice, research, education, policy, and advocacy.
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Affiliation(s)
- Randy Jones
- Professor University of Virginia School of Nursing, Assistant Director of Community Outreach and Engagement UVA Emily Couric Cancer Center
| | - Rachel Hirschey
- Assistant Professor, University of North Carolina at Chapel Hill, School of Nursing, Associate Member, Lineberger Comprehensive Cancer Center
| | - Grace Campbell
- Assistant Professor, University of Pittsburgh School of Nursing
| | - Mary E. Cooley
- Lecturer, Psychiatry, Harvard Medical School, Nurse Scientist, Nursing and Patient Care, Dana-Farber Cancer Institute
| | - Robin Lally
- Interim Associate Dean for Research, Professor, University of Nebraska College of Nursing, Member Fred & Pamela Buffett Cancer Center
| | - Darryl Somayaji
- Assistant Professor, University at Buffalo, School of Nursing, Adjunct Assistant Professor of Oncology, Roswell Park Comprehensive Cancer Center
| | | | - Mary Magee Gullatte
- Corporate Director Nursing Evidence Based Practice and Research, Emory Healthcare and Adjunct Faculty Emory Nell Hodgson Woodruff School of Nursing
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Phase 2 study of venetoclax plus carfilzomib and dexamethasone in patients with relapsed/refractory multiple myeloma. Blood Adv 2021; 5:3748-3759. [PMID: 34470049 DOI: 10.1182/bloodadvances.2020004146] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/10/2021] [Indexed: 12/20/2022] Open
Abstract
Proteins in the antiapoptotic B-cell lymphoma 2 (BCL-2) family play a role in the pathophysiology of multiple myeloma (MM). Venetoclax is a highly selective, potent, oral BCL-2 inhibitor that induces apoptosis of MM cells, and its efficacy may be potentiated through combination with agents that increase BCL-2 dependency or have complementary mechanisms of action. The safety, tolerability, pharmacokinetics, and antitumor activity of venetoclax in combination with carfilzomib and dexamethasone (VenKd) in adults with relapsed/refractory MM (RRMM) were investigated in this phase 2 dose-escalation study. Oral venetoclax (400 or 800 mg) was administered daily in combination with intravenous carfilzomib (27, 56, or 70 mg/m2) and oral dexamethasone (20 or 40 mg) in 4 dose-finding cohorts. The expansion cohort received venetoclax 800 mg, carfilzomib 70 mg/m2, and dexamethasone 40 mg. Forty-nine patients received treatment. Median prior lines of therapy was 1 (range, 1-3), and median time in the study was 27 months. The most common treatment-emergent adverse events were diarrhea (65%), fatigue (47%), nausea (47%), and lymphopenia (35%). Serious adverse events occurred in 26 (53%) patients. Of 3 treatment-emergent deaths, 1 was considered treatment related. The overall response rate was 80% in all patients, 92% in patients with t(11;14) (n = 13), and 75% in patients without (n = 36). The rate of complete response or better was 41%. Median progression-free survival was 22.8 months. Treatment with VenKd was well tolerated and showed promising response rates in this RRMM patient population, with greater responses observed in patients with t(11;14). This trial is registered at www.clinicaltrials.gov as #NCT02899052.
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Avram R, So D, Iturriaga E, Byrne J, Lennon R, Murthy V, Geller N, Goodman S, Rihal C, Rosenberg Y, Bailey K, Farkouh M, Bell M, Cagin C, Chavez I, El-Hajjar M, Ginete W, Lerman A, Levisay J, Marzo K, Nazif T, Olgin J, Pereira N. Patient Onboarding and Engagement to Build a Digital Registry after Enrollment in a Clinical Trial: Results of the TAILOR-PCI Digital Study (Preprint). JMIR Form Res 2021; 6:e34080. [PMID: 35699977 PMCID: PMC9237778 DOI: 10.2196/34080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study is a novel proof-of-concept study that evaluated the feasibility of extending the TAILOR-PCI randomized controlled trial (RCT) follow-up period by using a remote digital platform. Objective The aim of this study is to describe patients’ onboarding, engagement, and results in a digital study after enrollment in an RCT. Methods In this intervention study, previously enrolled TAILOR-PCI patients in the United States and Canada within 24 months of randomization were invited by letter to download the study app. Those who did not respond to the letter were contacted by phone to survey the reasons for nonparticipation. A direct-to-patient digital research platform (the Eureka Research Platform) was used to onboard patients, obtain consent, and administer activities in the digital study. The patients were asked to complete health-related surveys and digitally provide follow-up data. Our primary end points were the consent rate, the duration of participation, and the monthly activity completion rate in the digital study. The hypothesis being tested was formulated before data collection began. Results After the parent trial was completed, letters were mailed to 907 eligible patients (representing 18.8% [907/4837] of total enrolled in the RCT) within 15.6 (SD 5.2) months of randomization across 24 sites. Among the 907 patients invited, 290 (32%) visited the study website and 110 (12.1%) consented—40.9% (45/110) after the letter, 33.6% (37/110) after the first phone call, and 25.5% (28/110) after the second call. Among the 47.4% (409/862) of patients who responded, 41.8% (171/409) declined to participate because of a lack of time, 31.2% (128/409) declined because of the lack of a smartphone, and 11.5% (47/409) declined because of difficulty understanding what was expected of them in the study. Patients who consented were older (aged 65.3 vs 62.5 years; P=.006) and had a lower prevalence of diabetes (19% vs 30%; P=.02) or tobacco use (6.4% vs 24.8%; P<.001). A greater proportion had bachelor’s degrees (47.2% vs 25.7%; P<.001) and were more computer literate (90.5% vs 62.3% of daily internet use; P<.001) than those who did not consent. The average completion rate of the 920 available monthly electronic visits was 64.9% (SD 7.6%); there was no decrease in this rate throughout the study duration. Conclusions Extended follow-up after enrollment in an RCT by using a digital study was technically feasible but was limited because of the inability to contact most eligible patients or a lack of time or access to a smartphone. Among the enrolled patients, most completed the required electronic visits. Enhanced recruitment methods, such as the introduction of a digital study at the time of RCT consent, smartphone provision, and robust study support for onboarding, should be explored further. Trial Registration Clinicaltrails.gov NCT01742117; https://clinicaltrials.gov/ct2/show/NCT01742117
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Affiliation(s)
- Robert Avram
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Derek So
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Erin Iturriaga
- Department of Medicine, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Julia Byrne
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Ryan Lennon
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Vishakantha Murthy
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Nancy Geller
- Department of Medicine, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Shaun Goodman
- Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Yves Rosenberg
- Department of Medicine, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Kent Bailey
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Michael Farkouh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Malcolm Bell
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Charles Cagin
- Department of Medicine, Mayo Clinic Health System, La Crosse, WI, United States
| | - Ivan Chavez
- Department of Medicine, Minneapolis Heart Institute, Minneapolis, MN, United States
| | - Mohammad El-Hajjar
- Department of Medicine, Albany Medical College, Albany, NY, United States
| | - Wilson Ginete
- Department of Medicine, Essentia Institute of Rural Health, Duluth, MN, United States
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Justin Levisay
- Department of Medicine, Northshore University Health System, Evanston, IL, United States
| | - Kevin Marzo
- Department of Medicine, Winthrop University Hospital, Mineola, NY, United States
| | - Tamim Nazif
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Jeffrey Olgin
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Naveen Pereira
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
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Kahn JM, Gray DM, Oliveri JM, Washington CM, DeGraffinreid CR, Paskett ED. Strategies to improve diversity, equity, and inclusion in clinical trials. Cancer 2021; 128:216-221. [PMID: 34495551 PMCID: PMC9293140 DOI: 10.1002/cncr.33905] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 12/16/2022]
Abstract
There is a growing need for diversity, equity, and inclusion (DEI) in cancer care, particularly with respect to equal access and accrual to clinical trials. This commentary describe steps taken to address disparities in the authors' own clinical practice and proposes actions at the patient, provider, community, and institution levels to improve DEI in clinical trials.
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Affiliation(s)
- Justine M Kahn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Darrell M Gray
- Ohio State University Comprehensive Cancer Center, Division of Gastroenterology, Hepatology and Nutrition, Ohio State University College of Medicine, Columbus, Ohio
| | - Jill M Oliveri
- Department of Population Sciences, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Chasity M Washington
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Cecilia R DeGraffinreid
- Department of Population Sciences, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Department of Population Sciences, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Ohio State University Comprehensive Cancer Center, Division of Cancer Prevention and Control, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, Ohio
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113
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Ding J, Zhou Y, Khan MS, Sy RN, Khosa F. Representation of sex, race, and ethnicity in pivotal clinical trials for dermatological drugs. Int J Womens Dermatol 2021; 7:428-434. [PMID: 34621955 PMCID: PMC8484973 DOI: 10.1016/j.ijwd.2021.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/07/2021] [Accepted: 02/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is of paramount importance that clinical trials are designed with adequate health equity considerations to prevent disproportionate analyses of specific demographics. OBJECTIVE In this study, we investigated the representation of sex, race, and ethnicity in pivotal clinical trials for drugs with dermatological disease indications approved by the U.S. Food and Drug Administration between 1995 and 2019. METHODS Thirty-six novel drugs with indications to treat dermatological diseases, approved by the U.S. Food and Drug Administration between January 1995 and December 2019 were abstracted from Drugs@FDA. The drug approval label, statistical review, official record, and trial publication were reviewed for data on disease indication, approval year, pathway, number of participants, participant demographics (sex, race, and ethnicity), location, and sponsor type. RESULTS The overall female representation was 45.6% (n = 17,492 of 38,320). Adequate female representation was noted for five of six disease indications. Caucasians were predominantly overrepresented (80.4%; n = 28,065 of 34,890); Blacks (9.8%; n = 3242 of 33,240) and Asians (5.5%; n = 1535 of 27,696) were consistently underrepresented. Across sponsor types, there was a significant difference in the distribution of women (χ2 = 6.332; p = .042), as well as Caucasians (χ2 = 12.813; p = .002), Blacks (χ2 = 13.002; p = .002), and Hispanics/Latinos (χ2 = 7.747; p = .021). CONCLUSION Persistence of disparities disproportionately affect the quality of data behind therapies for certain demographics; as such, enrollment practices must continue to address the issue of underrepresentation. Efforts to facilitate demographic equity among clinical trial participants must be supported to ensure that safety and efficacy conclusions are drawn from representative population samples.
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Affiliation(s)
- Jeffrey Ding
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Shahzeb Khan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Rebecca N Sy
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Faisal Khosa
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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114
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Lerman MH, Holmes B, St Hilaire D, Tran M, Rioth M, Subramanian V, Winzeler AM, Brown T. Validation of a Mortality Composite Score in the Real-World Setting: Overcoming Source-Specific Disparities and Biases. JCO Clin Cancer Inform 2021; 5:401-413. [PMID: 33830788 PMCID: PMC8140809 DOI: 10.1200/cci.20.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study tested whether a composite mortality score could overcome gaps and potential biases in individual real-world mortality data sources. Complete and accurate mortality data are necessary to calculate important outcomes in oncology, including overall survival. However, in the United States, there is not a single complete and broadly applicable mortality data source. It is further likely that available data sources are biased in their coverage of sex, race, age, and socioeconomic status (SES).
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115
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Dzul S, Ninia J, Jang H, Kim S, Dominello M. Predictors of Acute Radiation Dermatitis and Esophagitis in African American Patients Receiving Whole Breast Radiotherapy. Pract Radiat Oncol 2021; 12:52-59. [PMID: 34710629 DOI: 10.1016/j.prro.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE/OBJECTIVES Adjuvant whole breast radiotherapy following breast conserving surgery is standard of care in the management of early stage breast cancer. Two of the most common acute toxicities of breast radiotherapy are radiation esophagitis (RE) and radiation dermatitis (RD). African Americans are at higher risk for experiencing treatment-related toxicity and are often under-represented in clinical trials. METHODS An institutional database was developed to include all African American patients with history of breast cancer or DCIS undergoing adjuvant radiotherapy at a single institution from 2013-2019. Records were reviewed to identify patient age, BMI, radiation dose, prone vs supine position, inclusion of boost, and inclusion of regional nodal irradiation (RNI). Radiation treatment plans were reviewed to identify breast size as well as dosimetric parameters to the breast and esophagus. Medical records were reviewed to identify which patients were prescribed silvadene or mylanta-lidocaine during or immediately following their course of radiotherapy which was used as a surrogate for Grade 2 or higher dermatitis (G2RD) and esophagitis (G2RE), respectively. RESULTS 272 patients were included in the final analysis. On univariable analysis, morbidly obese patients were more likely to develop G2RD while hypofractionated radiotherapy was associated with lower rates of G2RD. On multivariable analysis, increasing breast volume was associated with higher rates of G2RD. For the subset of patients receiving RNI, 19% of patients experienced G2RE with the best predictor on multivariable analysis being Dmean to the esophagus. CONCLUSION Radiation dermatitis and esophagitis are common toxicities in African American patients undergoing adjuvant breast radiotherapy. Breast size, irrespective of patient's BMI, was associated with worse rate of dermatitis. Prone position and hypofractionated radiation reduced rates of G2RD. Dmean to the esophagus was the dosimetric parameter best correlating with G2RE. These results may be used to help select patients are at higher risk for G2 or higher toxicity during radiotherapy.
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Affiliation(s)
- Stephen Dzul
- Wayne State University School of Medicine, Detroit, MI.
| | - James Ninia
- Wayne State University School of Medicine, Detroit, MI
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116
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Lee E, Wen P. Gender and sex disparity in cancer trials. ESMO Open 2021; 5:e000773. [PMID: 32816862 PMCID: PMC7440710 DOI: 10.1136/esmoopen-2020-000773] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/27/2022] Open
Abstract
The study population within phase III clinical trials leading to approval of new cancer agents should ideally more closely mirror the population who will ultimately receive these agents. Although the number of females participating in clinical trials has increased over the past several decades, females are still under-represented in preclinical studies, in early phase clinical trials and even in some later phase cancer clinical trials. In the USA, this is particularly true for women from minority populations and elderly women. In this review, we review gender and sex disparities in cancer trials, the reasons for these disparities, the barriers to clinical trial enrolment and ways to improve diversity in cancer clinical trials.
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Affiliation(s)
- Eudocia Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Patrick Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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117
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Warlick ED, Ustun C, Andreescu A, Bonagura AF, Brunner A, Chandra AB, Foran JM, Juckett MB, Kindwall-Keller TL, Klimek VM, Pease DF, Steensma DP, Waldman BM, Horowitz MM, Burns LJ, Khera N. Blood and Marrow Transplant Clinical Trials Network Study 1102 heralds a new era in hematopoietic cell transplantation in high-risk myelodysplastic syndromes: Challenges and opportunities in implementation. Cancer 2021; 127:4339-4347. [PMID: 34375439 DOI: 10.1002/cncr.33826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/16/2022]
Abstract
LAY SUMMARY People who have advanced myelodysplastic syndromes (MDS) may live longer if they get a bone marrow transplant (BMT) instead of other therapies. However, only 15% of people with MDS actually get BMT. Experts say community physicians and transplant physicians should team up with insurance companies and patient advocacy groups to 1) spread this news about lifesaving advances in BMT, 2) ensure that everyone can afford health care, 3) provide emotional support for patients and families, 4) help patients and families get transportation and housing if they need to travel for transplant, and 5) improve care for people of under-represented racial and ethnic backgrounds.
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Affiliation(s)
- Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | | | - Astrid Andreescu
- Northern Light Eastern Maine Medical Center, Lafayette Family Cancer Institute, Bangor, Maine
| | | | | | | | - James M Foran
- Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, Florida
| | - Mark B Juckett
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | | | | | | | | | - Bryce M Waldman
- Center for International Blood and Marrow Transplant, Milwaukee, Wisconsin
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant, Milwaukee, Wisconsin.,Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda J Burns
- Center for International Blood and Marrow Transplant, Milwaukee, Wisconsin
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118
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Saini G, Bhattarai S, Gogineni K, Aneja R. Quadruple-Negative Breast Cancer: An Uneven Playing Field. JCO Glob Oncol 2021; 6:233-237. [PMID: 32073910 PMCID: PMC7051792 DOI: 10.1200/jgo.19.00366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
| | | | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory University School of Medicine; Atlanta, GA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA
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119
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Bossé D, Xie W, Lin X, Simantov R, Lalani AKA, Graham J, Wells JC, Donskov F, Rini B, Beuselinck B, Alva A, Hansen A, Wood L, Soulières D, Kollmannsberger C, Patenaude F, Heng DYC, Choueiri TK, McKay RR. Outcomes in Black and White Patients With Metastatic Renal Cell Carcinoma Treated With First-Line Tyrosine Kinase Inhibitors: Insights From Two Large Cohorts. JCO Glob Oncol 2021; 6:293-306. [PMID: 32109159 PMCID: PMC7055470 DOI: 10.1200/jgo.19.00380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To investigate whether black race is an independent predictor of overall survival (OS) in metastatic renal cell carcinoma (mRCC). METHODS We performed a retrospective 2-cohort (International Metastatic Renal Cell Carcinoma Database Consortium [IMDC] and trial-database) study of patients with mRCC treated with first-line tyrosine kinase inhibitors (TKIs). Unmatched (UM) and matched (M) analyses accounting for imbalances in region, year of treatment, age, and sex between races were performed. Cox models adjusting for histology, number of metastatic sites, nephrectomy, and IMDC risk compared time to treatment failure (TTF; IMDC cohort), progression-free survival (PFS; trial-database cohort), and OS. RESULTS The IMDC cohort included 73 black versus 3,381 (UM) and 1,236 (M) white patients. The trial-database cohort included 21 black versus 1,040 (UM) and 431 (M) white patients. Median OS for black versus white patients was 18.5 versus 25.8 months in the IMDC group and 21.0 versus 25.6 months in the trial-database group. Differences in OS were not significant in multivariable analysis in the IMDC group (hazard ratio [HR]M, 1.0; 95% CI, 0.7 to 1.5; HRUM, 1.1; 95% CI, 0.8 to 1.4) and trial-database (HRM, 1.5; 95% CI, 0.8 to 2.7; HRUM, 1.4; 95% CI, 0.8 to 2.6) cohorts. TTF for black patients was shorter in the UM IMDC cohort (HRUM, 1.4; 95% CI, 1.1 to 1.8; P = .003), but not in the M analysis. PFS was shorter for black patients in both analyses in the trial-database cohort (HRM, 2.3; 95% CI, 1.4 to 3.9; P = .002; HRUM, 2.3; 95% CI, 1.4 to 3.9; P = .002). CONCLUSION Black patients had more IMDC risk factors and worse outcomes with TKIs versus white patients. Race was not an independent predictor of OS. Strategies to understand biologic determinants of outcomes for minority patients are needed to optimize care.
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Affiliation(s)
- Dominick Bossé
- The Ottawa Hospital, Division of Medical Oncology, University of Ottawa, Ottawa, Ontario, Canada.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Wanling Xie
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Xun Lin
- Pfizer Oncology, La Jolla, CA
| | | | - Aly-Khan A Lalani
- Juravinski Cancer Centre, Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | | | - J Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Brian Rini
- Department of Hematology and Medical Oncology, Cleveland Clinic-Taussig Cancer Institute, Cleveland, OH
| | - Benoit Beuselinck
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Aaron Hansen
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lori Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Division of Oncology, Montreal, Quebec, Canada
| | | | - Francois Patenaude
- Department of Oncology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Daniel Y C Heng
- University of California San Diego, Moores Cancer Center, San Diego, CA
| | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Rana R McKay
- University of California San Diego, Moores Cancer Center, San Diego, CA
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120
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Coert RMH, Timmis JK, Boorsma A, Pasman WJ. Stakeholder Perspectives on Barriers and Facilitators for the Adoption of Virtual Clinical Trials: Qualitative Study. J Med Internet Res 2021; 23:e26813. [PMID: 34255673 PMCID: PMC8294122 DOI: 10.2196/26813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/31/2021] [Accepted: 05/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background Conventional clinical trials are essential for generating high-quality evidence by measuring the efficacy of interventions in rigorously controlled clinical environments. However, their execution can be expensive and time-consuming. In addition, clinical trials face several logistical challenges regarding the identification, recruitment, and retention of participants; consistent data collection during trials; and adequate patient follow-up. This might lead to inefficient resource utilization. In order to partially address the current problems with conventional clinical trials, there exists the need for innovations. One such innovation is the virtual clinical trial (VCT). VCTs allow for the collection and integration of diverse data from multiple information sources, such as electronic health records, clinical and demographic data, patient-reported outcomes, anthropometric and activity measurements, and data collected by digital biomarkers or (small) samples that participants can collect themselves. Although VCTs have the potential to provide substantial value to clinical research and patients because they can lower clinical trial costs, increase the volume of data collected from patients’ daily environment, and reduce the burden of patient participation, so far VCT adoption is not commonplace. Objective This paper aims to better understand the barriers and facilitators to VCT adoption by determining the factors that influence individuals’ considerations regarding VCTs from the perspective of various stakeholders. Methods Based on online semistructured interviews, a qualitative study was conducted with pharmaceutical companies, food and health organizations, and an applied research organization in Europe. Data were thematically analyzed using Rogers’ diffusion of innovation theory. Results A total of 16 individuals with interest and experience in VCTs were interviewed, including persons from pharmaceutical companies (n=6), food and health organizations (n=4), and a research organization (n=6). Key barriers included a potentially low degree of acceptance by regulatory authorities, technical issues (standardization, validation, and data storage), compliance and adherence, and lack of knowledge or comprehension regarding the opportunities VCTs have to offer. Involvement of regulators in development processes, stakeholder exposure to the results of pilot studies, and clear and simple instructions and assistance for patients were considered key facilitators. Conclusions Collaboration among all stakeholders in VCT development is crucial to increase knowledge and awareness. Organizations should invest in accurate data collection technologies, and compliance of patients in VCTs needs to be ensured. Multicriteria decision analysis can help determine if a VCT is a preferred option by stakeholders. The findings of this study can be a good starting point to accelerate the development and widespread implementation of VCTs.
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Affiliation(s)
- Romée Melanie Helena Coert
- Department of Microbiology and Systems Biology, Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek, Zeist, Netherlands.,Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - James Kenneth Timmis
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - André Boorsma
- Department of Microbiology and Systems Biology, Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek, Zeist, Netherlands
| | - Wilrike J Pasman
- Department of Microbiology and Systems Biology, Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek, Zeist, Netherlands
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121
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Nickles MA, Kulkarni V, Garg SP, Patel MM, Kirchner A, Prabhu AV. Racial diversity in melanoma research from 2015 to 2020: a cross-sectional study. Int J Dermatol 2021; 61:e274-e275. [PMID: 34212372 DOI: 10.1111/ijd.15763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/25/2021] [Accepted: 06/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Melissa A Nickles
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Vishnutheertha Kulkarni
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Swati P Garg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mit M Patel
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Allison Kirchner
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Arpan V Prabhu
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, UAMS Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA
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122
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Olsen TA, Martini DJ, Goyal S, Liu Y, Evans ST, Magod B, Brown JT, Yantorni L, Russler GA, Caulfield S, Goldman JM, Harris WB, Kucuk O, Carthon BC, Master VA, Nazha B, Bilen MA. Racial Differences in Clinical Outcomes for Metastatic Renal Cell Carcinoma Patients Treated With Immune-Checkpoint Blockade. Front Oncol 2021; 11:701345. [PMID: 34222024 PMCID: PMC8242950 DOI: 10.3389/fonc.2021.701345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Immune-checkpoint-inhibitors (ICIs) have become the cornerstone of metastatic renal-cell-carcinoma (mRCC) therapy. However, data are limited regarding clinical outcomes by race. In this study, we compared the real-world outcomes between African American (AA) and Caucasian mRCC patients treated with ICIs. METHODS We performed a retrospective study of 198 patients with mRCC who received ICI at the Emory Winship Cancer Institute from 2015-2020. Clinical outcomes were measured by overall survival (OS), progression-free survival (PFS), and overall response rate (ORR) defined as a complete or partial response maintained for at least 6 months per response evaluation criteria in solid tumors version 1.1. Univariate and multivariable analyses were carried out for OS and PFS by Cox proportional-hazard model and ORR by logistical-regression model. Descriptive statistics compared rates of immune-related adverse events (irAEs) and non-clear-cell-RCC (nccRCC) histology were assessed using Chi-square test. RESULTS Our cohort was comprised of 38 AA and 160 Caucasian patients. Most were diagnosed with clear-cell-RCC (ccRCC) (78%) and more than half received (57%) PD-1/PD-L1 monotherapy. Most patients were intermediate or poor-risk groups (83%). Comparing to Caucasians, our AA cohort contained more females and nccRCC cases. Kaplan-Meier method showed AAs had no statistically different median OS (17 vs 25 months, p=0.368) and PFS (3.1 vs 4.4 months, p=0.068) relative to Caucasian patients. On multivariable analysis, AA patients had significantly shorter PFS (HR=1.52, 95% CI: 1.01-2.3, p=0.045), similar ORR (OR=1.04, 95% CI: 0.42-2.57, p=0.936) and comparable OS (HR=1.09, 95% CI: 0.61-1.95, p=0.778) relative to Caucasians. CONCLUSIONS Our real-world analysis of ICI-treated mRCC patients showed that AAs experienced shorter PFS but similar OS relative to Caucasians. This similarity in survival outcomes is reassuring for the use of ICI amongst real-world patient populations, however, the difference in treatment response is poorly represented in early outcomes data from clinical trials. Thus, the literature requires larger prospective studies to validate these findings.
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Affiliation(s)
- T. Anders Olsen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Dylan J. Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Subir Goyal
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Sean T. Evans
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Benjamin Magod
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Jacqueline T. Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Greta Anne Russler
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Sarah Caulfield
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, United States
| | - Jamie M. Goldman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Wayne B. Harris
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Bradley C. Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
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Spielman DB, Schlosser RJ, Liebowitz A, Sharma R, Overdevest J, Mattos J, Gudis DA. Do Federal Regulations Affect Gender, Racial, and Ethnic Disparities in Chronic Rhinosinusitis Research? Otolaryngol Head Neck Surg 2021; 166:1211-1218. [PMID: 34126802 DOI: 10.1177/01945998211021011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Food and Drug Administration and the National Institutes of Health (NIH) have asserted that diverse demographic representation in clinical trials is essential. In light of these federal guidelines, the objective of this study is to assess the racial, ethnic, and gender demographics of patients enrolled in clinical trials registered with the NIH that evaluate chronic rhinosinusitis with nasal polyposis (CRSwNP) relative to the demographics of the US population. STUDY DESIGN Cross-sectional study. SETTING Not applicable. METHODS ClinicalTrials.gov was queried to identify all prospective clinical trials for CRSwNP. Individual study and pooled data were compared with national US census data. RESULTS Eighteen studies were included comprising 4125 patients and evaluating dupilumab, mepolizumab, omalizumab, fluticasone/OptiNose, MediHoney, mometasone, and SINUVA. Women constituted 42.7% of clinical trial participants. Of the 4125 participants, 69.6% identified as White, 6.6% as Black, 20.8% as Asian, 0.1% as Pacific Islander, 0.4% as American Indian, 8.0% as Hispanic, and 2.4% as other. The racial, ethnic, and gender composition of the pooled study population differs significantly from national US census data, with underrepresentation of Black, Hispanic, Pacific Island, and American Indian individuals, as well as females (P < .05). CONCLUSION The racial, ethnic, and gender demographics of patients enrolled in CRSwNP clinical trials registered with the NIH differ significantly from the demographics of the US population, despite federal guidelines advising demographically representative participation. Proactive efforts to enroll participants that better represent anticipated treatment populations should be emphasized by researchers, institutions, and editorial boards.
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Affiliation(s)
- Daniel B Spielman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andi Liebowitz
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rahul Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jose Mattos
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Paczesny S, Pasquini MC, Pavletic SZ, Agarwal A, Spellman S, Kean L, Bernatchez C, Gust J, Staedtke V, Perales MA. Blueprint for the discovery of biomarkers of toxicity and efficacy for CAR T cells and T-cell engagers. Blood Adv 2021; 5:2519-2522. [PMID: 34100901 PMCID: PMC8238483 DOI: 10.1182/bloodadvances.2021004604] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/10/2021] [Indexed: 01/16/2023] Open
Affiliation(s)
- Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Steven Z Pavletic
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN
| | - Leslie Kean
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Verena Staedtke
- Johns Hopkins Comprehensive Neurofibromatosis Center, Johns Hopkins University, Baltimore, MD; and
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Sae-Hau M, Disare K, Michaels M, Gentile A, Szumita L, Treiman K, Weiss ES. Overcoming Barriers to Clinical Trial Participation: Outcomes of a National Clinical Trial Matching and Navigation Service for Patients With a Blood Cancer. JCO Oncol Pract 2021; 17:e1866-e1878. [PMID: 34077244 DOI: 10.1200/op.20.01068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE There are numerous barriers to cancer clinical trial participation in the United States. This paper describes the approach and outcomes of The Leukemia & Lymphoma Society's Clinical Trial Support Center (CTSC), whose nurse navigators assist patients with a blood cancer and their oncologists by identifying all appropriate trials based on clinical data and patient preference, facilitating informed and shared decision making, and minimizing enrollment barriers. METHODS Data on patients served from October 2017 to October 2019 were analyzed using bivariate and multivariate analyses to determine demographic and clinical characteristics associated with enrollment. Reasons for nonenrollment were examined. RESULTS The CTSC opened 906 patient cases during this time frame. Among all US patients with a closed case (n = 750), the clinical trial enrollment rate was 16.1%. Among those with a known enrollment outcome after a trial search (n = 537), the enrollment rate was 22.5%. Multivariate analysis controlling for variables significant in bivariate analyses (insurance, treatment status, Eastern Cooperative Oncology Group performance status, and urban or rural residence) revealed that patients with Medicaid were less likely to enroll than those with private or commercial insurance (adjusted odds ratio, 0.054; CI, 0.003 to 0.899), and patients in treatment or maintenance were less likely to enroll than those relapsed or refractory to most recent therapy (adjusted odds ratio, 0.312; CI, 0.139 to 0.702). Primary reasons for nonenrollment were preference for standard of care (66.3%) and patient passed away (16.1%). CONCLUSION The CTSC is an effective, replicable model for addressing multilevel barriers to clinical trial participation. The findings highlight the need to increase opportunities for trial participation sooner after diagnosis and among patients with Medicaid.
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Affiliation(s)
| | - Kate Disare
- The Leukemia & Lymphoma Society, Rye Brook, NY
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Undercutting efforts of precision medicine: roadblocks to minority representation in breast cancer clinical trials. Breast Cancer Res Treat 2021; 187:605-611. [PMID: 34080093 DOI: 10.1007/s10549-021-06264-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022]
Abstract
Precision (or personalized) medicine holds great promise in the treatment of breast cancer. The success of personalized medicine is contingent upon inclusivity and representation for minority groups in clinical trials. In this article, we focus on the roadblocks for the African American demographic, including the barriers to access and enrollment in breast oncology trials, the prevailing classification of race and ethnicity, and the need to refine monolithic categorization by employing genetic ancestry mapping tools for a more accurate determination of race or ethnicity.
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Marron JM, Charlot M, Gaddy J, Rosenberg AR. The Ethical Imperative of Equity in Oncology: Lessons Learned From 2020 and a Path Forward. Am Soc Clin Oncol Educ Book 2021; 41:e13-e19. [PMID: 34061560 DOI: 10.1200/edbk_100029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic and the simultaneous increased focus on structural racism and racial/ethnic disparities across the United States have shed light on glaring inequities in U.S. health care, both in oncology and more generally. In this article, we describe how, through the lens of fundamental ethical principles, an ethical imperative exists for the oncology community to overcome these inequities in cancer care, research, and the oncology workforce. We first explain why this is an ethical imperative, centering the discussion on lessons learned during 2020. We continue by describing ongoing equity-focused efforts by ASCO and other related professional medical organizations. We end with a call to action-all members of the oncology community have an ethical responsibility to take steps to address inequities in their clinical and academic work-and with guidance to practicing oncologists looking to optimize equity in their research and clinical practice.
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Affiliation(s)
- Jonathan M Marron
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Center for Bioethics, Harvard Medical School, Boston, MA
| | - Marjory Charlot
- Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jacquelyne Gaddy
- Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
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Allison K, Patel DG, Greene L. Racial and Ethnic Disparities in Primary Open-Angle Glaucoma Clinical Trials: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e218348. [PMID: 34003274 PMCID: PMC8132140 DOI: 10.1001/jamanetworkopen.2021.8348] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE The disease burden for primary open-angle glaucoma (POAG) is highest among racial/ethnic minority groups, particularly Black individuals. The prevalence of POAG worldwide is projected to increase from 52.7 million in 2020 to 79.8 million in 2040, a 51.4% increase attributed mainly to Asian and African individuals. Given this increase, key stakeholders need to pay particular attention to creating a diverse study population in POAG clinical trials. OBJECTIVE To assess the prevalence of racial/ethnic minorities in POAG clinical research trials compared with White individuals. DATA SOURCES This meta-analysis consisted of publicly available POAG clinical trials using ClinicalTrials.gov, PubMed, and Drugs@FDA from 1994 to 2019. STUDY SELECTION Randomized clinical trials that reported on interventions for POAG and included demographic subgroups including sex and race/ethnicity. DATA EXTRACTION AND SYNTHESIS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2 independent reviewers extracted study-level data for a random-effects meta-analysis. A third person served as the tiebreaker on study selection. Microsoft Excel 2016 (Microsoft Corporation) and SAS, version 9.4 (SAS Institute) were used for data collection and analyses. MAIN OUTCOMES AND MEASURES The primary outcomes were the prevalence of each demographic subgroup (White, Black, Hispanic/Latino, other race/ethnicity groups, and female or male) in each trial according to the trial start year, study region, and study sponsor. Participation rates are expressed as percentages. RESULTS A total of 105 clinical trials were included in the meta-analysis, including 33 428 POAG clinical trial participants (18 404 women [55.1%]). Overall, 70.7% were White patients, 16.8% were Black patients, 3.4% were Hispanic/Latino patients, and 9.1% were individuals of other races/ethnicities, including Asian, Native Hawaiian or Pacific Islander, American Indian or Alaska Native, and unreported as defined by the US Census. The mean (SD) numbers of participants by race/ethnicity were 236.5 (208.2) for White, 58.4 (70.0) for Black, 29.9 (71.1) for Hispanic/Latino, and 31.1 (94.3) for other race/ethnicity. According to the test for heterogeneity using the Cochrane Risk of Bias tool, the I2 statistic was 98%, indicating high heterogeneity of outcomes in the included trials. A multiple linear regression analysis was performed to assess any trend and significance between participation by Black individuals and the year the study started, the region in which the study took place, and the study sponsor. There was no significant increase of Black participant enrollment from 1994 to 2019 (r2 = 0.11; P = .17) and no significant association between Black participant enrollment and clinical trial region (r2 = 0.16; P = .50), but there was a significant association between Black participant enrollment and study sponsor (r2 = 0.94; P = .03). CONCLUSIONS AND RELEVANCE This meta-analysis found that compared with White individuals, individuals from racial/ethnic minority groups had a very low participation rate in POAG clinical trials despite having a higher prevalence among the disease population. Despite measures to increase clinical trial diversity, there has not been a significant increase in clinical trial participation among Black individuals, the group most affected by this disease; this disparity in POAG clinical trial representation can raise questions about the true safety and efficacy of approved medical interventions for this disease and should prompt further research on how to increase POAG clinical trial diversity.
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Affiliation(s)
| | | | - Leah Greene
- School of Health Sciences and Practice & Institute of Public Health, New York Medical College, Valhalla
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Stein JN, Charlot M, Cykert S. Building Toward Antiracist Cancer Research and Practice: The Case of Precision Medicine. JCO Oncol Pract 2021; 17:273-277. [PMID: 33974820 PMCID: PMC8257901 DOI: 10.1200/op.20.01070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jacob N. Stein
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Marjory Charlot
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Samuel Cykert
- Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC
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Peravali M, Ahn J, Chen K, Rao S, Veytsman I, Liu SV, Kim C. Safety and Efficacy of First-Line Pembrolizumab in Black Patients with Metastatic Non-Small Cell Lung Cancer. Oncologist 2021; 26:694-700. [PMID: 33844354 DOI: 10.1002/onco.13787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/19/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Pembrolizumab, an immune checkpoint inhibitor (ICI), has become an integral part of front-line treatment of metastatic non-small cell lung cancer (NSCLC). However, pivotal trials had significant underrepresentation of Black patients (pts). Lack of sufficient evidence regarding safety and efficacy of ICIs among minority racial groups poses a challenge in delivery of optimal cancer directed care. METHODS We retrospectively reviewed pts with stage IV NSCLC treated with first-line pembrolizumab across three MedStar facilities between January 1, 2014, and May 3, 2019. Progression-free survival (PFS) and overall survival (OS) were primary endpoints and were calculated using the Kaplan-Meier method. Immune-related adverse events (irAEs) were assessed according to Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE v5.0). RESULTS In total, 136 pts were identified, with 74 (54.4%) White, 53 (39%) Black, 2 (1.5%) Asian, and 7 (5.1%) other racial groups. Median age was 70 years in White pts and 65 years in Black pts (p < .01). There was no difference in median PFS (5.7 vs. 5.9 months; p = .651) or OS (11.8 vs. 12.4 months; p = .949) between White and Black pts. In the subset of patients whose tumors had high programmed death-ligand 1 (PD-L1) expression (≥50%), there was still no difference in efficacy by race. Median PFS (8.7 vs. 3.9 months; p = .843) and OS (14.7 vs. 11.3 months; p = .581) in White versus Black pts were not different. Incidence of irAEs in White versus Black pts was 24.3% and 22.6%, respectively (p = .83). CONCLUSION We found no major differences in either safety or efficacy of first-line pembrolizumab between White and Black pts. Use of first-line pembrolizumab-based treatment in Black pts with stage IV NSCLC is safe and efficacious, based on these real-world data. IMPLICATIONS FOR PRACTICE Immunotherapy has revolutionized treatment of solid and hematological malignancies. There are certain populations of patients underrepresented in the original trials including minority racial groups, patients with autoimmune diseases, and those with chronic viral illnesses. Our study focuses on Black patients with metastatic lung cancer who received pembrolizumab and concludes similar safety and response to treatment when compared with White patients. Black patients are an important demographic group in clinical practice often facing systemic health care disparities. This study paves a path for future studies in underrepresented populations receiving immunotherapy across various malignancies.
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Affiliation(s)
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
| | - Kevin Chen
- MedStar Franklin Square Medical Center, Baltimore, Maryland, USA
| | - Suman Rao
- MedStar Franklin Square Medical Center, Baltimore, Maryland, USA
| | | | - Stephen V Liu
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - Chul Kim
- MedStar Georgetown University Hospital, Washington, DC, USA
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Thrul J, Garcia-Romeu A. Whitewashing psychedelics: racial equity in the emerging field of psychedelic-assisted mental health research and treatment. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1897331] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Habr D, Ferdinand R. Addressing racial/ethnic disparities in cancer clinical trials: Everyone has a role to play. Cancer 2021; 127:3282-3289. [PMID: 33904590 DOI: 10.1002/cncr.33600] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
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Huey RW, George GC, Phillips P, White R, Fu S, Janku F, Karp DD, Naing A, Piha-Paul S, Subbiah V, Tsimberidou AM, Pant S, Yap TA, Rodon J, Meric-Bernstam F, Shih YCT, Hong DS. Patient-Reported Out-of-Pocket Costs and Financial Toxicity During Early-Phase Oncology Clinical Trials. Oncologist 2021; 26:588-596. [PMID: 33783054 DOI: 10.1002/onco.13767] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clinical trials are an important therapeutic option for patients with cancer. Although financial burden in cancer treatment is well documented, the financial burden associated with clinical trials is not well understood. PATIENTS AND METHODS We conducted a survey regarding economic burden and financial toxicity in patients with cancer enrolled in phase I clinical trials for >1 month. Financial toxicity score was assessed using the Comprehensive Score for Financial Toxicity survey. Patients also reported monthly out-of-pocket (OOP) costs. RESULTS Two hundred and thirteen patients completed the survey (72% non-Hispanic White; 45% with annual income ≤$60,000; 50% lived >300 miles from the clinic; 37% required air travel). Forty-eight percent of patients had monthly OOP costs of at least $1,000. Fifty-five percent and 64% of patients reported unanticipated medical and nonmedical expenses, respectively. Worse financial toxicity was associated with yearly household income <$60,000 (odds ratio [OR]: 2.7; p = .008), having unanticipated medical costs (OR: 3.2; p = .024), and living >100 miles away from the clinical trial hospital (OR: 2.3; p = .043). Non-White or Hispanic patients (OR: 2.5; p = .011) and patients who were unemployed or not working outside the home (OR: 2.5; p = .016) were more likely to report high unanticipated medical costs. CONCLUSION Among patients with cancer participating in clinical trials, economic burden is high, and most of patients' OOP costs were nonmedical costs. Financial toxicity is disproportionally higher in patients with lower income and those who travel farther, and unexpected medical costs were more common among non-White or Hispanic patients. OOP costs can be substantial and are often unexpected for patients. IMPLICATIONS FOR PRACTICE The financial burden of cancer treatment is well documented, but there are limited data regarding the financial burden associated with cancer clinical trials. This study surveyed 213 patients enrolled in early-phase clinical trials. Monthly out-of-pocket costs were at least $1000 for nearly half of patients. Worse financial toxicity was associated with income <$60,000 and living farther away from the hospital. Racial/ethnic minorities had higher rates of unanticipated medical costs. These data help to quantify the high financial burden for patients and may reveal a cause of disparities in clinical trial enrollment for underrepresented populations.
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Affiliation(s)
- Ryan W Huey
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Goldy C George
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Penny Phillips
- Clinical Center for Targeted Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Revenda White
- Clinical Center for Targeted Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shubham Pant
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Timothy A Yap
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jordi Rodon
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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D’Aiello A, Lin J, Gucalp R, Tabatabaie V, Cheng H, Bloomgarden NA, Tomer Y, Halmos B. Thyroid Dysfunction in Lung Cancer Patients Treated with Immune Checkpoint Inhibitors (ICIs): Outcomes in a Multiethnic Urban Cohort. Cancers (Basel) 2021; 13:cancers13061464. [PMID: 33806774 PMCID: PMC8004603 DOI: 10.3390/cancers13061464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/22/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Which factors predispose individuals to developing immune-related adverse events (irAEs) remains unclear. In addition, the relationship between irAEs and survival outcomes warrants further investigation. We sought to investigate the association between immunotherapy-related thyroid dysfunction and demographic and clinical characteristics in a diverse urban cohort of patients with lung cancer receiving immune checkpoint inhibitors (ICIs). This study was conducted with the aim of helping to identify patients at a higher risk of experiencing irAEs and clarify whether irAEs portend a survival advantage. Abstract We sought to characterize thyroid dysfunction and its association with baseline clinical and demographic characteristics, as well as progression-free survival (PFS), in a multiethnic cohort of lung cancer patients treated with ICIs. A retrospective chart review of lung cancer patients receiving an anti-PD1 or PD-L1 agent was performed. Multivariate Cox proportional hazards were fitted to compare time to thyroid dysfunction among race subgroups controlling for age, gender, treatment type, and duration. Thyroid dysfunction was based on laboratory testing; clinical symptoms were not required. PFS at a 24-week landmark analysis point among patients with and without thyroid dysfunction was compared using a log-rank test. We identified 205 subjects that received ICIs, including 76 (37.1%) who developed thyroid dysfunction. Rates of thyroid dysfunction by one year occurred at similar frequencies among all races (p = 0.92). Gender and concurrent chemotherapy showed no significant association with thyroid dysfunction (p = 0.81 and p = 0.67, respectively). Thyrotoxicosis occurred at higher rates in Black (25, 31.6%) subjects than in White (7, 16.7%) and Hispanic (8, 12.7%) subjects when employing the log-rank test (p = 0.016) and multivariate Cox regression (HR 0.48, p = 0.09 for White and HR 0.36, p = 0.01 for Hispanic compared to Black subjects). PFS was similar among subjects with and without thyroid dysfunction when applying the log-rank test (p = 0.353). Gender, concurrent treatment with chemotherapy, and PFS were not associated with thyroid dysfunction in patients receiving ICIs; however, Black race was a risk factor for thyrotoxicosis. The mechanisms underlying the role of race in the development of irAEs warrant further study.
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Affiliation(s)
- Angelica D’Aiello
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA;
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Rasim Gucalp
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.G.); (H.C.)
| | - Vafa Tabatabaie
- Division of Endocrinology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA; (V.T.); (N.A.B.); (Y.T.)
| | - Haiying Cheng
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.G.); (H.C.)
| | - Noah A. Bloomgarden
- Division of Endocrinology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA; (V.T.); (N.A.B.); (Y.T.)
| | - Yaron Tomer
- Division of Endocrinology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA; (V.T.); (N.A.B.); (Y.T.)
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA; (R.G.); (H.C.)
- Correspondence: ; Tel.: +1-718-405-8404
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Gallicchio L, Tonorezos E, de Moor JS, Elena J, Farrell M, Green P, Mitchell SA, Mollica MA, Perna F, Gottlieb Saiontz N, Zhu L, Rowland J, Mayer DK. Evidence Gaps in Cancer Survivorship Care: A Report from the 2019 National Cancer Institute Cancer Survivorship Workshop. J Natl Cancer Inst 2021; 113:1136-1142. [PMID: 33755126 DOI: 10.1093/jnci/djab049] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022] Open
Abstract
Today, there are more than 16.9 million cancer survivors in the United States; this number is projected to grow to 22.2 million by 2030. While much progress has been made in understanding cancer survivors needs and in improving survivorship care since the seminal 2006 Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition, there is a need to identify evidence gaps and research priorities pertaining to cancer survivorship. Thus, in April 2019, the National Cancer Institute convened grant-funded extramural cancer survivorship researchers, representatives of professional organizations, cancer survivors, and advocates for a one-day in-person meeting. At this meeting, and in a subsequent webinar aimed at soliciting input from the wider survivorship community, evidence gaps and ideas for next steps in the following six areas, identified from the 2006 Institute of Medicine report, were discussed: surveillance for recurrence and new cancers, management of long-term and late physical effects, management of long-term and late psychosocial effects, health promotion, care coordination, and financial hardship. Identified evidence gaps and next steps across the areas included the need to understand and address disparities among cancer survivors, to conduct longitudinal studies as well as longer-term (>5 years post-diagnosis) follow-up studies, to leverage existing data, and to incorporate implementation science strategies to translate findings into practice. Designing studies to address these broad evidence gaps, as well as those identified in each area, will expand our understanding of cancer survivors' diverse needs, ultimately leading to the development and delivery of more comprehensive evidence-based quality care.
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Affiliation(s)
- Lisa Gallicchio
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Emily Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Janet S de Moor
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Joanne Elena
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Margaret Farrell
- Division of Communications and Marketing, Office of the Director, National Institutes of Health
| | - Paige Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Sandra A Mitchell
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Michelle A Mollica
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Frank Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Nicole Gottlieb Saiontz
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Li Zhu
- Statistical Research and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Julia Rowland
- Smith Center for Healing and the Arts, Washington DC
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill; University of North Carolina Lineberger Comprehensive Cancer Center
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Gamble A, Beech BM, Blackshear C, Cranston KL, Herring SJ, Moore JB, Welsch MA. Recruitment planning for clinical trials with a vulnerable perinatal adolescent population using the Clinical Trials Transformative Initiative framework and principles of partner and community engagement. Contemp Clin Trials 2021; 104:106363. [PMID: 33737198 PMCID: PMC8180492 DOI: 10.1016/j.cct.2021.106363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 12/11/2022]
Abstract
Recruitment planning is needed to establish a foundation for obesity prevention research with high risk, disadvantaged perinatal adolescent populations. In the context of developing clinical trial protocols, investigators partnered with Mississippi's Nutrition Program for Women, Infants and Children (WIC) and adopted the Clinical Trials Transformative Initiative (CTTI) framework for recruitment planning to identify and mitigate challenges to recruitment early in the clinical trial development process. The recruitment protocol consisted of 20 passive strategies grounded in principles of partner and community engagement and was flexible, accommodating, altruistic, community-focused, and minimally burdensome to partners and participants. The recruitment goal included 150 adolescent-coparticipant dyads and 145 dyads (96.7%) were successfully recruited. Investigators demonstrated the feasibility of recruiting a disadvantaged and vulnerable perinatal adolescent population that is underrepresented in health research, in one of the most persistently impoverished and poor health regions in the U.S. Four important aspects of recruitment planning using the CTTI framework are discussed including: (1) establishing partnerships with trusted community resources is a paramount investment; (2) dedicating time and resources to know and go to your community is invaluable; (3) fostering trust by offering convenient, continuous and clear communication; and (4) encouraging collaboration and participation through limiting partner and participant burden. Establishing organizational and community partnership requires a substantial amount of invaluable time and fosters recruitment success. Following the CTTI recommendations for recruitment planning led to a robust recruitment protocol that will be used in future intervention trials with an understudied perinatal adolescent population with high risk for poor maternal and fetal health outcomes.
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Affiliation(s)
- Abigail Gamble
- Department of Preventive Medicine, Department of Pediatrics, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
| | - Bettina M Beech
- Strategic Initiatives and Population Health Research, Office of the Provost, College of Medicine, University of Houston, 4302 University Drive, Houston, TX 77204, United States of America.
| | - Chad Blackshear
- Department of Data Science, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
| | - Katherine L Cranston
- Medical Student Research Program, School of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, United States of America.
| | - Sharon J Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Philadelphia, PA 19140, United States of America.
| | - Justin B Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, 425 Vine Street, Winston-Salem, NC, 27101, United States of America.
| | - Michael A Welsch
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
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Kong WY, Saber H, Marawar R, Basha MM. Racial and ethnic trends in antiseizure medications trial enrolment: A systematic review using ClinicalTrials.gov. Epilepsy Res 2021; 173:106613. [PMID: 33743520 DOI: 10.1016/j.eplepsyres.2021.106613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the racial and gender distribution in antiseizure medications (ASM) clinical trials using a systemic review of clinical trial registry database. METHODS We searched ClinicalTrials.gov database for ASM trials registered from September 1988 to January 2019. All randomized and non-randomized trials investigating ASM for epilepsy were included. Trials with intervention other than ASM or condition other than epilepsy were excluded. Data on age, race, ethnicity, and gender were extracted directly from database and from published data where available. Study location, trial identifier, year of completion, and funding sources were also collected. Meta-analysis of proportions was conducted using R software. RESULT Two hundred and thirty studies conducted globally with 39,576 participants were included. Overall, there are 53 % male on all registered ASM studies globally. For trials conducted in the United States (61 studies/5126 participants), 52 % of the participants were male with the following weighted racial distribution (80 % White 13 % Black 3% Asian 7% Hispanic). Subgroup analysis revealed that non-pharma-sponsored studies (50 studies, 4296 participants) have a higher representation of minorities as compared to pharma-sponsored studies (180 studies, 35,280 participants), including Hispanic (9% vs 3% respectively) and Black (18 % vs 11 % respectively). Temporal trends in racial distribution were noted when the duration of 2007-2019 was split into two groups: 2007-2013 (0% Asian, 5% Hispanic, 20 % Black); 2014-2019 (4% Asian, 7% Hispanic, 8% Black). CONCLUSION In this systematic review, participation of racial and ethnic minorities of Asian and Hispanic background was under-represented. Disparities of all minorities including Black participants was more notable over time and in studies sponsored by industry. Generalizability of ASM clinical trials to certain subgroups should be further examined.
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Affiliation(s)
- Wan Yee Kong
- Department of Neurology, Wayne State University, Detroit Medical Centre, Michigan University Health Center, 4201 St Antoine A, Detroit, MI, 48201, United States.
| | - Hamidreza Saber
- Department of Neurology, University of California, Los Angeles 710 Westwood Plaza, Los Angeles, CA, 90095-1769, United States.
| | - Rohit Marawar
- Department of Neurology, Wayne State University, Detroit Medical Centre, Michigan University Health Center, 4201 St Antoine A, Detroit, MI, 48201, United States.
| | - Maysaa Merhi Basha
- Department of Neurology, Wayne State University, Detroit Medical Centre, Michigan University Health Center, 4201 St Antoine A, Detroit, MI, 48201, United States.
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Kusnoor SV, Villalta-Gil V, Michaels M, Joosten Y, Israel TL, Epelbaum MI, Lee P, Frakes ET, Cunningham-Erves J, Mayers SA, Stallings SC, Giuse NB, Harris PA, Wilkins CH. Design and implementation of a massive open online course on enhancing the recruitment of minorities in clinical trials - Faster Together. BMC Med Res Methodol 2021; 21:44. [PMID: 33673809 PMCID: PMC7936494 DOI: 10.1186/s12874-021-01240-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/24/2021] [Indexed: 12/01/2022] Open
Abstract
Background Racial and ethnic minorities are often underrepresented in clinical trials, threatening the generalizability of trial results. Several factors may contribute to underrepresentation of minorities in clinical trials, including lack of training for researchers and staff on the importance of diversity in clinical trials and effective strategies for recruiting and retaining minority populations. Methods Applying community engaged research principles, we developed a massive open online course (MOOC) to help research team members develop knowledge and skills to enhance the recruitment of minorities in clinical trials. A transdisciplinary working group, consisting of clinical researchers, community engagement specialists, minority clinical trial recruitment and retention educators and specialists, and knowledge management information scientists, was formed to develop an evidence-based curriculum. Feedback from the Recruitment Innovation Center Community Advisory Board was incorporated to help finalize the curriculum. The course was implemented in Coursera, an online learning platform offering MOOCs. A bootstrap paired sample t-test was used to compare pre- and post-assessments of knowledge, attitudes, and intentions as it relates to minority recruitment. Results The final course, entitled Faster Together, was divided into eight 1-h modules. Each module included video presentations, reading assignments, and quizzes. After 10 months, 382 individuals enrolled in the course, 105 participants completed the pre-test, and 14 participants completed the post-test. Participants’ knowledge scores were higher with an increase in the mean number of correct answers from 15.4 (95% CI:12.1–18.7) on the pre-test to 18.7 (95% CI:17.42–20.2) on the post-test. All post-test respondents (n = 14) indicated that the course improved their professional knowledge, and 71.4% of respondents indicated that they were very likely to make changes to their recruitment practices. Conclusions Faster Together, a massive open online course, is an acceptable, accessible approach to educating research teams on minority recruitment in clinical trials. Preliminary evidence indicates the course increased knowledge on how to recruit minorities into clinical trials and could promote change in their recruitment practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01240-x.
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Affiliation(s)
- Sheila V Kusnoor
- Center for Knowledge Management, Strategy and Innovation, Vanderbilt University Medical Center, 3401 West End, Suite 304, Nashville, TN, 37203, USA.
| | - Victoria Villalta-Gil
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Margo Michaels
- Health Action and Access Consulting, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Yvonne Joosten
- Department of Medical Education and Administration, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tiffany L Israel
- Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marcia I Epelbaum
- Center for Knowledge Management, Strategy and Innovation, Vanderbilt University Medical Center, 3401 West End, Suite 304, Nashville, TN, 37203, USA
| | - Patricia Lee
- Center for Knowledge Management, Strategy and Innovation, Vanderbilt University Medical Center, 3401 West End, Suite 304, Nashville, TN, 37203, USA
| | - Elizabeth T Frakes
- Center for Knowledge Management, Strategy and Innovation, Vanderbilt University Medical Center, 3401 West End, Suite 304, Nashville, TN, 37203, USA
| | | | - Stephanie A Mayers
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah C Stallings
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nunzia B Giuse
- Center for Knowledge Management, Strategy and Innovation, Vanderbilt University Medical Center, 3401 West End, Suite 304, Nashville, TN, 37203, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul A Harris
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Consuelo H Wilkins
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA.,Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vice President for the Office of Health Equity, Vanderbilt University Medical Center, Nashville, TN, USA
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140
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Parikh AB, Zhong X, Mellgard G, Qin Q, Patel VG, Wang B, Alerasool P, Garcia P, Leiter A, Gallagher EJ, Clinton S, Mortazavi A, Monk P, Folefac E, Yin M, Yang Y, Galsky M, Oh WK, Tsao CK. Risk Factors for Emergency Room and Hospital Care Among Patients With Solid Tumors on Immune Checkpoint Inhibitor Therapy. Am J Clin Oncol 2021; 44:114-120. [PMID: 33417323 PMCID: PMC7902456 DOI: 10.1097/coc.0000000000000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Immune checkpoint inhibitors (ICIs) are being increasingly used across cancer types. Emergency room (ER) and inpatient (IP) care, common in patients with cancer, remain poorly defined in this specific population, and risk factors for such care are unknown. METHODS We retrospectively reviewed charts for patients with solid tumors who received >1 ICI dose at 1 of 2 sites from January 1, 2011 to April 28, 2017. Demographics, medical history, cancer diagnosis/therapy/toxicity details, and outcomes were recorded. Descriptive data detailing ER/IP care at the 2 associated hospitals during ICI therapy (from first dose to 3 mo after last dose) were collected. The Fisher exact test and multivariate regression analysis was used to study differences between patients with versus without ER/IP care during ICI treatment. RESULTS Among 345 patients studied, 50% had at least 1 ER visit during ICI treatment and 43% had at least 1 IP admission. Six percent of ER/IP visits eventually required intensive care. A total of 12% of ER/IP visits were associated with suspected or confirmed immune-related adverse events. Predictors of ER care were African-American race (odds ratio [OR]: 3.83, P=0.001), Hispanic ethnicity (OR: 3.12, P=0.007), and coronary artery disease (OR: 2.43, P=0.006). Predictors of IP care were African-American race (OR: 2.38, P=0.024), Hispanic ethnicity (OR: 2.29, P=0.045), chronic kidney disease (OR: 3.89, P=0.006), angiotensin converting enzyme inhibitor/angiotensin receptor blocker medication use (OR: 0.44, P=0.009), and liver metastasis (OR: 2.32, P=0.003). CONCLUSIONS Understanding demographic and clinical risk factors for ER/IP care among patients on ICIs can help highlight disparities, prospectively identify high-risk patients, and inform preventive programs aimed at reducing such care.
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Affiliation(s)
- Anish B Parikh
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital, Columbus OH USA
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
| | - Xiaobo Zhong
- Division of Biostatistics, Icahn School of Medicine at Mount Sinai, New York NY USA
| | | | - Qian Qin
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
| | - Vaibhav G Patel
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
| | - Bo Wang
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
| | - Parissa Alerasool
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
- New York Medical College, Valhalla NY USA
| | - Philip Garcia
- Icahn School of Medicine at Mount Sinai, New York NY USA
| | - Amanda Leiter
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York NY USA
| | - Emily J Gallagher
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York NY USA
| | - Steven Clinton
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital, Columbus OH USA
| | - Amir Mortazavi
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital, Columbus OH USA
| | - Paul Monk
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital, Columbus OH USA
| | - Edmund Folefac
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital, Columbus OH USA
| | - Ming Yin
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital, Columbus OH USA
| | - Yuanquan Yang
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital, Columbus OH USA
| | - Matthew Galsky
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
| | - William K Oh
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
| | - Che-Kai Tsao
- Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York NY USA
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Osarogiagbon RU, Sineshaw HM, Unger JM, Acuña-Villaorduña A, Goel S. Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes. Am Soc Clin Oncol Educ Book 2021; 41:1-13. [PMID: 33830825 DOI: 10.1200/edbk_323523] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Avoidable differences in the care and outcomes of patients with cancer (i.e., cancer care disparities) emerge or worsen with discoveries of new, more effective approaches to cancer diagnosis and treatment. The rapidly expanding use of immunotherapy for many different cancers across the spectrum from late to early stages has, predictably, been followed by emerging evidence of disparities in access to these highly effective but expensive treatments. The danger that these new treatments will further widen preexisting cancer care and outcome disparities requires urgent corrective intervention. Using a multilevel etiologic framework that categorizes the targets of intervention at the individual, provider, health care system, and social policy levels, we discuss options for a comprehensive approach to prevent and, where necessary, eliminate disparities in access to the clinical trials that are defining the optimal use of immunotherapy for cancer, as well as its safe use in routine care among appropriately diverse populations. We make the case that, contrary to the traditional focus on the individual level in descriptive reports of health care disparities, there is sequentially greater leverage at the provider, health care system, and social policy levels to overcome the challenge of cancer care and outcomes disparities, including access to immunotherapy. We also cite examples of effective government-sponsored and policy-level interventions, such as the National Cancer Institute Minority-Underserved Community Oncology Research Program and the Affordable Care Act, that have expanded clinical trial access and access to high-quality cancer care in general.
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Affiliation(s)
| | | | - Joseph M Unger
- Health Services Research, Public Health Sciences Division, Fred Hutchinson Cancer Research Center Affiliate, University of Washington, Seattle, WA
| | | | - Sanjay Goel
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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142
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Saini G, Swahn MH, Aneja R. Disentangling the Coronavirus Disease 2019 Health Disparities in African Americans: Biological, Environmental, and Social Factors. Open Forum Infect Dis 2021; 8:ofab064. [PMID: 33732752 PMCID: PMC7928626 DOI: 10.1093/ofid/ofab064] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
The stark racial disparities related to the coronavirus disease 2019 (COVID-19) pandemic in the United States, wherein minority populations are disproportionately getting infected and succumbing to the disease, is of grave concern. It is critical to understand and address the underlying causes of these disparities that are complex and driven by interacting environmental, social and biological factors. In this article we focus on the African American community and examine how social and environmental determinants of health intersect with biological factors (comorbidities, underlying genetics, host immunity, vitamin D levels, epigenetics) to exacerbate risk for morbidity and mortality.
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Affiliation(s)
- Geetanjali Saini
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta, Georgia, USA
| | - Monica H Swahn
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Ritu Aneja
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta, Georgia, USA
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143
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Peravali M, Gomes-Lima C, Tefera E, Baker M, Sherchan M, Farid S, Burman K, Constantinescu F, Veytsman I. Racial disparities in immune-related adverse events of immune checkpoint inhibitors and association with survival based on clinical and biochemical responses. World J Clin Oncol 2021; 12:103-114. [PMID: 33680877 PMCID: PMC7918525 DOI: 10.5306/wjco.v12.i2.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICPi) cause various immune-related adverse events (irAE) with thyroid dysfunction as a commonly reported abnormality. There is increasing evidence showing positive association with development of irAE and survival. However, prior trials with ICPi had underrepresentation of minorities with < 5% African Americans.
AIM To evaluate the association between development of irAE and survival outcomes among a racially diverse patient population.
METHODS Data on patients with stage IV solid malignancies treated with programmed cell death-protein 1/programmed death ligand 1 blockers between January 2013 and December 2018 across MedStar Georgetown Cancer Institute facilities were retrospectively reviewed. Patients treated with cytotoxic T-lymphocyte-associated protein 4 inhibitors were excluded. Progression free survival (PFS) and overall survival (OS) were primary endpoints and were calculated using Kaplan-Meier methods and Wilcoxon rank sum test for comparison.
RESULTS Out of 293 patients who met eligibility criteria, 91 pts (31%) had any grade irAE; most common AE were endocrine (40.7%) specifically TSH elevation, dermatological (23.1%) and rheumatologic (18.7%). Proportion of irAE was significantly higher in Caucasians vs African Americans (60.4% vs 30.8%), in patients with low programmed death ligand 1, lower LDH, older age, and those who had more treatment cycles with ICPi. Rate of progression was lower in patients with irAE (30.8% vs 46.0%, P = 0.0140). Median PFS (5.8 vs 3.0 mo, P = 0.0204) and OS (17.1 vs 7.2 mo, P < 0.0001) were higher with irAE. Statistically significant difference in OS (17.1 vs 8.6 mo, P = 0.0002) but not in PFS (5.8 vs 3.3 mo, P = 0.0545) was noted with endocrine irAE. No differences in survival were observed among other commonly reported irAE. Differences in survival among subgroups of patients with irAE are described.
CONCLUSION Development of irAE positively correlated with improved PFS and OS as reported in previous studies. To our knowledge, this is the first study observing differences in OS favoring endocrine AE and Caucasian race. These factors may be potential surrogate markers of prognosis pending replication of these results in large-scale studies.
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Affiliation(s)
- Monica Peravali
- Department of Hematology/Oncology, MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Cristiane Gomes-Lima
- Department of Endocrinology, MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Eshetu Tefera
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Washington, DC 20010, United States
| | - Mairead Baker
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Mamta Sherchan
- Department of Rheumatology, MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Saira Farid
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Kenneth Burman
- Department of Endocrinology, MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Florina Constantinescu
- Department of Rheumatology, MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Irina Veytsman
- Department of Hematology/Oncology, MedStar Washington Hospital Center, Washington, DC 20010, United States
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144
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Spielman DB, Liebowitz A, Kelebeyev S, Smith TL, McKinney K, Woodard T, Safi C, Overdevest JB, Gudis DA. Race in Rhinology Clinical Trials: A Decade of Disparity. Laryngoscope 2021; 131:1722-1728. [PMID: 33493376 DOI: 10.1002/lary.29371] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE/HYPOTHESIS The aim of this study is to assess the ethnic and racial demographics of patients enrolled in prospective chronic rhinosinusitis (CRS) studies relative to the corresponding geographic demographics of the United States (U.S.) census data. STUDY DESIGN Systematic Review and Population analysis. METHODS A systematic review was performed to identify CRS clinical trials, conducted in the U.S. and published between 2010 and 2020 in which patients were prospectively enrolled. Pooled racial and ethnicity data were compared to national and corresponding regional census data. RESULTS Eighty-three studies were included, comprising 12,027 patients. 50.4% were male and the average age was 49.2 years. 8,810 patients underwent a surgical procedure. Of the 12,027 patients, 81.67% were identified as White, 5.35% as Black, 1.27% as Asian, 0.02% as Pacific Islander, 0.12% as American Indian, and 11.57% were classified as Other. The racial and ethnic composition of the pooled study population differs significantly from the national U.S. census data with the underrepresentation of each minority population (P ≤ .0002). Regional sub-analyses yield variable results. In the Northeast and West, there was an underrepresentation of all minority populations. In the South and Midwest, Black enrollment was similar to the U.S. census data, while all other minorities were underrepresented. CONCLUSIONS The racial and ethnic composition of patients enrolled in prospective CRS clinical trials differs significantly from the demographics of the U.S. POPULATION The generalizability and external validity of findings derived from studies comprised of demographically mismatched populations has not been established. Future efforts to enroll more representative populations should be emphasized by the research community, funding bodies, and editorial boards. LEVEL OF EVIDENCE NA Laryngoscope, 131:1722-1728, 2021.
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Affiliation(s)
- Daniel B Spielman
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Andi Liebowitz
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Saveliy Kelebeyev
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Kibwei McKinney
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, U.S.A
| | - Troy Woodard
- Department of Otolaryngology Head and Neck Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Chetan Safi
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Jonathan B Overdevest
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - David A Gudis
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
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Lavery JA, Callahan MK, Panageas KS. Apples and Oranges? Considerations for EHR-Based Analyses Aggregating Data From Interventional Clinical Trials and Point-of-Care Encounters in Oncology. JCO Clin Cancer Inform 2021; 5:21-23. [PMID: 33411618 DOI: 10.1200/cci.20.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jessica A Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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146
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OUTCOMES OF INTRAVESICAL BACILLUS CALMETTE-GUERIN IN A MULTIRACIAL COHORT WITH NON-MUSCLE-INVASIVE BLADDER CANCER. UROLOGY PRACTICE 2021; 8:100-105. [PMID: 34017909 DOI: 10.1097/upj.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction We sought to determine if outcomes of Bacillus Calmette-Guerin (BCG) therapy in patients with non-muscle-invasive bladder cancer (NMIBC) vary by race. Methods A retrospective chart review was conducted on 149 patients treated with BCG for intermediate- and high-risk NMIBC between 2001 and 2018, and who were followed up for cancer recurrence through March 2019.The primary outcomes were disease-free survival (DFS), low-grade disease-free survival (LGDFS), high-grade disease-free survival (HGDFS), and progression-free survival (PFS) at five years. Kaplan-Meier survival curves stratified by race (African American vs non-African American) were analyzed for all the above outcomes and multivariate Cox regression analyses were also performed to compare recurrence differences by race, after adjusting for age, sex, initial stage and grade. Results Of the 149 patients, 37.6% were Caucasian, 24.8% were African American, 26.8% were Hispanic, and 10.7% were of other/unknown race. Disease stage at initial presentation was 65.1% Ta, 34.9% T1, and 18.1% CIS. African American patients (N=37) did not have evidence for worse outcomes compared to non-African American patients when considering DFS (54.1% vs. 65.7%, p = 0.202), HGDFS (58.8% vs. 71.7%, p = 0.158), and PFS (83.8% vs. 92.6%, p = 0.117) at five years. Multivariate analysis did not reveal statistically significant racial differences in recurrence or progression. Conclusions African Americans with NMIBC did not have worse disease recurrence and progression after receiving intravesical BCG treatment. Although there did appear to be a trend towards worse oncologic outcomes in African Americans, larger studies are needed to validate this finding.
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Abstract
In this brief report, the author shares lessons from Loretta Jones, MA and William Jenkins, PhD, two elders who shaped her research with communities that occupy intersecting marginalized categories. These lessons were echoed and amplified by the community panelists at the RCMAR workshop on recruitment and retention of diverse elders. They include centering the priorities of communities themselves, helping community members envision the types of positive transformations that research can help bring about, engaging and valuing the contributions of diverse sectors of the community, and recognizing the desire of aging individuals and communities to leave a legacy. Because heath care, research, and governmental institutions have engendered so much mistrust in racial/ethnic minority communities, researchers must learn first the particular histories and experience of the populations they intend to study. Equipped with this knowledge, cultural humility, and a willingness to listen, researchers can then use these strategies to earn the trust necessary for successful recruitment and retention in research.
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Affiliation(s)
- Nina T Harawa
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA); Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science (CDU); Department of Epidemiology, Fielding School of Public Health at UCLA, CA
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148
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Mamdani H, Schwartz AG. Genomic Characterization of NSCLC in African Americans: A Step Toward "Race-Aware" Precision Medicine. J Thorac Oncol 2020; 15:1800-1802. [PMID: 33246591 DOI: 10.1016/j.jtho.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hirva Mamdani
- Department of Oncology, Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
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Nazha B, Yang JCH, Owonikoko TK. Benefits and limitations of real-world evidence: lessons from EGFR mutation-positive non-small-cell lung cancer. Future Oncol 2020; 17:965-977. [PMID: 33242257 DOI: 10.2217/fon-2020-0951] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
While randomized controlled trials (RCTs) are the gold standard for evidence-based medicine, they do not always reflect real-world patient populations, limiting their generalizability and external validity. Real-world evidence (RWE), generated during routine clinical practice, is increasingly important in determining effectiveness outside of the tightly controlled conditions of RCTs, and is now recognized by regulatory bodies as a valuable complement to RCTs. Consequently, it is increasingly important for physicians to understand how RWE data can be used alongside clinical trial data. Here, we discuss the different types of real-world observational studies, outline the benefits and limitations of RWE, and, using examples from EGFR mutation-positive non-small-cell lung cancer, outline how RWE can be used to help inform treatment decisions.
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Affiliation(s)
- Bassel Nazha
- Winship Cancer Institute, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - James C-H Yang
- National Taiwan University Cancer Center & National Taiwan University Hospital, 7 Chung-Shan S Road, 100 Taipei, Taiwan
| | - Taofeek K Owonikoko
- Winship Cancer Institute, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA
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150
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Ensuring Black Lives Matter in Drug Development. Ther Innov Regul Sci 2020; 55:245-246. [PMID: 33094425 PMCID: PMC7580499 DOI: 10.1007/s43441-020-00232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/09/2020] [Indexed: 10/31/2022]
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