1
|
Alpert AB, Obedin-Maliver J, Gjelsvik A, Amanullah S, Shireman TI, Blosnich JR. Does cancer clinical trial enrollment for sexual and gender minority people differ from heterosexual, cisgender people? Contemp Clin Trials 2024; 146:107695. [PMID: 39303766 DOI: 10.1016/j.cct.2024.107695] [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: 03/27/2024] [Revised: 09/01/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Sexual and gender minority (SGM) people experience cancer disparities compared to heterosexual and cisgender (non-SGM) people and likely have barriers to cancer clinical trial enrollment. Data are sparse, however, regarding cancer clinical trial enrollment for SGM versus non-SGM people. METHODS Using data from the 2020 Behavioral Risk Factor Surveillance Survey (BRFSS), we applied a logistic regression to assess associations between SGM status and clinical trial enrollment for 346 SGM and 9441 non-SGM people diagnosed with cancer. The model was adjusted for age at diagnosis, race/ethnicity, partnership status, education, employment, and sex assigned at birth. RESULTS SGM individuals had 94 % greater odds than non-SGM individuals to report participation in a clinical trial (aOR 1.94; 95 % CI 1.02-3.68) after adjusting for other factors. CONCLUSIONS Data from the BRFSS suggest that SGM people with cancer have higher odds of clinical trial enrollment compared to non-SGM people with cancer. Future work is needed to prospectively track oncology treatment, including clinical trial participation, and outcomes of SGM people versus non-SGM people with cancer. Other studies will be needed to develop and implement systematic, consistent, and non-stigmatizing sexual orientation and gender identity data collection methods.
Collapse
Affiliation(s)
- Ash B Alpert
- Yale Cancer Center, New Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Annie Gjelsvik
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Siraj Amanullah
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA; Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Theresa I Shireman
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| |
Collapse
|
2
|
Sakuma Y, Miller MLE, Babalis DS, Baker A, Reddi M, Anjum A, Bruton J, Jones KN, Mulla UZ, Taddese H. Shining a spotlight on the inclusion of disabled participants in clinical trials: a mixed methods study. Trials 2024; 25:281. [PMID: 38671497 PMCID: PMC11046956 DOI: 10.1186/s13063-024-08108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND It is crucial to include a wide range of the population in clinical trials for the outcome to be applicable in real-world settings. Existing literature indicates that under-served groups, including disabled people, have been excluded from participating in clinical trials without justification. Exclusion from clinical trials exacerbates disparities in healthcare and diminishes the benefits for excluded populations. Therefore, this study was conducted to investigate potential obstacles that prevent disabled people from participating in clinical trials in the United Kingdom (UK). METHODS The study was carried out through an explanatory sequential mixed methods design. The Imperial Clinical Trials Unit devised and implemented an online questionnaire-based survey (with open/closed-ended questions) and an online focus group discussion. The target population were disabled people, family members/carers of disabled people and staff involved in clinical trials, whereupon the sample was recruited by convenience sampling methods via posters and emails through various networks. The Qualtrics XM survey system was used as the host platform for the online survey, and Microsoft Teams was used for an online focus group discussion. The focus group discussion was conducted to gain a deeper understanding of the themes identified from the survey responses. We analysed responses to the survey via descriptive analysis and used thematic analysis to synthesise the free-text answers from the survey and focus group discussion. RESULTS We received 45 responses to the survey questionnaire and 5 disabled people took part in a focus group discussion. Our findings highlighted the differences between the perspectives of researchers and those "being researched" and different types of barriers experienced by disabled people: opportunity barriers (inadequate recruitment strategy and ambiguous eligibility criteria), awareness barriers (perception of disability) and acceptance/refusal barriers (available support and adjustment, and sharing of trial results). CONCLUSION Our findings support perspectives drawn from the Ford Framework regarding the need to consider all barriers, not just up to the point of enrolment into trials but also beyond the point of inclusion in clinical trials. We support calls for the introduction of legislation on including disabled people in clinical trials, implementation of industry/community-wide participatory approaches and the development of guidelines, a combined public-private approach.
Collapse
Affiliation(s)
- Yoshiko Sakuma
- Faculty of Medicine, School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Marie L E Miller
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Ln, London, W12 7RH, UK
| | - Daphne S Babalis
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Ln, London, W12 7RH, UK
| | - Alex Baker
- Imperial Clinical Trials Unit - Cancer, Department of Surgery and Cancer, Convergence Science Centre, Imperial College London, South Kensington Campus, London, Cancer Research, SW7 2AZ, UK
| | - Meena Reddi
- Imperial Clinical Trials Unit - Cancer, Department of Surgery and Cancer, Convergence Science Centre, Imperial College London, South Kensington Campus, London, Cancer Research, SW7 2AZ, UK
| | - Aisha Anjum
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Ln, London, W12 7RH, UK
| | - Jane Bruton
- Patient Experience Research Centre, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Kathryn N Jones
- Patient Experience Research Centre, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Umm Zeinab Mulla
- Faculty of Medicine, School of Public Health, Medical School, Imperial College London, St Mary's Campus, 167, Praed Street, London, W2 1NY, UK
| | - Henock Taddese
- Faculty of Medicine, School of Public Health, Medical School, Imperial College London, St Mary's Campus, 167, Praed Street, London, W2 1NY, UK
| |
Collapse
|
3
|
Nemala A, Ullah A, Yacur M, Karim NA. Do Current Lung Cancer Clinical Trials Represent All Patient Populations Including Minorities? Clin Lung Cancer 2023; 24:573-580. [PMID: 37574437 DOI: 10.1016/j.cllc.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
The under-representation of racial, sexual, and gender minorities in cancer clinical trials has long been a deficit in clinical cancer research. This review aims to survey current literature to determine the participation of minorities in the United States in lung cancer clinical trials and to find educational methods that have been studied and researched in order to improve patient clinical trial enrollment. A literature search of relevant articles published since 2015 was conducted using PubMed and Google Scholar. Clinical trials conducted in the United States from Clinicaltrials.gov were also collected to determine minority patient enrollment in lung cancer clinical trials. The results of the literature search yielded 6 relevant articles about racial minority representation in lung cancer clinical trials and one relevant article about LGBTQ+ minority representation in cancer clinical trials. Collectively, the literature highlighted the under-representation of racial minorities (such as Black, Hispanic, and American Indian) in clinical trials. Many articles showed that disparities in enrollment were less significant for Asian patients with lung cancer. However, many articles did not mention minorities like Middle Eastern/North Africans and failed to mention the lack of distinguishment of South Asian minorities from Pacific Asian minorities. The findings of this literature review support the idea that current lung cancer clinical trials lack representation of minority patient populations in the United States. The inclusion of racial, sexual, and gender diversity in clinical trial patient populations will aid providers in determining appropriate therapeutics and could potentially improve lung cancer outcomes. Future directions for improving diversity in lung cancer clinical trial enrollment include the utilization of various educational tools to increase minority patient participation in trials, the inclusion of detailed demographic data in cancer clinical trial analysis, and the recruitment of providers and research staff from various minorities to conduct cancer clinical trials.
Collapse
Affiliation(s)
| | - Asad Ullah
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Melissa Yacur
- Department of Hematology-Oncology, Inova Schar Cancer Institute, University of Virginia, Fairfax, VA
| | - Nagla Abdel Karim
- Department of Hematology-Oncology, Inova Schar Cancer Institute, University of Virginia, Fairfax, VA.
| |
Collapse
|
4
|
Roy E, Chino F, King B, Madu C, Mattes M, Morrell R, Pollard-Larkin J, Siker M, Takita C, Ludwig M. Increasing Diversity of Patients in Radiation Oncology Clinical Trials. Int J Radiat Oncol Biol Phys 2023; 116:103-114. [PMID: 36526234 PMCID: PMC10414211 DOI: 10.1016/j.ijrobp.2022.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/21/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
Radiation oncology clinical trials lack full representation of the ethnic and racial diversity present in the general United States and in the cancer patient population. There are low rates of both recruitment and enrollment of individuals from underrepresented ethnic and racial backgrounds, especially Black and Hispanic patients, people with disabilities, and patients from underrepresented sexual and gender groups. Even if approached for enrollment, barriers such as mistrust in medical research stemming from historical abuse and contemporary biased systems, low socioeconomic status, and lack of awareness prohibit historically marginalized populations from participating in clinical trials. In this review, we reflect on these specific barriers and detail approaches to increase diversity of the patient population in radiation oncology clinical trials to better reflect the communities we serve. We hope that implementation of these approaches will increase the diversity of clinical trials patient populations in not only radiation oncology but also other medical specialties.
Collapse
Affiliation(s)
- Emily Roy
- Baylor College of Medicine, Houston, Texas
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin King
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chika Madu
- Department of Radiation Oncology, Staten Island University Hospital, Staten Island, New York
| | - Malcolm Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rosalyn Morrell
- Advanced Radiation Center of Beverly Hills, Beverly Hills, California
| | | | - Malika Siker
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christiane Takita
- Department of Radiation Oncology, Miami University School of Medicine, Miami, Florida
| | - Michelle Ludwig
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
5
|
Research Ambassador Program: An innovative educational approach to addressing underrepresentation of minority populations in clinical research. J Clin Transl Sci 2023; 6:e129. [PMID: 36756076 PMCID: PMC9879877 DOI: 10.1017/cts.2022.496] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022] Open
Abstract
Clinical trial participation among historically underrepresented populations remains low in large part due to mistrust of academic institutions and research investigators. Mistrust may be ever greater today given misinformation related to COVID-19. The Research Ambassador Program is an interactive educational workshop delivered by Promotoras de Salud/Community Health Workers and designed to both address common myths, fears, and concerns about research and encourage research participation among underrepresented populations. An evaluation conducted with 819 Latino and Black participants demonstrated a change in behavior and intention to participate in a clinical trial, with half of participants enrolling in a clinical trial research registry.
Collapse
|
6
|
Wood SF, Brooks J, Eliason MJ, Garbers S, McElroy JA, Ingraham N, Haynes SG. Recruitment and Participation of Older Lesbian and Bisexual Women in Intervention Research. Womens Health Issues 2016; 26 Suppl 1:S43-52. [DOI: 10.1016/j.whi.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 11/29/2022]
|
7
|
Kamen CS, Smith-Stoner M, Heckler CE, Flannery M, Margolies L. Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers. Oncol Nurs Forum 2015; 42:44-51. [PMID: 25542320 DOI: 10.1188/15.onf.44-51] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe factors related to diagnosis, identity disclosure, and social support among lesbian, gay, bisexual, and transgender (LGBT) patients with cancer, and to explore associations between these factors and self-rated health. DESIGN Cross-sectional self-report survey design using descriptive and exploratory multivariate statistical approaches. SETTING Online, Internet-based. SAMPLE 291 LGBT patients (89% Caucasian; 50% gay, 36% lesbian, 7% bisexual, 3% transgender) with mixed cancers. METHODS Participants completed a researcher-designed online survey assessing experiences of cancer diagnosis among LGBT patients at a single time point. MAIN RESEARCH VARIABLES Demographics, which provider(s) delivered the patients' cancer diagnoses, to whom patients had disclosed their LGBT identity, how they disclosed, who was on their social support team at the time of diagnosis, and current self-rated health. FINDINGS 79% of participants reported disclosing their identities to more than one cancer care provider. Participants most commonly introduced the topic of LGBT identity themselves, sometimes as a way to correct heterosexual assumptions (34%). Friends were the most common members of LGBT patients' support teams (79%). Four disclosure and support factors were consistently associated with better self-rated health. CONCLUSIONS Disclosure of LGBT identity is a common experience in the context of cancer care, and disclosure and support factors are associated with better self-reported health among LGBT patients. IMPLICATIONS FOR NURSING Creating safe environments for LGBT patients to disclose could improve cancer care delivery to this underserved population. Nurses and other providers should acknowledge and include diverse support team members in LGBT patients' care.
Collapse
Affiliation(s)
- Charles S Kamen
- Department of Surgery, University of Rochester Medical Center in New York
| | | | | | | | | |
Collapse
|
8
|
Jabson JM, Farmer GW, Bowen DJ. Health Behaviors and Self-Reported Health Among Cancer Survivors by Sexual Orientation. LGBT Health 2015; 2:41-7. [PMID: 26790017 DOI: 10.1089/lgbt.2014.0038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Health behaviors and self-reported health are important for understanding cancer survivor health. However, there is a paucity of published research about how cancer survivors' health behaviors and self-rated health vary by sexual orientation. This study examined cancer survivors' health behaviors and self-reported health by sexual orientation. METHODS This study used data from the National Health and Nutrition Examination Survey (NHANES) from 2001-2010. Self-reported health and cancer-related health behaviors were compared by sexual orientation. Propensity score adjustment was used to account for differences in age, race, education, gender and health insurance status. RESULTS Of the 602 survivors eligible for the study, 4.3% identified as sexual minorities. Sexual minorities were 2.6 times more likely to report a history of illicit drug use (adjusted odds ratio [aOR]=2.4, 95% confidence interval [CI]: 1.04, 5.35), and 60% less likely to report their current health status as good (aOR=0.40, 95% CI: 0.18, 0.89), compared to heterosexual cancer survivors. These disparities persisted even after adjustment for socio-demographic characteristics. CONCLUSION Our findings suggest that sexual minority cancer survivors may be at greater risk for poorer outcomes after cancer than other survivors. A possible explanation for the observed differences involves minority stress. Future research should test stress as an explanation for these differences. However, using population-methods to achieve this goal requires larger samples of lesbian, gay, and bisexual (LGB) cancer survivors.
Collapse
Affiliation(s)
- Jennifer M Jabson
- 1 Department of Public Health, University of Tennessee , Knoxville, Tennessee
| | - Grant W Farmer
- 2 Division of Public Health Sciences Department of Surgery, Washington University , St. Louis, Missouri
| | - Deborah J Bowen
- 3 University of Washington School of Medicine , Department of Bioethics and Humanities, Seattle, Washington
| |
Collapse
|
9
|
Eliason MJ. Chronic Physical Health Problems in Sexual Minority Women: Review of the Literature. LGBT Health 2014; 1:259-68. [PMID: 26789854 DOI: 10.1089/lgbt.2014.0026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although there is substantial literature about sexual minority women's mental health and use of alcohol, tobacco, and other drugs (ATOD), only recently has attention been focused on chronic physical health disorders thought to stem from stress and exposure to ATOD use. The most extensively studied aspect of physical health has been weight, with the majority of studies reporting higher prevalence of overweight and obesity. In addition, many studies report higher levels of stressful experiences in both childhood and adulthood for sexual minority women. In this paper, the hypothesized relationship between stress, unhealthy behaviors, and five common chronic physical health disorders is explored via review of the literature. Only asthma appeared to be consistently more common in sexual minority women, and few or no differences in diabetes, hypertension, cardiovascular disease, and most cancers were found. The limitations of these studies are reviewed, and the need for studies that directly address the relationships among stress, health-damaging practices, and chronic disorder is emphasized. However, if these findings hold up, and sexual minority women are not more prone to these disorders, the field may need better theoretical frameworks from which to explore potential differences in the manifestation of mental versus chronic physical health disparities.
Collapse
Affiliation(s)
- Michele J Eliason
- Department of Health Education, San Francisco State University , San Francisco, California
| |
Collapse
|