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Luningham JM, Akpan IN, Alkhatib S, Taskin T, Desai P, Vishwanatha JK, Thompson EL. COVID-19 clinical trial participation and awareness in Texas. Hum Vaccin Immunother 2024; 20:2340692. [PMID: 38658140 PMCID: PMC11057562 DOI: 10.1080/21645515.2024.2340692] [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: 08/28/2023] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
The COVID-19 pandemic required the rapid development of COVID-19 vaccines and treatments, necessitating quick yet representative clinical trial enrollment to evaluate these preventive measures. However, misinformation around the COVID-19 pandemic and general concerns about clinical trial participation in the U.S. hindered clinical trial enrollment. This study assessed awareness of, willingness to participate in, and enrollment in COVID-19 vaccine and treatment clinical trials in Texas. A quota sample of 1,089 Texas residents was collected online from June - July 2022. Respondents were asked if they were aware of, willing to participate in, and had enrolled in clinical trials for COVID-19 vaccines or treatments. Overall, 45.8% of respondents reported being aware of clinical trials for COVID-19 treatments or vaccines, but only 21.7% knew how to enroll and only 13.2% had enrolled in a COVID-19 clinical trial. Respondents with bachelor's or graduate degrees were more likely to be aware of clinical trials, more likely to have enrolled in trials, and more willing to participate in treatment trials. Women were less willing to participate and less likely to have enrolled in COVID-19 clinical trials than men. Respondents aged 55 years and older were more willing to participate, but less likely to have enrolled in COVID-19 clinical trials than 18-to-24-year-olds. Common reasons given for not participating in clinical trials included concerns that COVID-19 treatments may not be safe, government distrust, and uncertainty about what clinical trial participation would entail. Substantial progress is needed to build community awareness and increase enrollment in clinical trials.
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Affiliation(s)
- Justin M. Luningham
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Idara N. Akpan
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Sarah Alkhatib
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Tanjila Taskin
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Palak Desai
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Jamboor K. Vishwanatha
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Erika L. Thompson
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
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2
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Zuckerman MC, Edwards HA. Diversity in U.S. Clinical Trials for Head and Neck Cancer: Are We Improving? Head Neck 2024. [PMID: 39400951 DOI: 10.1002/hed.27943] [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: 12/09/2023] [Revised: 07/29/2024] [Accepted: 09/16/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND This study assesses whether national initiatives undertaken to improve diversity in clinical trial enrollment have been successful within head and neck cancer (HNC) trials. METHODS A retrospective analysis was conducted of HNC trials published on clinicaltrials.gov with start dates between 2000 and 2023. Demographic data for 8998 HNC trial enrollees was abstracted and analyzed to investigate potential demographic shifts. RESULTS In the past 20 years, the percentage of White patients increased 6.1%, Asian patient population decreased 3.1%, and Black patient population increased 0.8%. Compared with previously published SEER data, HNC trials have significantly more White patients, fewer Black patients, and fewer Asian/Native-Hawaiian patients than HNC patients at large. CONCLUSIONS Despite efforts to increase diversity in HNC clinical trials in the United States, diversity has significantly decreased in the past 10 years. As current approaches are failing to show improvement, novel approaches to improving representation in clinical trials are necessitated.
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Affiliation(s)
| | - Heather Ann Edwards
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Boston Medical Center Department of Otolaryngology, Boston, Massachusetts, USA
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3
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Stradford J, Heyworth NC, Jackson M, Norman M, Banks SJ, Sundermann EE, Thames AD. Increasing research study engagement in minoritized populations: An example from the Black Women Inflammation and Tau Study. Alzheimers Dement 2024; 20:7403-7410. [PMID: 39140387 PMCID: PMC11485412 DOI: 10.1002/alz.14177] [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: 05/10/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024]
Abstract
Black women are sorely underrepresented in studies of Alzheimer's disease and related dementias (ADRD) despite higher rates of ADRD diagnoses than in non-Hispanic White women. There are many reasons for underrepresentation, including medical mistrust, limited access to clinical studies, and restrictive study inclusion criteria. These pervasive barriers to research participation are often not considered during study development and, if eventually thought of tend to be after the fact. Community-engaged research (CER) approaches are an effective method for reducing participation barriers. This article describes how CER approaches were used to develop the Black Women Inflammation and Tau Study (BWITS), a prospective study to identify biopsychosocial risk factors for ADRD in Black women. Guidelines discussed here for future ADRD research in diverse populations are informed by Community-Based Participatory Research (CBPR), the National Institute on Minority Health and Health Disparities (NIMHD), and the Patient-Centered Outcomes Research Institute (PCORI). HIGHLIGHTS: Understand the historical tragedies related to medical practices and research designs that may contribute to the underrepresentation of Black Americans in research studies today. Highlight community-engaged research approaches that effectively reduce participation barriers in minoritized groups. Review Community-Based Participatory Research, National Institute of Minority Health and Health Disparities, and the Patient-Centered Outcomes Research Institute guidelines for conducting research with minoritized communities. Describe using the three frameworks to inform the study development protocol for the Black Women Inflammation and Tau Study. Conclude by offering study design considerations that we hope can be a helpful starting point for others conducting research with minoritized communities.
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Affiliation(s)
- Joy Stradford
- SDSU/UCSD Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Nadine C. Heyworth
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Michelle Jackson
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Marc Norman
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Sarah J. Banks
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Erin E. Sundermann
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - April D. Thames
- Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesCaliforniaUSA
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Baig Mirza A, Fayez F, Rashed S, Burn L, Evans ZM, Karagozlu Z, Vastani A, Lavrador JP, Vergani F, Gullan R, Bhangoo R, Ashkan K. Ethnicity in neuro-oncology research: How are we doing and how can we do better? J Neurooncol 2024:10.1007/s11060-024-04769-1. [PMID: 39316318 DOI: 10.1007/s11060-024-04769-1] [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: 06/09/2024] [Accepted: 07/03/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE This study systematically reviews and meta-analyses the extent of ethnic minority representation in neuro-oncology Phase III and IV clinical trials, explores the effect of ethnicity on outcomes, and identifies predictors for the inclusion of ethnicity data in publications. METHODS Adhering to PRISMA guidelines, we conducted a comprehensive literature search across multiple databases, on Phase III and IV trials in neuro-oncology that reported on adult and/or paediatric subjects. Through meta-analysis, we synthesized information on overall survival, event-free survival, and the incidence of adverse outcomes across ethnicities. RESULTS From 448 identified articles, a fraction reported ethnicity data, with an even smaller number providing outcome data stratified by ethnicity. Most study participants were identified as White, underscoring a significant underrepresentation of minorities. Our meta-analysis did not reveal significant outcome differences by ethnicity, which may be attributed to the limited and inadequate reporting of data. Predictors for including ethnicity data were identified, including trials in North America(OR2.39, 95%CI 1.18-5.12, p < 0.02),trials of drugs or biologic agents(OR 5.28, 95%CI 1.43-3.42, p < 0.05),and trials funded by charities(OR 2.28, 95% CI 1.04-5.27, p < 0.05) or pharmaceutical companies(OR 3.98, 95% CI 1.60-10.0, p < 0.005). CONCLUSION The underrepresentation of minorities in neuro-oncology clinical trials and the inadequately characterized impact of ethnicity on treatment outcomes highlight a critical need for more inclusive recruitment strategies and improved reporting standards. Change is necessary to ensure trials reflect the diversity of the patient population, which is essential for developing tailored strategies and improving outcomes. Future research should prioritize understanding the role of ethnicity in neuro-oncology to facilitate personalized treatment approaches.
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Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
- Department of Neurosurgery, Queens Hospital Romford, Romford, UK.
| | - Feras Fayez
- Imperial College Healthcare Trust, London, UK
| | - Sami Rashed
- Department of Neurosurgery, Queens Hospital Romford, Romford, UK
| | - Layla Burn
- Barts and The London School of Medicine and Dentistry, London, UK
| | | | | | - Amisha Vastani
- Department of Neurosurgery, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Francesco Vergani
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Richard Gullan
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
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McDonnell SM, Flynn KE, Barnekow K, Kim UO, Brazauskas R, Ahamed SI, McIntosh JJ, Pitt MB, Leuthner SR, Kruper A, Basir MA. Black Women and the Preemie Prep for Parents (P3) Program: Exploratory Analysis of a Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.28.24312637. [PMID: 39252895 PMCID: PMC11383483 DOI: 10.1101/2024.08.28.24312637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background The smartphone Preemie Prep for Parents (P3) program was developed to address the gap in prenatal education of preterm birth in high-risk pregnancies. Despite a higher incidence of preterm birth, Black women are less likely to receive prenatal education. Methods Pregnant women with medical conditions that predisposed them to preterm birth were randomized to receive the P3 program or links to American College of Obstetricians and Gynecologists webpages (control). The P3 group received periodic text messages, starting as early as 18 weeks gestational age, each with a link to a short, animated educational video. Participants completed the Parent Prematurity Knowledge Questionnaire, PROMIS Anxiety scale, and a feedback survey. This is a subgroup analysis of the Black, non-Hispanic participants in the P3 trial. Results Of the 26 Black non-Hispanic women enrolled, the P3 group (n=14) had higher knowledge scores than the control group (n=12), 67.5% correct vs. 43.6% (difference 24.0; 95% CI, 7.4 to 40.6), without experiencing an increase in anxiety. More P3 participants reported discussing preterm birth with their partner (100%) than control participants (57%; difference 43; 95% CI, 6 to 80). Conclusions The P3 program appears to be an effective method of providing preterm birth education to Black pregnant women.
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Kwok G, Senger A, Sharma A, Mandato I, Devine KA. Understanding the multilevel factors influencing the implementation of digital health interventions for supportive care in Adolescents and Young Adult (AYA) cancer survivorship: determinants of adopting mindfulness-based mobile applications. Implement Sci Commun 2024; 5:76. [PMID: 39020422 PMCID: PMC11253365 DOI: 10.1186/s43058-024-00612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Adolescents and Young Adult (AYA) cancer survivors are at risk for psychological distress due to their unique developmental and medical needs. Healthcare providers can leverage the convenience and appeal of technology to provide supportive care for this vulnerable population. Using evidence-based mindfulness-based mobile interventions as a case example, the goal of this study was to identify key patient-, provider-, and organization-level barriers and facilitators to supportive care and implementing digital health interventions in AYA survivorship care. METHODS Twenty semi-structured interviews were conducted with stakeholders including AYA survivors (n = 10; between 18-29 years old) and clinical providers and administrators (n = 10). Interviews were transcribed and deductively mapped using the Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) complementary frameworks. RESULTS Results indicated that factors like cost and patients' needs and resources were prevalent among both survivors and providers. There were key differences between providers and AYA survivors. Providers' adoption and promotion of digital health interventions were influenced most strongly by contextual factors, including available resources (Inner Setting), culture (Outer Setting), and networks and communications (Outer Setting). On the other hand, survivors emphasized individual and intervention-related factors; they reported that social influence and knowledge influenced their adoption and use of digital health interventions, including meditation apps. CONCLUSIONS These results identified barriers and facilitators to the adoption of supportive care digital health interventions from multiple stakeholders. Results can be used to guide the development of implementation strategies to improve the uptake of digital health interventions in survivorship care, ultimately improving the psychosocial well-being of AYA cancer survivors.
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Affiliation(s)
- Gary Kwok
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation, at Hackensack Meridian Health, Nutley, NJ, 07110, USA.
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA.
| | - Angela Senger
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Archana Sharma
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Ivelisse Mandato
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Katie A Devine
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
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7
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Hantel A, Brunner AM, Plascak JJ, Uno H, Varela JC, Luskin MR, Rebbeck TR, Stone RM, Lathan CS, DeAngelo DJ, Abel GA. Racial and ethnic associations with comprehensive cancer center access and clinical trial enrollment for acute leukemia. J Natl Cancer Inst 2024; 116:1178-1184. [PMID: 38518098 PMCID: PMC11223832 DOI: 10.1093/jnci/djae067] [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: 08/04/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Clinical trial participation at Comprehensive Cancer Centers (CCC) is inequitable for minoritized racial and ethnic groups with acute leukemia. CCCs care for a high proportion of adults with acute leukemia. It is unclear if participation inequities are due to CCC access, post-access enrollment, or both. METHODS We conducted a retrospective cohort study of adults with acute leukemia (2010-2019) residing within Massachusetts, the designated catchment area of the Dana-Farber/Harvard Cancer Center (DF/HCC). Individuals were categorized as non-Hispanic Asian (NHA), Black (NHB), White (NHW), Hispanic White (HW), or Other. Decomposition analyses assessed covariate contributions to disparities in (1) access to DF/HCC care and (2) post-access enrollment. RESULTS Of 3698 individuals with acute leukemia, 85.9% were NHW, 4.5% HW, 4.3% NHB, 3.7% NHA, and 1.3% Other. Access was lower for HW (age- and sex-adjusted OR = 0.64, 95% CI = 0.45 to 0.90) and reduced post-access enrollment for HW (aOR = 0.54, 95% CI =0.34 to 0.86) and NHB (aOR = 0.60, 95% CI = 0.39 to 0.92) compared to NHW. Payor and socioeconomic status (SES) accounted for 25.2% and 21.2% of the +1.1% absolute difference in HW access. Marital status and SES accounted for 8.0% and 7.0% of the -8.8% absolute disparity in HW enrollment; 76.4% of the disparity was unexplained. SES and marital status accounted for 8.2% and 7.1% of the -9.1% absolute disparity in NHB enrollment; 73.0% of the disparity was unexplained. CONCLUSIONS A substantial proportion of racial and ethnic inequities in acute leukemia trial enrollment at CCCs are from post-access enrollment, the majority of which was not explained by sociodemographic factors.
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Affiliation(s)
- Andrew Hantel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew M Brunner
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jesse J Plascak
- Department of Internal Medicine, Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA
| | - Hajime Uno
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Juan C Varela
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Timothy R Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Gregory A Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Nwachukwu C, Makhnoon S, Person M, Muthukrishnan M, Kazmi S, Anderson LD, Kaur G, Kapinos KA, Williams EL, Fatunde O, Sadeghi N, Robles F, Basey A, Hulsey T, Pruitt SL, Gerber DE. Transferring care to enhance access to early-phase cancer clinical trials: Protocol to evaluate a novel program. Contemp Clin Trials Commun 2024; 39:101292. [PMID: 38623454 PMCID: PMC11016932 DOI: 10.1016/j.conctc.2024.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/14/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Involving diverse populations in early-phase (phase I and II) cancer clinical trials is critical to informed therapeutic development. However, given the growing costs and complexities of early-phase trials, trial activation and enrollment barriers may be greatest for these studies at healthcare facilities that provide care to the most diverse patient groups, including those in historically underserved communities (e.g., safety-net healthcare systems). To promote diverse and equitable access to early-phase cancer clinical trials, we are implementing a novel program for the transfer of care to enhance access to early-phase cancer clinical trials. We will then perform a mixed-methods study to determine perceptions and impact of the program. Specifically, we will screen, recruit, and enroll diverse patients from an urban, integrated safety-net healthcare system to open and active early-phase clinical trials being conducted in a university-based cancer center. To evaluate this novel program, we will: (1) determine program impact and efficiency; and (2) determine stakeholder experience with and perceptions of the program. To achieve these goals, we will conduct preliminary cost analyses of the program. We will also conduct surveys and interviews with patients and caregivers to elucidate program impact, challenges, and areas for improvement. We hypothesize that broadening access to early-phase cancer trials conducted at experienced centers may improve equity and diversity. In turn, such efforts may enhance the efficiency and generalizability of cancer clinical research.
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Affiliation(s)
- Chika Nwachukwu
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sukh Makhnoon
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Marieshia Person
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Meera Muthukrishnan
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Syed Kazmi
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Larry D. Anderson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gurbakhash Kaur
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kandice A. Kapinos
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- RAND Corporation, Arlington, VA, USA
| | - Erin L. Williams
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Oluwatomilade Fatunde
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Navid Sadeghi
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health, Dallas, TX, USA
| | - Fabian Robles
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health, Dallas, TX, USA
| | - Alice Basey
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Patient Advocate Program, Office of Community Outreach, Engagement, and Equity, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Hulsey
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Patient Advocate Program, Office of Community Outreach, Engagement, and Equity, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sandi L. Pruitt
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Fairley R, Lillard JW, Berk A, Cornew S, Gaspero J, Gillespie J, Horne LL, Kidane S, Munro SB, Parsons M, Powers ER, Rizzo SE, Tishcler A, Wohl H, Weiss MC. Increasing Clinical Trial Participation of Black Women Diagnosed with Breast Cancer. J Racial Ethn Health Disparities 2024; 11:1701-1717. [PMID: 37314691 PMCID: PMC11101578 DOI: 10.1007/s40615-023-01644-z] [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: 03/21/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023]
Abstract
Despite racial disparities in breast cancer mortality, Black women remain underrepresented in clinical trials. In this mixed methods research, 48 Black women were engaged via focus group discussions and in-depth interviews to better understand the lived experience of women with breast cancer. The results of this qualitative study informed the development of a subsequent online survey to identify barriers, motivators, and other factors that influence decision-making by Black women diagnosed with breast cancer when considering clinical trial participation. Among the 257 Black survey participants, most (95%) were aware of clinical trials; of those, most viewed them as lifesaving (81%) and/or benefiting others (90%). Negative perceptions such as serious side effects (58%), not receiving real treatment (52%), or risk of potential harm (62%) were indicated. Barriers included financial expenses (49%), concerns that their condition could be made worse (29%), that they would receive a placebo (28%), or that treatment was unapproved (28%). Participants were more likely than their health care providers (HCPs) to initiate discussions of clinical trials (53% versus 33%), and 29% of participants indicated a need for more information about risks and benefits, even after having those conversations. The most trustworthy sources of information on clinical trials were HCPs (66%) and breast cancer support groups (64%). These results suggest that trusted communities are key for providing education on clinical trials. However, there is also a need for HCPs to proactively discuss clinical trials with patients to ensure that they are adequately informed about all aspects of participation.
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Affiliation(s)
- Ricki Fairley
- TOUCH, The Black Breast Cancer Alliance, Annapolis, MD, USA
| | - James W Lillard
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Sophia Cornew
- Patient Network and Data, Invitae, San Francisco, CA, USA
| | | | | | - LaTrisha L Horne
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | | | | | | | - Emily R Powers
- TOUCH, The Black Breast Cancer Alliance, Annapolis, MD, USA.
| | | | | | | | - Marisa C Weiss
- Breastcancer.org, Ardmore, PA, USA
- Lankenau Medical Center, Wynnewood, PA, USA
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10
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Fedewa SA, Valentino LA, Koo A, Cafuir L, Tran DQ, Antun A, Kempton CL. Race and ethnicity reporting and representation in hemophilia clinical trials. Blood Adv 2024; 8:2351-2360. [PMID: 38547444 PMCID: PMC11127208 DOI: 10.1182/bloodadvances.2024012862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
ABSTRACT Racial and ethnic representativeness in clinical trials is crucial to mitigate disparities in outcomes; however, diversity among hemophilia trials is unknown. The aim of this study is to examine the reporting and representation of race and ethnicity in trials of people with hemophilia (PwH). In this cross-sectional study, the ClinicalTrials.gov database was queried in April 2023 for interventional clinical trials involving PwH between 2007 and 2022. The distribution of participants (observed) was compared with expected proportions based on US Hemophilia Treatment Center (HTC) and country-specific census data with observed-to-expected ratios (OERs). Of 129 trials included, 94.6% were industry sponsored, with a mean of 62 participants and mean age of 26.8 years. Overall, 52.0% (n = 66) of trials reported data on race and ethnicity, increasing from 13.9% in 2007-2012 to 22.5% in 2013-2016 to 100% in 2017-2022 (P = .001). Among these 66 trials, 65.8%, 22.8%, 5.1%, 3.9% of participants were White, Asian, Hispanic, and Black, respectively. OERs were 10% to 20% lower for White participants vs US HTC, and US, UK, and Canadian census populations and ∼75% lower for Black or Hispanic participants when compared with US HTC and US census population. OERs for Asian participants were 1.6 to 3 times higher than Canada, US, and UK census populations. The reporting of race and ethnicity in hemophilia trials has drastically improved; however, Black and Hispanic PwH remain especially underrepresented. To address these disparities, stakeholders across the clinical trial enterprise need to implement strategies to ensure equitable participation.
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Affiliation(s)
- Stacey A. Fedewa
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | | | - Andee Koo
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Lorraine Cafuir
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | | | - Ana Antun
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | - Christine L. Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
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11
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Marandu G, Malale K, Laisser R, Mwanga J, Sabuni PA, Rambau P. Evaluation of Breast Health Promotion Intervention Among Catholic Nuns in Lake Zone 'Tanzania. Eur J Breast Health 2024; 20:129-135. [PMID: 38571689 PMCID: PMC10985581 DOI: 10.4274/ejbh.galenos.2024.2024-1-10] [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: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
Objective Despite facing unique barriers, Catholic nuns in Tanzania require accessible breast health promotion. This study explores interventions to empower nuns through knowledge, improved attitudes, and positive practices, ultimately promoting well-being and early detection for better breast cancer outcomes. Materials and Methods A quasi-experimental design study guided by the Health Belief Model was conducted to monitor the implementation of a breast health intervention program aimed at increasing breast cancer screening knowledge among 385 Catholic nuns aged 20 to over 60 years old within Lake Zone, Tanzania. Data were collected at two-time points: pre-intervention (baseline) and implementation phase intervention (after three months). The intervention consisted of a 2-hour educational session. Participants had opportunities to ask questions and provide feedback. Results The breast health promotion intervention was well-received by Catholic nuns, with 339 (88%) expressing strong motivation to learn and promote awareness. The training effectively increased knowledge and positive attitudes towards breast cancer screening. Researcher assistants successfully delivered the program, and 354 (92%) of participants expressed interest in continued education and support. The intervention addressed cultural barriers and empowered nuns to take charge of their health, though some challenges remain meanwhile 158 (41%) had limited prior knowledge, 81 (21%) hesitated to discuss breast health due to religious beliefs, and some faced difficulty applying the learnings. Conclusion Overall, the breast health promotion intervention had a positive outcome on the Catholic nuns' awareness and knowledge of breast health. However, addressing the identified barriers and challenges is crucial to further enhance the intervention's effectiveness and sustainability.
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Affiliation(s)
- Gotfrida Marandu
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kija Malale
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Rose Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Joseph Mwanga
- Department of Community Medicine, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Paul Alikado Sabuni
- Public Health Consultant, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Peter Rambau
- Department of Pathology, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
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Hawke LJ, Nelson E, O'Brien P, Crossley KM, Choong PF, Bunzli S, Dowsey MM. Influences on clinical trial participation: Enhancing recruitment through a gender lens - A scoping review. Contemp Clin Trials Commun 2024; 38:101283. [PMID: 38456181 PMCID: PMC10918492 DOI: 10.1016/j.conctc.2024.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
Background Suboptimal clinical trial recruitment contributes to research waste. Evidence suggests there may be gender-based differences in willingness to participate in clinical research. Identifying gender-based differences impacting the willingness of trial participation may assist trial recruitment. Objectives To examine factors that influence the willingness of men and women to participate in clinical trials and to identify modifiable factors that may be targeted to optimise trial participation. Material and methods Electronic databases were searched with key words relating to 'gender', 'willingness to participate' and 'trial'. Included studies were English language and reported gender-based differences in willingness to participate in clinical trials, or factors that influence a single gender to participate in clinical trials. Studies were excluded if they described the demographic factors of trial participants or if the majority of participants were pregnant. Extracted data were coded, categorized, analysed thematically and interpreted using Arksey and O'Malley's framework. Results Sixty-three studies were included. Two main themes were identified: trial characteristics and participant characteristics. A number of gender-based differences moderating willingness to participate were observed although only one, 'concern for self' was found to influence actual trial participation rates between genders. Conclusion The relationship between factors influencing willingness to participate in clinical trials is complex. The influence of gender on willingness to participate, while important, may be moderated by other factors including socioeconomic status, ethnicity and health condition. Exploring factors that influence willingness to participate specific to a study cohort likely offers the most promise to optimise trial recruitment of that cohort.
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Affiliation(s)
- Lyndon J. Hawke
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Elizabeth Nelson
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Penny O'Brien
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Kay M. Crossley
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter F. Choong
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Michelle M. Dowsey
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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13
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Ebrahimi H, Megally S, Plotkin E, Shivakumar L, Salgia NJ, Zengin ZB, Meza L, Chawla N, Castro DV, Dizman N, Bhagat R, Liv S, Li X, Rock A, Liu S, Tripathi A, Dorff T, Oyer RA, Boehmer L, Pal S, Chehrazi-Raffle A. Barriers to Clinical Trial Implementation Among Community Care Centers. JAMA Netw Open 2024; 7:e248739. [PMID: 38683608 PMCID: PMC11059033 DOI: 10.1001/jamanetworkopen.2024.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024] Open
Abstract
Importance While an overwhelming majority of patients diagnosed with cancer express willingness to participate in clinical trials, only a fraction will enroll onto a research protocol. Objective To identify critical barriers to trial enrollment to translate findings into actionable practice changes that increase cancer clinical trial enrollment. Design, Setting, and Participants This survey study included designated site contacts at oncology practices with teams who were highly involved with the Association of Community Cancer Centers (ACCC) Community Oncology Research Institute (ACORI) clinical trials activities, all American Society of Clinical Oncology (ASCO)-ACCC collaboration pilot sites, and/or sites providing care to at least 25% African American and Hispanic residents. To determine participation trends among health care practices in oncology-focused research, identify barriers to clinical trial implementation and operation, and establish unmet needs for cancer clinics interested in trial participation, a 34-question survey was designed. Survey questions were defined within 3 categories: cancer center demographic characteristics, clinical trial characteristics, and referral practices. The survey was distributed through email and was open from June 20 through October 5, 2022. Main Outcomes and Measures Participation in and barriers to conducting oncology trials in different community oncology settings. Results The survey was distributed to 100 cancer centers, with completion by 58 centers (58%) across 25 states. Fifty-two centers (88%) reported that they conduct therapeutic clinical trials, of which 33 (63%) were from urban settings, 11 (21%) were from suburban settings, and 8 (15%) were from rural settings. Only 25% of rural practices (2 of 8) offered phase 1 trials, compared with 67% of urban practices (22 of 33) (P = .01). Respondents noted challenges in conducting research, including patient recruitment (27 respondents [52%]), limited staffing (27 [52%]), and nonrelevant trials for their patient population (25 [48%]). Among sites not offering therapeutic trials, barriers to research conduct included limited infrastructure, funding, and staffing. Most centers (46 of 58 [79%]) referred patients to outside centers for clinical trial enrollment, particularly in the context of late-stage disease and/or disease progression. Only 17 of these sites (37%) had established protocols for patient follow-up subsequent to outside referral. Conclusions and Relevance In this national survey study of barriers to clinical trial implementation, most sites offered therapeutic trials, but there were significant disparities in trial availability across care settings. Furthermore, fundamental deficiencies in trial support infrastructure limited research activity, including within programs currently conducting research as well as at sites interested in future clinical research opportunities. These results identify crucial unmet needs for oncology clinics to effectively offer clinical trials to patients seeking care.
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Affiliation(s)
- Hedyeh Ebrahimi
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sandra Megally
- Association of Community Cancer Centers, Rockville, Maryland
| | - Elana Plotkin
- Association of Community Cancer Centers, Rockville, Maryland
| | | | | | - Zeynep B. Zengin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Luis Meza
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Neal Chawla
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Nazli Dizman
- Department of Internal Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Ruma Bhagat
- Genentech, Inc, South San Francisco, California
| | - Seila Liv
- Genentech, Inc, South San Francisco, California
| | - Xiaochen Li
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Adam Rock
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sandy Liu
- City of Hope Orange County Lennar Foundation Cancer Center, Irvine, California
| | | | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Randall A. Oyer
- Penn Medicine Ann B. Barshinger Cancer Institute, Lancaster, Pennsylvania
| | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, Maryland
| | - Sumanta Pal
- City of Hope Comprehensive Cancer Center, Duarte, California
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14
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Lee AY, Jahansooz JR, Guittu D, Suzuki R, Pak L, Ishikawa KM, Goo C, Chen JJ, Carrazana E, Viereck J, Liow KK. Barriers to Alzheimer Disease Clinical Trial Participation in a Minority Population. Cogn Behav Neurol 2024; 37:40-47. [PMID: 37878413 PMCID: PMC10948321 DOI: 10.1097/wnn.0000000000000359] [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: 10/01/2022] [Accepted: 06/12/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Alzheimer disease (AD), the most common neurodegenerative disorder in the United States, disproportionately burdens minority populations. OBJECTIVE To explore barriers to AD clinical trial participation by Asian and Native Hawaiian patients diagnosed with AD or mild cognitive impairment. METHOD We surveyed 187 patients with a Mini-Mental State Examination score ≥14 between January 2022 and June 2022. The score cutoff for clinical trial eligibility was set by the institution. Individuals also completed a 15-question telephone survey that assessed demographics, barriers to clinical trial participation, and clinical trial improvement methods. RESULTS Forty-nine patients responded, with a response rate of 26%. Asian and Native Hawaiian patients were less likely than White patients to participate in AD trials. The main barrier to participation was a lack of information about AD trials. Providing additional information regarding AD trials to patients and family members were listed as the top two reasons patients would consider participating in a clinical trial. CONCLUSION Insufficient information about AD clinical trials is the primary barrier to participation among Asian and Native Hawaiian patients, followed by difficulty coordinating transportation and, in the case of Asians, the time required for clinical trials. Increased outreach, education, and assistance with logistics in these populations should be pursued to improve rates of participation in clinical trials.
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Affiliation(s)
- Anson Y Lee
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Julia R Jahansooz
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Darrell Guittu
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
| | - Rexton Suzuki
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
| | - Lauren Pak
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
| | - Kyle M Ishikawa
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Connor Goo
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - John J Chen
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Enrique Carrazana
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Jason Viereck
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Kore K Liow
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Pulle J, Loue S, Kiwanuka GN, Francis B. Trust in Medical Research: A Comparative Study among Patients at a Regional Referral Hospital and Community Members in Lira District, Northern Uganda. J Empir Res Hum Res Ethics 2024; 19:48-57. [PMID: 38216325 PMCID: PMC10957324 DOI: 10.1177/15562646231224374] [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] [Indexed: 01/14/2024]
Abstract
Events such as the Tuskegee syphilis study shaped how the public perceives and trusts medical research globally. However, few studies have examined trust in medical research in developing countries. We tested the hypothesis that levels of trust may be lower among community members compared to hospitalized persons in Uganda. We enrolled 296 participants in rural northern Uganda, and 148(50%) were from the community, 192(65%) were female. Mean level of trust for medical research was higher among hospitalized persons compared to community members (p = 0.0001). Previous research participation (p = 0.03), and willingness to participate in future research (p = 0.001) were positively associated with trust. Medical personnel should engage more with the communities in which they practice fostering trust in medical research.
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Affiliation(s)
- Jafesi Pulle
- Department of Community Health, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
- Uganda Heart Institute, Kampala, Uganda
| | - Sana Loue
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland OH 44106, USA
| | - Gertrude N. Kiwanuka
- Department of Biochemistry, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Bajunirwe Francis
- Department of Community Health, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
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Shahzad M, Khalid MF, Amin MK, Basharat A, Ammad-Ud-Din M, Park R, Anwar I, Faisal MS, Jaglal M. Geographic and Racial Disparities in Chimeric Antigen Receptor-T Cells and Bispecific Antibodies Trials Access for Diffuse Large B-Cell Lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00034-X. [PMID: 38342727 DOI: 10.1016/j.clml.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND We investigate the geographical and racial disparities in accessing CAR-T and bispecific antibodies trials for DLBCL. MATERIALS AND METHODS ClinicalTrials.gov was searched, and 75 trials with at least 1 open site in the US were included. 2020 US Census Bureau data was used to obtain data on race and ethnicity. SPSS version 26 was used for analysis. RESULTS There were 62 CAR-T and 13 bispecific antibodies trials with 6221 enrolled or expected to enroll patients. Eighty-five percent of the clinical trials were only open in the US, and the majority 64% were pharmaceutical-funded. There were 126 unique study sites distributed over 31 states with 11 (0-51) mean number of trials per state and 4.5 (1-26) and 4.4 (1-24) mean number of CAR-T and bispecific antibodies trials per site, respectively. Southern states had the most number of trials 31%, followed by Midwestern 25%, Northeastern 24%, and Western 20%. The highest number of study locations were in California 13, New York 9, and Pennsylvania 9, while the highest number of open studies were in California 51, Texas 32, and New York 23. Twenty states had no open CAR-T or bispecific antibodies trials. Only 33% of African Americans (AA) lived in a county with a trial, and 7 out of 10 states with the highest proportion of AA residents (18.6%-41.4%) have no or less than 4 trial sites. Of the 62 counties analyzed, 92% were White predominant, while only 8% were AA predominant (P = .009). CONCLUSIONS Strategies should be framed to address the observed disparities and to improve access.
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Affiliation(s)
- Moazzam Shahzad
- H. Lee Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL.
| | | | | | | | | | - Robin Park
- H. Lee Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL
| | - Iqra Anwar
- Kansas University Medical Center, Kansas City, KS
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Negrete M, Ademiluyi A, Karayeva E, Eskridge G, Huggins M, Eskridge CM, Price BD, Bendinskas KG, Watson KS, Kim SJ. Bridging the Gap: Engaging Black Men in Lung Cancer Research Through Barbershop Collaboration. Am J Mens Health 2024; 18:15579883241229417. [PMID: 38339791 PMCID: PMC10859066 DOI: 10.1177/15579883241229417] [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: 09/25/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024] Open
Abstract
Health disparities persist among Black men, notably in the context of lung cancer and stress-related health outcomes. This study explores these disparities through a community-based participatory research (CBPR) approach, citizen science, and social network theory, leveraging the expertise and trust of Black barbers as community leaders. The purpose is to understand the nuanced connections between stress and lung cancer in this demographic. Engaging 161 Black men across four Chicago neighborhoods, the study successfully collected hair samples and survey data, emphasizing the importance of culturally sensitive recruitment strategies. Findings highlight the effectiveness of the collaboration, showcasing the role of barbershops as community hubs for research. The study concludes by advocating for sustained partnerships with community leaders, emphasizing transparency in research communication, and promoting culturally grounded approaches to address health disparities and enhance research participation among underrepresented populations.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Karriem S. Watson
- National Institutes of Health (NIH) All of Us Research Program, Bethesda, MD, USA
| | - Sage J. Kim
- University of Illinois Chicago, Chicago, IL, USA
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18
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Sawaf T, Gudipudi R, Ofshteyn A, Sarode AL, Bingmer K, Bliggenstorfer J, Stein SL, Steinhagen E. Disparities in Clinical Trial Enrollment and Reporting in Rectal Cancer: A Systematic Review and Demographic Comparison to the National Cancer Database. Am Surg 2024; 90:130-139. [PMID: 37670471 DOI: 10.1177/00031348231191175] [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] [Indexed: 09/07/2023]
Abstract
BACKGROUND Cancer care guidelines based on clinical trial data in homogenous populations may not be applicable to all rectal cancer patients. The aim of this study was to evaluate whether patients enrolled in rectal cancer clinical trials (CTs) are representative of United States (U.S.) rectal cancer patients. METHODS Prospective rectal cancer CTs from 2010 to 2019 in the United States were systematically reviewed. In trials with multiple arms reporting separate demographic variables, each arm was considered a separate CT group in the analysis. Demographic variables considered in the analysis were age, sex, race/ethnicity, facility location throughout the United States, rural vs urban geography, and facility type. Participant demographics from trial and the National Cancer Database (NCDB) participants were compared using chi-squared goodness of fit and one-sample t-test where applicable. RESULTS Of 50 CT groups identified, 42 (82%) studies reported mean or median age. Trial participants were younger compared to NCDB patients (P < .001 all studies). All but three trials had fewer female patients than NCDB (48.2% female, P < .001). Less than half the CT groups reported on race or ethnicity. Eighteen out of 22 trials (82%) had a smaller percentage of Black patients and 4 out of 8 (50%) trials had fewer Hispanic or Spanish origin patients than the NCDB. No CTs reported comorbidities, socioeconomic factors, or education. CT primary sites were largely at academic centers and in urban areas. CONCLUSION The present study supports the need for improved demographic representation and transparency in rectal cancer clinical trials.
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Affiliation(s)
- Tuleen Sawaf
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rachana Gudipudi
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anuja L Sarode
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Sharon L Stein
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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19
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Commaroto S, Camacho-Rivera M, Guo Y, Hong YR, Turner K, Islam IK, Rivera A, Islam JY. Racial and ethnic disparities in knowledge, attitudes, and invitation to participate in clinical trials among cancer survivors in the United States: An analysis of the 2020 U.S. HINTS. Prev Med Rep 2024; 37:102564. [PMID: 38205172 PMCID: PMC10776641 DOI: 10.1016/j.pmedr.2023.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Background Despite the use of clinical trials to provide gold-standard evidence of cancer treatment and intervention effectiveness, racial/ethnic minorities are frequently underrepresented participants. Our objective was to evaluate racial/ethnic differences in knowledge and attitudes towards clinical trials among U.S. cancer survivors. Methods We leveraged the 2020 Health Informational National Trends Survey (HINTS) data (February-June 2020), which is a weighted, nationally representative survey of 3865 adults (≥18 years), including cancer survivors. We descriptively evaluated cancer survivor's (n = 553) knowledge of clinical trials, and trusted sources of information regarding clinical trials. Using Poisson regression, we estimated predictors of self-reported knowledge of clinical trials. Results Among cancer survivors, 82 % were NH-White and 60 % self-reported to at least have some knowledge about clinical trials. When asked about factors that would influence their decision to participate in clinical trials, participants across racial groups frequently chose "I would want to get better" and "If the standard care was not covered by my insurance." NH-White (76 %), NH-Black (78 %), and Hispanic/Latinx (77 %) cancer survivors reported their trusted source of information about clinical trials was their health care provider; NH-Asian cancer survivors reported their health care provider (51 %) as well as government health agencies (30 %) as trusted sources. Cancer survivors with only a high school degree were less likely to have any knowledge of clinical trials compared to those with a Baccalaureate degree or more (aPR:0.61;95 % CI:0.45-0.83). Conclusion Health care providers are a trusted source of clinical trial information.
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Affiliation(s)
- Sarah Commaroto
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- University of South Florida Morsani College of Medicine, USA
| | - Marlene Camacho-Rivera
- Department of Community Health, SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- UF Health Cancer Center, Gainesville, FL, USA
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, FL, 33635, USA
| | - Imran K. Islam
- College of Letters and Science, University of Wisconsin Oshkosh, Oshkosh, WI, USA
| | - Argelis Rivera
- Department of Hospital Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 36635, USA
- Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, FL, 33635, USA
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Murphy A, Cottrell-Daniels CC, Awasthi S, Katende E, Park JY, Denis J, Green BL, Yamoah K. Understanding and Addressing Prostate Cancer Disparities in Diagnosis, Treatment, and Outcomes Among Black Men. Cancer Control 2024; 31:10732748241275389. [PMID: 39149902 PMCID: PMC11329981 DOI: 10.1177/10732748241275389] [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: 04/30/2024] [Revised: 07/23/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024] Open
Abstract
Despite advances in screening, diagnosis, and treatment for prostate cancer (PCa), Black men tend to be diagnosed at younger ages, have higher mortality rates, and are at increased risk of recurrence or metastasis compared to their White counterparts. PCa disparities among Black men are caused by a complex interaction of social, behavioral, and biological factors across the public policy, community, organizational, interpersonal, and individual levels. Key contributing factors include mistrust in the health care system, poor communication between patients and providers, low awareness of screening guidelines, and high medical costs. These disparities are further exacerbated by the low representation of Black men in clinical trials, which limits access to high-quality cancer care and generalizability for PCa treatments. In this narrative review of the existing literature, we examined the epidemiology and identified contributing factors, and propose multi-level strategies to address and mitigate disparities among Black men with PCa.
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Affiliation(s)
- Anastasia Murphy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Shivanshu Awasthi
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Esther Katende
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jong Y. Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Justin Denis
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - B. Lee Green
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kosj Yamoah
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
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21
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Struble LM, Potempa K, Lichtenberg PA, Croff RL, Ellis A, Dodge HH. Including Socially Isolated Black, Older Old Adults (Aged 80 and Above) with and without Mild Cognitive Impairment in a Clinical Trial: Recruitment Strategies and Perspectives. J Multidiscip Healthc 2023; 16:3663-3673. [PMID: 38046050 PMCID: PMC10693244 DOI: 10.2147/jmdh.s427946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
Objective This study describes strategies for the recruitment of socially isolated older old Black individuals to participate in the "Internet-based conversational engagement clinical trial (I-CONECT)" (Clinical Trial.gov: NCT02871921) and lessons learned in this critical population segment. Methods Best practice strategies to recruit the target population included mass mailings, advertisements, and direct community outreach, including the collaboration with a community group created to reach Black individuals interested in research participation. We also made protocol changes to measure recruitment criteria for older old Black adults more accurately and to increase their participation. Results Descriptive data related to the challenges and successes in recruiting Black participants compared to the White participants is presented. The primary site contacted 17,523 primarily White potential participants and enrolled/randomized 145 White and 2 Asian/mixed race participants (0.8%). The Midwest site contacted 12,141 Black potential participants and enrolled/randomized 39 (0.3%) participants. Discussion While best practices were employed, several factors complicated recruitment, including the need to adjust recruitment criteria, navigate regional regulations, and respect diverse community preferences. Conclusion Older old African Americans are reachable and willing to participate in research when considering their beliefs and practices, influenced by their community and experience.
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Affiliation(s)
- Laura M Struble
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter A Lichtenberg
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Raina L Croff
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alexis Ellis
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Gupta K, Spertus JA, Birmingham M, Gosch KL, Husain M, Kitzman DW, Pitt B, Shah SJ, Januzzi JL, Lingvay I, Butler J, Kosiborod M, Lanfear DE. Racial Differences in Quality of Life in Patients With Heart Failure Treated With Sodium-Glucose Cotransporter 2 Inhibitors: A Patient-Level Meta-Analysis of the CHIEF-HF, DEFINE-HF, and PRESERVED-HF Trials. Circulation 2023; 148:220-228. [PMID: 37191040 PMCID: PMC10523916 DOI: 10.1161/circulationaha.122.063263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Health status outcomes, including symptoms, function, and quality of life, are worse for Black compared with White patients with heart failure. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular mortality and improve health status in patients with heart failure, but whether the health status benefit of SGLT2is is similar across races is not established. The objective of this study was to compare the treatment effect of SGLT2is (versus placebo) on health status for Black compared with White patients with heart failure. METHODS We combined patient-level data from 3 randomized clinical trials of SGLT2is: DEFINE-HF (Dapagliflozin Effect on Symptoms and Biomarkers in Patients With Heart Failure; n=263), PRESERVED-HF (Dapagliflozin in Preserved Ejection Fraction Heart Failure; n=324), and CHIEF-HF (A Study on Impact of Canagliflozin on Health Status, Quality of Life, and Functional Status in Heart Failure; n=448). These 3 United States-based trials enrolled a substantial proportion of Black patients, and each used the Kansas City Cardiomyopathy Questionnaire (KCCQ) to measure health status at baseline and after 12 weeks of treatment. Among 1035 total participants, selecting self-identified Black and White patients with complete information yielded a final analytic cohort of 935 patients. The primary endpoint was KCCQ Clinical Summary score. Twelve-week change in KCCQ with SGLT2is versus placebo was compared between Black and White patients by testing the interaction between race and treatment using multivariable linear regression models adjusted for trial, baseline KCCQ (as a restricted cubic spline), race, and treatment. The data that support the findings of this study are available from the corresponding author upon reasonable request. RESULTS Among 935 participants, 236 (25%) self-identified as Black, and 469 (50.2%) were treated with an SGLT2i. Treatment with an SGLT2i, compared with placebo, resulted in KCCQ Clinical Summary score improvements at 12 weeks of +4.0 points (95% CI, 1.7-6.3; P=0.0007) in White patients and +4.7 points (95% CI, 0.7-8.7; P=0.02) in Black patients, with no significant interaction by race and treatment (P=0.76). Other KCCQ scales showed similar results. CONCLUSIONS Treatment with an SGLT2i resulted in consistent and significant improvements in health status for both Black and White patients with heart failure.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (K.G., J.A.S., K.L.G., M.K.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (K.G., J.A.S., K.L.G., M.K.)
| | | | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (K.G., J.A.S., K.L.G., M.K.)
| | - Mansoor Husain
- Ted Rogers Centre for Heart Research, Toronto, Canada (M.H.)
| | - Dalane W Kitzman
- Wake Forest University School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor (B.P.)
| | | | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston (J.L.J.)
| | - Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas (I.L.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.)
- University of Mississippi Medical Center, Jackson (J.B.)
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (K.G., J.A.S., K.L.G., M.K.)
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23
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Cobb CBC, Heath CR, Byrd AS, McKinley-Grant LJ, Callender V, Adamson AS, Brown S, Desai SR, Glass DA, Jaleel T, Okoye GA, Taylor SC, Harvey VM. The Skin of Color Society's Meeting the Challenge Summit, 2022: Diversity in Dermatology Clinical Trials Proceedings. JAMA Dermatol 2023; 159:757-762. [PMID: 37223905 DOI: 10.1001/jamadermatol.2023.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Importance Clinical trials remain the cornerstone for determining the safety and efficacy of an intervention. A diverse participant pool in dermatology clinical trials is critical to ensure that results are generalizable among the patient population who will ultimately depend on the efficacy of the intervention. The Skin of Color Society hosted the inaugural Meeting the Challenge Summit: Diversity in Dermatology Clinical Trials in Washington, DC, from June 10 to 11, 2022. The summit was an interactive and collaborative effort to advance discussions regarding the need for broader inclusion of racial and ethnic minority patients in dermatology clinical trials. Observations The summit focused on 3 principal areas: (1) understanding the current clinical trials landscape; (2) breaking down patient, clinician, industry, and regulatory barriers; and (3) effecting change through a diversity-focused strategy. The program hosted thought-provoking panel talks and discussions with various stakeholder groups, including a keynote presentation from the family of Henrietta Lacks. Conclusions and Relevance Panel discussions and insightful presentations from physicians, industry leaders, community trailblazers, and patients fostered new collaborations. The summit provided recommendations and suggested strategies for future initiatives designed to increase the representation of minority individuals in dermatology clinical trials.
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Affiliation(s)
- Caryn B C Cobb
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Candrice R Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Angel S Byrd
- Department of Dermatology, Howard University College of Medicine, Washington, DC
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lynn J McKinley-Grant
- Department of Dermatology, Howard University College of Medicine, Washington, DC
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Valerie Callender
- Department of Dermatology, Howard University College of Medicine, Washington, DC
- Callender Dermatology and Cosmetic Center, Washington, DC
| | - Adewole S Adamson
- Division of Dermatology and Dermatologic Surgery, Dell Medical School at The University of Texas at Austin
| | | | - Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas
- Innovative Dermatology, Dallas, Texas
| | - Donald A Glass
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Ginette A Okoye
- Department of Dermatology, Howard University College of Medicine, Washington, DC
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valerie M Harvey
- Hampton Roads Center for Dermatology, Newport News, Virginia
- Skin of Color Research Institute, Hampton University, Hampton, Virginia
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Riggan KA, Rousseau A, Halyard M, James SE, Kelly M, Phillips D, Allyse MA. "There's not enough studies": Views of black breast and ovarian cancer patients on research participation. Cancer Med 2023; 12:8767-8776. [PMID: 36647342 PMCID: PMC10134334 DOI: 10.1002/cam4.5622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Black breast and ovarian cancer patients are underrepresented in clinical cancer trials disproportionate to the prevalence of these cancers in Black females. Historically, lower enrollment has been attributed to individualized factors, including medical mistrust, but more recently structural factors, including systemic racism, have received additional scrutiny. We interviewed Black women with a personal or family history of breast and ovarian cancer to understand their views and experiences related to research participation. METHODS Qualitative interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to the offer and participation in cancer clinical trials and research studies, impact on cancer care, and recommendations to increase enrollment of Black patients. RESULTS Sixty-one Black women completed an interview. Participants expressed that Black women are underrepresented in cancer research, and that this negatively impacted their own care. Many cited past historical abuses, including the Tuskegee syphilis trial, as a potential factor for lower enrollment but suggested that lower enrollment was better understood in the context of the entirety of their healthcare experiences, including present-day examples of patient mistreatment or dismissal. Participants suggested that proactive community engagement, transparency, and increased representation of Black research team members were strategies likely to foster trust and bolster research participation. CONCLUSION(S) Medical mistrust is only a partial factor in the lower participation of Black patients in cancer research. Researchers should implement the strategies identified by our participants to promote diverse enrollment and ensure that Black patients are included in future therapeutic advances.
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Affiliation(s)
| | - Abigail Rousseau
- Biomedical Ethics Research ProgramMayo ClinicRochesterMinnesotaUSA
| | - Michele Halyard
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
| | - Sarah E. James
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
| | - Marion Kelly
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
- Department of Community EngagementMayo ClinicScottsdaleArizonaUSA
| | - Daphne Phillips
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
- Department of Speech PathologyMayo ClinicPhoenixArizonaUSA
| | - Megan A. Allyse
- Biomedical Ethics Research ProgramMayo ClinicRochesterMinnesotaUSA
- Department of Obstetrics & GynecologyMayo ClinicRochesterMinnesotaUSA
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25
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McClary T, Blee S, Avinger A, Dai Q, Switchenko J, Dixon M, Pentz R. Accounting for the High Enrollment of African Americans on Winship Cancer Institute's Myeloma Clinical Trials. ETHICS, MEDICINE, AND PUBLIC HEALTH 2023; 27:100877. [PMID: 37007841 PMCID: PMC10062432 DOI: 10.1016/j.jemep.2023.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background Thirty-four percent of Multiple Myeloma (MM) clinical trial participants at Winship Cancer Institute (Winship) are African American (AA); however, AAs make up only 4.5 percent of myeloma clinical trial participants in the United States. Given our high enrollment, we aimed to measure AAs' trust in providers and identify if clinical trial enrollment barriers exist. Methodology A member of the ethics research team surveyed AA patients who had consented to a MM clinical trial at Winship. Three validated surveys were used: Trust in Medical Research (TMR); Human Connection (THC) which measures how much patients feel they are heard and valued by their physicians; and the Duke Intrinsic Religiosity Scale (DUREL) which measures strength of religious engagement and belief. The survey also included questions about the impact of side effects, distance to the trial center and trial related costs on the decision to participate in clinical trial. Results Ninety-two percent (61/67) of patients approached consented. The mean TMR score and the mean THC score were significantly higher (P-value < 0.001) than the results obtained in key national surveys (TMR 14.9 compared to 11.65; THC 57.7 compared to 54.6). These two surveys were significantly correlated, meaning trust and human connection increase or decrease in tandem. The 3 religiosity subscale results showed high religiosity (3.84, 4.36, and 4.35 with 5 being the highest score). The mean scores of the importance of the investigational agent's side effects, trial costs, and distance to trial center on the decision to enroll in a clinical trial were also high (8.5, 7.8, and 6.5, respectively, with 10 being the most important). Conclusion In our study population, high trust and human connection overcame other trial participation barriers: strong religious beliefs and concerns about side effects, costs, and travel distance. We present a roadmap to guide investigators to increase human connection, and hopefully trust.
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Affiliation(s)
- T.S. McClary
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
- South University Orlando Campus5900 Lake Ellenor Dr, Orlando Fl 32809
| | - S.M. Blee
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
- Creighton University Medical School2621 Burt Street, Omaha, Nebraska 68178
| | - A.M. Avinger
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
- Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC 27101
| | - Q. Dai
- School of Public Health, Emory University Rollins, 1518, Clifton Road, 30322 Atlanta, GA, USA
| | - J. Switchenko
- School of Public Health, Emory University Rollins, 1518, Clifton Road, 30322 Atlanta, GA, USA
| | - M.D. Dixon
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
| | - R.D. Pentz
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
- Emory University School of Medicine, 100, Woodruff Circle, 30322 Atlanta, GA, USA
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26
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Murong M, Giannopoulos E, Pirrie L, Giuliani ME, Fazelzad R, Bender J, Jones J, Papadakos J. The Experience of Informal Newcomer Cancer Caregivers with Limited Language Proficiency: A Scoping Review. J Immigr Minor Health 2023; 25:436-448. [PMID: 36538206 DOI: 10.1007/s10903-022-01442-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
This scoping review explored what is known about the experiences of informal cancer caregivers (CGs) who are newcomers with limited language proficiency. A literature search was performed in seven databases and the search yielded 11,289 articles. After duplicate removal and title and abstract screening, 216 articles underwent full text review and 57 articles and were synthesized. Most studies (n = 41, 72%) were qualitative and were published in North America (n = 35, 61%). Most CG participants were female (69%) and only 19 studies explicitly identified the CG country of origin. Of those that did, 26% originated from Asia, with most migrating from East Asia. Significant challenges were experienced by newcomer CGs and chief among these were related to communication challenges with HCPs that were exacerbated by a lack of availability of medical interpreters and the complexity of oncology health information. Efforts are needed to better integrate newcomer CGs into cancer care.
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Affiliation(s)
- Mijia Murong
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Eleni Giannopoulos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | - Lorraine Pirrie
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Meredith Elana Giuliani
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada.,The Institute for Education Research, University Health Network, Toronto, Canada.,Department of Radiation of Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jacqueline Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,The Institute for Education Research, University Health Network, Toronto, Canada.
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Varma T, Jones CP, Oladele C, Miller J. Diversity in clinical research: public health and social justice imperatives. JOURNAL OF MEDICAL ETHICS 2023; 49:200-203. [PMID: 35428737 DOI: 10.1136/medethics-2021-108068] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
It is well established that demographic representation in clinical research is important for understanding the safety and effectiveness of novel therapeutics and vaccines in diverse patient populations. In recent years, the National Institutes of Health and Food and Drug Administration have issued guidelines and recommendations for the inclusion of women, older adults, and racial and ethnic minorities in research. However, these guidelines fail to provide an adequate explanation of why racial and ethnic representation in clinical research is important. This article aims to both provide the missing arguments for why adequate representation of racial and ethnic minorities in clinical research is essential and to articulate a number of recommendations for improving diversity going forward.Appropriate racial and ethnic representation and fair inclusion help (1) increase the generalisability of clinical trial results, (2) equitably distribute any benefits of clinical research and (3) enable trust in the research enterprise.
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Affiliation(s)
- Tanvee Varma
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Camara P Jones
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Harvard University Radcliffe Institute for Advanced Study, Cambridge, Massachusetts, USA
| | - Carol Oladele
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Miller
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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McIntire RK, Keith SW, Nowlan T, Butt S, Cambareri K, Callaghan J, Halstead T, Chandrasekar T, Kelly WK, Leader AE. Predictors of consenting to participate in a clinical trial among urban cancer patients. Contemp Clin Trials 2023; 125:107061. [PMID: 36567059 DOI: 10.1016/j.cct.2022.107061] [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: 09/06/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patient participation in clinical trials is influenced by demographic and other individual level characteristics. However, there is less research on the role of geography and neighborhood-level factors on clinical trial participation. This study identifies the demographic, clinical, geographic, and neighborhood predictors of consenting to a clinical trial among cancer patients at a large, urban, NCI-designated cancer center in the Mid-Atlantic region. METHODS We used demographic and clinical data from patients diagnosed with cancer between 2015 and 2017. We geocoded patient addresses and calculated driving distance to the cancer center. Additionally, we linked patient data to neighborhood-level educational attainment, social capital and cancer prevalence. Finally, we used generalized linear mixed-effects conditional logistic regression to identify individual and neighborhood-level predictors of consenting to a clinical trial. RESULTS Patients with higher odds of consenting to trials were: Non-Hispanic White, aged 50-69, diagnosed with breast, GI, head/neck, hematologic, or certain solid tumor cancers, those with cancers at regional stage, never/former tobacco users, and those with the highest neighborhood social capital index. Patients who lived further from the cancer center had higher odds of consenting to a trial. With every 1-km increase in residential distance, there was a 4% increase in the odds that patients would consent to a trial. Neither of the additional neighborhood-level variables predicted consenting to a clinical trial. CONCLUSIONS This study identifies important demographic, patient-level, and geographic factors associated with consenting to cancer clinical trials, and lays the groundwork for future research exploring the role of neighborhood-level factors in clinical trial participation.
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Affiliation(s)
- Russell K McIntire
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America.
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology, Physiology, & Cancer Biology, Thomas Jefferson University, 130 S 9(th) St., 17(th) Floor, Philadelphia, PA 19107, United States of America
| | - Thomas Nowlan
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Seif Butt
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Katherine Cambareri
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Joseph Callaghan
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Tiara Halstead
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Thenappan Chandrasekar
- Department of Urology, Thomas Jefferson University, 1025 Walnut Street, Suite 1112, Philadelphia, PA 19107, United States of America
| | - Wm Kevin Kelly
- Division of Solid Tumor Oncology, Department of Medical Oncology, Thomas Jefferson University, 925 Chestnut Street, Suite 220A, Philadelphia, PA 19107, United States of America
| | - Amy E Leader
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Benjamin Franklin House, Suite 320, Philadelphia, PA 19107, United States of America
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Varma T, Mello M, Ross JS, Gross C, Miller J. Metrics, baseline scores, and a tool to improve sponsor performance on clinical trial diversity: retrospective cross sectional study. BMJ MEDICINE 2023; 2:e000395. [PMID: 36936269 PMCID: PMC9951369 DOI: 10.1136/bmjmed-2022-000395] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023]
Abstract
Objective To develop a measure for fair inclusion in pivotal trials by assessing transparency and representation of enrolled women, older adults (aged 65 years and older), and racially and ethnically minoritized patients. Design Retrospective cross sectional study. Population Sponsors of novel oncology therapeutics that were approved by the US Food and Drug Administration over 1 January 2012 to 31 December 2017. Data sources Trial data from Drugs@FDA, ClinicalTrials.gov, and corresponding publications; cancer incidence demographics from US Cancer Statistics and the American Cancer Society. Main outcome measures Transparency measures assess whether trials publicly report participant sex, age, and racial and ethnic identity. Representation measures assess whether trial participant demographics represent more than 80% of the US patient population for studied conditions, calculated by dividing the percentage of study participants in each demographic subgroup by the percentage of the US cancer population with the studied condition per group. Composite fair inclusion measures assess average transparency and representation scores, overall and for each demographic group. Results are reported at the trial, product, and sponsor levels. Results Between 1 January 2012 and 31 December 2017, the FDA approved 59 novel cancer therapeutics, submitted by 25 sponsors (all industry companies) on the basis of 64 pivotal trials. All 25 sponsors (100%) reported participant sex, 10 (40%) reported age, and six (24%) reported race and ethnicity. Although 14 (56%) sponsors had adequate representation of women in trials, only six (24%) adequately represented older adults, and four (16%) adequately represented racially and ethnically minoritized patients (black, Asian, Hispanic or Latinx). On overall fair inclusion, one sponsor scored 100% and the median sponsor score was 81% (interquartile range 75-87%). More than half of sponsors (13 (56%) of 25) fairly included women, 20% (n=5) fairly included older adults, and 4% (n=1) fairly included racially and ethnically minoritized patients in trials. 80% of product had pivotal trials that fairly included women, 24% fairly included older adults, and 5% fairly included racially and ethnically minoritized patients. Conclusions This novel approach evaluates trials, products, and sponsors on their fair inclusion of demographic groups in research. For oncology trials, substantial room was noted for improved inclusion of older adults and patients who identify as black or Latinx and transparency around the number of participants identifying as Native Hawaiian, Pacific Islander, American Indian, and Alaska Native. These measures can be used by sponsors, ethics committees, among others, to set and evaluate trial diversity goals to help spur progress toward greater research equity in the US.
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Affiliation(s)
| | - Michelle Mello
- Stanford University Law School, Stanford, CA, USA
- School of Medicine, Stanford University, Stanford, CA, USA
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Joseph S Ross
- Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale New Haven Hospital, New Haven, CT, USA
- Yale University School of Public Health, New Haven, CT, USA
| | - Cary Gross
- Yale University School of Public Health, New Haven, CT, USA
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Jennifer Miller
- Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Program for Biomedical Ethics; Yale Center for Interdisciplinary Bioethics, Yale School of Medicine, New Haven, CT, USA
- Bioethics International, New York, NY, USA
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
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Garg T, Gong AJ, Khalil A, Gowda PC, Weinstein RM, Holly BP, Weiss CR. Racial and Ethnic Disparities among Participants in Hepatocellular Carcinoma Clinical Studies Evaluating Transarterial Therapies. J Vasc Interv Radiol 2023; 34:4-10.e3. [PMID: 36167300 DOI: 10.1016/j.jvir.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/31/2022] [Accepted: 09/17/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the racial and ethnic representation of transarterial therapy for hepatocellular carcinoma (HCC) clinical trials in the United States. MATERIALS AND METHODS The ClinicalTrials.gov database was examined to identify all completed studies with transarterial therapies for the management of HCC in the United States and extract information about the observed number of participants for each racial and ethnic group (based on the Office of Management and Budget definitions). The expected number of participants was calculated by multiplying the total number of participants in a trial with the U.S.-population HCC-based proportion for each group. The effects of the study phase, funding source, number of centers involved in the study, and the location of the participating center on racial and ethnic distribution were explored. RESULTS Seventy-nine relevant studies were identified, of which 27 (34.2%) and 18 (22.8%) reported ethnic and race characteristics, respectively. Most study participants were White (81%, 1,591/1,964) by ethnicity and not Hispanic or Latino (93%, 937/1,008) by race. In terms of the observed-to-expected ratios by race and ethnicity in all trials, White and not Hispanic or Latino participants were overrepresented with a ratio of 1.22 (1.10-1.37) and 1.33 (1.26-1.41), respectively, and all other racial and ethnic groups were underrepresented. The enrollment of African Americans and Asian Americans varied by the study phase, and a higher enrollment of African Americans was noted in the National Institutes of Health-funded and multicenter studies (P < .05). CONCLUSIONS This cross-sectional study demonstrates that in HCC transarterial therapy clinical trials, racial and ethnic minorities were underrepresented and the majority of the studies identified failed to report this demographic information.
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Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland. https://twitter.com/gargtushark
| | - Anna J Gong
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adham Khalil
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Prateek C Gowda
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert M Weinstein
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian P Holly
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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BrintzenhofeSzoc K, Canin B, Casas-Silva E, Denicoff A, Braun-Inglis C, Okado I, Bakos A. Through the Lens of Patient Partners: Challenges in Accrual of Older Adults to NCI Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:125-134. [PMID: 36519817 PMCID: PMC9949584 DOI: 10.1093/jncimonographs/lgac022] [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: 05/27/2022] [Revised: 08/15/2022] [Accepted: 09/11/2022] [Indexed: 12/23/2022] Open
Abstract
The workshop "Engaging Older Adults in Cancer Clinical Trials Conducted in the NCI Clinical Trials Network: Challenges and Opportunities" included a Patient Stakeholder Workgroup that explored the needs and concerns of older adults with cancer regarding clinical trials. To accomplish this, the workgroup conducted patient focus groups in which participants were interviewed, recorded conversations were analyzed and coded, and salient themes were identified. The focus groups identified general barriers to accrual such as complex consent forms, general communication, restrictive eligibility, nonreferrals, patient costs, cultural insensitivity, limited accessibility in community settings, and transportation issues. They also identified the influence of knowledgeable information presenters, improved care, family or caregiver support, and the desire to help others as drivers or reasons to participate in clinical trials. The workshop concluded that multi-level interventions could be used to increase the accrual of older adults to National Cancer Institute clinical trials as well as others.
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Affiliation(s)
- Karlynn BrintzenhofeSzoc
- Correspondence to: Karlynn BrintzenhofeSzoc, PhD, MSW, FAOSW, University of Louisville, 2301 S. 3rd St, Louisville, KY 40292, USA (e-mail: )
| | - Beverly Canin
- SCOREboard Patient Advocate Board, The Cancer and Aging Research Group, USA
| | - Esmeralda Casas-Silva
- Center for Biomedical Informatics and Information Technology, Informatics and Data Science Program, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
| | - Andrea Denicoff
- Division of Cancer Treatment and Diagnosis, Cancer Therapy and Evaluation Program, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
| | - Christa Braun-Inglis
- Clinical Faculty, UH Nancy Atmospera-Walch School of Nursing, University of Hawaii Cancer Center/Hawaii M/U NCORP, Honolulu, HI, USA
| | - Izumi Okado
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Alexis Bakos
- Division of Cancer Prevention, Community Oncology and Prevention Trials Research Group, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
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Ahn JC, Lauzon M, Luu M, Noureddin M, Ayoub W, Kuo A, Sundaram V, Kosari K, Nissen N, Gong J, Hendifar A, Roberts LR, Abou-Alfa GK, Singal AG, Yang JD. Racial and ethnic disparities in early treatment with immunotherapy for advanced HCC in the United States. Hepatology 2022; 76:1649-1659. [PMID: 35429171 DOI: 10.1002/hep.32527] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Immunotherapy has emerged as an effective treatment for patients with advanced-stage HCC. We aimed to investigate the efficacy of immunotherapy for advanced HCC in a nationwide cohort and racial and ethnic disparities in access to immunotherapy. APPROACH AND RESULTS We used the US National Cancer Database to identify patients with tumor-node-metastasis stage 3 or 4 HCC between 2017 and 2018. We performed multivariable Cox regression to identify factors associated with overall survival (OS) and logistic regression to identify factors associated with receipt of immunotherapy. Of the 3,990 patients treated for advanced HCC, 3,248 (81.4%) patients received chemotherapy and 742 (18.6%) patients received immunotherapy as a first-line treatment. Immunotherapy was associated with improved OS compared with chemotherapy (adjusted HR: 0.76, 95% CI: 0.65-0.88) after adjusting for covariates. There were racial and ethnic disparities in access to immunotherapy, with Hispanic (adjusted OR [aOR]: 0.63, 95% CI: 0.46-0.83) and Black patients (aOR: 0.71, 95% CI: 0.54-0.89) less likely to receive immunotherapy compared with White patients. There was a significant interaction between race-ethnicity and facility type, with higher disparity observed in nonacademic centers (interaction p = 0.004). CONCLUSIONS Immunotherapy was associated with improved OS compared with chemotherapy in advanced HCC. There are significant disparities in early access to immunotherapy, likely due to differential access to clinical trials and experimental therapies. A comprehensive approach to monitoring and eliminating racial-ethnic disparities in the management of advanced HCC is urgently needed.
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Affiliation(s)
- Joseph C Ahn
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Marie Lauzon
- 22494Biostatistics and Bioinformatics Research CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Michael Luu
- 22494Biostatistics and Bioinformatics Research CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Mazen Noureddin
- 22494Comprehensive Transplant CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Karsh Division of Gastroenterology and HepatologyCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Walid Ayoub
- 22494Comprehensive Transplant CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Karsh Division of Gastroenterology and HepatologyCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Alexander Kuo
- 22494Comprehensive Transplant CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Karsh Division of Gastroenterology and HepatologyCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Vinay Sundaram
- 22494Comprehensive Transplant CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Karsh Division of Gastroenterology and HepatologyCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Kambiz Kosari
- 22494Comprehensive Transplant CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Department of SurgeryCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Nicholas Nissen
- 22494Comprehensive Transplant CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Department of SurgeryCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jun Gong
- 22494Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Andrew Hendifar
- 22494Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Lewis R Roberts
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Ghassan K Abou-Alfa
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA.,Department of MedicineWeill Medical College at Cornell UniversityNew YorkNew YorkUSA
| | - Amit G Singal
- Harold C. Simmons Comprehensive Cancer CenterUT Southwestern Medical CenterDallasTexasUSA.,Division of Digestive and Liver DiseasesUT Southwestern Medical CenterDallasTexasUSA
| | - Ju Dong Yang
- 22494Comprehensive Transplant CenterCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Karsh Division of Gastroenterology and HepatologyCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,22494Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
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LILLEY CULLENM, DELILLE MINERVE, MIRZA KAMRANM, PARILLA MEGAN. Toward a More Just System of Care in Molecular Pathology. Milbank Q 2022; 100:1192-1242. [PMID: 36454130 PMCID: PMC9836258 DOI: 10.1111/1468-0009.12587] [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: 02/02/2022] [Revised: 05/09/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
Abstract
Policy Points American health care policy must be critically assessed to establish the role it plays in sustaining and alleviating the health disparities that currently exist in molecular genetic testing. It is critical to understand the economic and sociocultural influences that drive patients to undergo or forgo molecular testing, especially in marginalized patient populations. A multipronged solution with actions necessary from multiple stakeholders is required to reduce the cost of health care, rebalance regional disparities, encourage physician engagement, reduce data bias, and earn patients' trust. CONTEXT The health status of a population is greatly influenced by both biological processes and external factors. For years, minority and low socioeconomic patient populations have faced worse outcomes and poorer health in the United States. Experts have worked extensively to understand the issues and find solutions to alleviate this disproportionate burden of disease. As a result, there have been some improvements and successes, but wide gaps still exist. Diagnostic molecular genetic testing and so-called personalized medicine are just now being integrated into the current American health care system. The way in which these tests are integrated can either exacerbate or reduce health disparities. METHODS We provide case scenarios-loosely based on real-life patients-so that nonexperts can see the impacts of complex policy decisions and unintentional biases in technology without needing to understand all the intricacies. We use data to explain these findings from an extensive literature search examining both peer-reviewed and gray literature. FINDINGS Access to diagnostic molecular genetic testing is not equitable or sufficient, owing to at least five major factors: (1) cost to the patient, (2) location, (3) lack of provider buy-in, (4) data-set bias, and (5) lack of public trust. CONCLUSIONS Molecular genetic pathology can be made more equitable with the concerted efforts of multiple stakeholders. Confronting the five major factors identified here may help us usher in a new era of precision medicine without its discriminatory counterpart.
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Affiliation(s)
| | | | - KAMRAN M. MIRZA
- Loyola University Chicago, Strich School of Medicine
- Loyola Medical Center
| | - MEGAN PARILLA
- Loyola University Chicago, Strich School of Medicine
- Loyola Medical Center
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Nouvini R, Parker PA, Malling CD, Godwin K, Costas-Muñiz R. Interventions to increase racial and ethnic minority accrual into cancer clinical trials: A systematic review. Cancer 2022; 128:3860-3869. [PMID: 36107740 PMCID: PMC10456972 DOI: 10.1002/cncr.34454] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Racial and ethnic minorities (REMs) continue to be underrepresented in clinical trials despite the 1993 National Institutes of Health's Revitalization Act mandating the representation of women and underrepresented minority groups in clinical trials. Although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates are disproportionately low at 4% to 6% and 3% to 6%, respectively. A systematic review exploring interventions aimed at improving cancer clinical trial (CCT) enrollment for REMs was conducted. METHODS A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English-language studies since 1993. Inclusion criteria included peer-reviewed, US-based studies with interventions aimed to recruit underrepresented minority adult patients into cancer clinical trials. REM groups were defined as Black, Hispanic, Asian, American Indian, and Native Hawaiian/other Pacific Islander. RESULTS The systematic search identified 3123 studies, of which nine met inclusion criteria. Interventions included patient navigation/coaching (n = 4), a clinical trial educational video (n = 2), institutional research infrastructure changes (n = 1), a relationship building and social marketing recruitment model (n = 1), and cultural competency training for providers (n = 1). A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos and an institutional research infrastructure change. CONCLUSIONS This systematic review illustrates several potential mechanisms by which to increase CCT recruitment for patients of REM backgrounds in various clinical settings. More randomized controlled trials are needed to further explore the benefits of these interventions for REMs.
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Affiliation(s)
- Rosa Nouvini
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Kendra Godwin
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Salomon RE, Dobbins S, Harris C, Haeusslein L, Lin CX, Reeves K, Richoux S, Roussett G, Shin J, Dawson-Rose C. Antiracist symptom science: A call to action and path forward. Nurs Outlook 2022; 70:794-806. [PMID: 36400578 PMCID: PMC10916506 DOI: 10.1016/j.outlook.2022.07.014] [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: 04/06/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
Nurse scientists recognize the experience of racism as a driving force behind health. However, symptom science, a pillar of nursing, has rarely considered contributions of racism. Our objective is to describe findings within symptom science research related to racial disparities and/or experiences of racism and to promote antiracist symptom science within nursing research. In this manuscript, we use an antiracist lens to review a predominant symptom science theory and literature in three areas of symptom science research-oncology, mental health, and perinatal health. Finally, we make recommendations for increasing antiracist research in symptom science by altering (a) research questions, (b) recruitment methods, (c) study design, (d) data analysis, and (e) dissemination of findings. Traditionally, symptom science focuses on individual level factors rather than broader contexts driving symptom experience and management. We urge symptom science researchers to embrace antiracism by designing research with the specific intent of dismantling racism at multiple levels.
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Affiliation(s)
- Rebecca E Salomon
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Sarah Dobbins
- San Francisco Department of Public Health, San Francisco, California
| | | | | | - Chen-Xi Lin
- University of California, San Francisco, San Francisco, California
| | - Katie Reeves
- University of California, San Francisco, San Francisco, California
| | - Sarah Richoux
- University of California, San Francisco, San Francisco, California
| | - Greg Roussett
- University of California, San Francisco, San Francisco, California
| | - Joosun Shin
- University of California, San Francisco, San Francisco, California
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Cunningham-Erves J, Kusnoor SV, Villalta-Gil V, Stallings SC, Ichimura JS, Israel TL, Harris PA, Wilkins CH. Development and pilot implementation of guidelines for culturally tailored research recruitment materials for African Americans and Latinos. BMC Med Res Methodol 2022; 22:248. [PMID: 36153481 PMCID: PMC9508728 DOI: 10.1186/s12874-022-01724-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies support cultural tailoring of recruitment materials as a strategy to promote the enrollment of minoritized groups in clinical trials. However, there is a lack of guidance for research teams to create culturally tailored materials, potentially contributing to low recruitment rates of minoritized groups. We describe the development and pilot testing of recruitment material guidelines used to culturally tailor clinical trial recruitment materials targeting African Americans and Latinos. Methods The guideline development team consisted of investigators, research staff, and community leaders and members experienced in the recruitment and community engagement of minoritized groups. The recruitment material guidelines were developed using the literature, focus groups with African Americans and Latinos, the teams’ research experience, and guidance from a community advisory board. To assess the effectiveness of the guidelines, a pilot study was conducted comparing advertisement click-through rates and enrollment outcomes between two institutions differing in use of culturally tailored versus non-tailored Facebook banner ads for the “Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness” (ADAPTABLE) study. Results Five themes emerged from focus groups: (1) employ diversity and inclusion in recruitment efforts; (2) access multiple recruitment channels to increase reach and possible participation; (3) increase your “footwork”; (4) personalize outreach and recruitment to specific groups’ beliefs and values; (5) align recruitment messaging with language preferences and motivations for study participation; and (6) specify incentives for participation. Guidelines were: 1) be inclusive; 2) use all forms of media; 3) take a personalized approach; 4) align recruitment messaging with motivations for study participation; 5) specify incentives; and 6) get out into the community. Additional guidelines were developed addressing specific considerations for images and language when targeting African American and Latino populations. Pilot study results demonstrated that clicks per impression ratio (0.47 clicks per impression vs. 0.03 clicks per impression) and the percentage of African American enrollment were significantly higher when using tailored compared to non-tailored ads (12.8% vs. 8.3%, respectively). Conclusion The recruitment material guidelines offer practical recommendations to reach diverse populations for clinical trial participation more effectively. Our preliminary data supports use of these guidelines as a strategy to enhance recruitment of minoritized groups into clinical research studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01724-4.
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Chowdhury-Paulino IM, Ericsson C, Vince R, Spratt DE, George DJ, Mucci LA. Racial disparities in prostate cancer among black men: epidemiology and outcomes. Prostate Cancer Prostatic Dis 2022; 25:397-402. [PMID: 34475523 PMCID: PMC8888766 DOI: 10.1038/s41391-021-00451-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/09/2022]
Abstract
Prostate cancer has the widest racial disparities of any cancer, and these disparities appear at every stage of the cancer continuum. This review focuses on the disparities in prostate cancer between Black and White men, spanning from prevention and screening to clinical outcomes. We conduct an expansive review of the literature on racial disparities in prostate cancer, interpret the findings, and discuss areas of unmet need in research. We provide an overview of epidemiologic concepts necessary to understanding the current state of prostate cancer disparities, discuss the complexities of studying race, and review potential drivers of disparities in incidence and mortality. We argue that the cause of this disparity is multifactorial and due to a combination of social and environmental factors. The path forward needs to focus on enrolling and retaining Black men in prostate cancer clinical trials and observational studies and identifying potential interventions to improve prevention and clinical outcomes in Black men.
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Affiliation(s)
| | - Caroline Ericsson
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston MA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Daniel E. Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH,Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Daniel J. George
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston MA
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Rudolph KE, Russell M, Luo SX, Rotrosen J, Nunes EV. Under-representation of key demographic groups in opioid use disorder trials. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100084. [PMID: 36187300 PMCID: PMC9524855 DOI: 10.1016/j.dadr.2022.100084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/15/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
Background The extent to which clinical trials of medications for opioid use disorder (MOUD) are representative or not is unknown. Some patient characteristics modify MOUD effectiveness; if these same characteristics differ in distribution between the trial population and usual-care population, this could contribute to lack of generalizability-a discrepancy between trial and usual-care effectiveness. Our objective was to identify interpretable, multidimensional subgroups who were prescribed MOUD in substance use treatment programs in the US but who were not represented or under-represented by clinical trial participants. Methods This was a secondary descriptive analysis of trial and real-world data. The trial data included twenty-seven US opioid treatment programs in the National Drug Abuse Treatment Clinical Trials Network, N = 2,199 patients. The real-world data included US substance use treatment programs that receive public funding, N = 740,015 patients. We characterized real-world patient populations who were non-represented and under-represented in the trial data in terms of sociodemographic and clinical characteristics that could modify MOUD effectiveness. Results We found that 10.7% of MOUD patients in TEDS-A were not represented in the three clinical trials. As expected, pregnant MOUD patients (n = 19,490) were not represented. Excluding pregnancy, education and marital status from the characteristics, 2.6% of MOUD patients were not represented. Patients aged 65 years and older (n = 11,204), and those 50-64 years who identified as other (non-White, non-Black, and non-Hispanic) race/ethnicity or multi-racial (n = 7,281) were under-represented. Conclusions Quantifying and characterizing non- or under-represented subgroups in trials can provide the data necessary to improve representation in future trials and address research-to-practice gaps.
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Affiliation(s)
- Kara E Rudolph
- Department of Epidemiology, Columbia University, 722 W 168th St, Room 522, New York, NY 10032, United States
| | - Matthew Russell
- Department of Epidemiology, Columbia University, 722 W 168th St, Room 522, New York, NY 10032, United States
| | - Sean X Luo
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, New York, United States
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, United States
| | - Edward V Nunes
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, New York, United States
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Li G, Zhang J, Van Spall HGC, Douglas PS, Wang Y, Sun X, Thabane L. Exploring ethnic representativeness in diabetes clinical trial enrolment from 2000 to 2020: a chronological survey. Diabetologia 2022; 65:1461-1472. [PMID: 35705796 PMCID: PMC9200441 DOI: 10.1007/s00125-022-05736-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/07/2022] [Indexed: 02/05/2023]
Abstract
AIMS/HYPOTHESIS Ethnic representativeness of participant enrolment in diabetes RCTs involving multiple ethnicities remains unknown. The aims of this study were to evaluate the status and temporal trend of ethnic representativeness in enrolment to diabetes RCTs, and to assess under-enrolment of non-white ethnic groups and explore trial characteristics associated with under-enrolment. METHODS We conducted a chronological survey by systematically searching the literature to include eligible RCTs published between January 2000 and December 2020. We assessed temporal trends in enrolment of ethnic groups in the included trials. Univariable logistic regression was used to explore the association between trial characteristics and under-enrolment of non-white groups, using a participant to prevalence ratio of <0.8 to define under-enrolment. This study was registered in PROSPERO (CRD42021229100). RESULTS We included 405 RCTs for analysis (327 multi-country trials, 69 conducted in the USA and nine conducted in the UK). The median enrolment rate of all non-white groups was 24.0% in the overall RCTs. Trials conducted in the USA and the UK had median enrolment rates of 29.0% and 12.0% for all non-white groups, respectively. There was a temporal trend towards increased participation of non-white ethnic groups in the overall RCTs; however, no significant improvement over time was found in the US or UK trials. Non-white groups were under-enrolled in most included trials: 62.3% (43/69) in US trials and 77.8% (7/9) in UK trials. The US trials with a high female proportion were associated with lower odds of under-enrolment of all non-white groups (OR 0.22; 95% CI 0.07, 0.65), while trials receiving funding from industry showed increased odds of under-enrolment (OR 4.64; 95% CI 1.50, 14.35). Outpatient enrolment and intervention duration were significantly associated with under-enrolment of Black participants. Only a small proportion of trials reported subgroup results or explored the effect modification by ethnicity. CONCLUSIONS/INTERPRETATION A temporal trend towards increased non-white ethnic enrolment was found in diabetes RCTs globally, but not in the USA or the UK. Non-white ethnic groups were under-represented in the majority of diabetes trials conducted in the USA and the UK. Some trial characteristics may be associated with non-white under-enrolment in diabetes trials. These findings provide some evidence for non-white ethnic representativeness in diabetes trials over the past two decades, and highlight the need for more effective strategies and endeavours to alleviate under-enrolment of non-white ethnic groups.
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Affiliation(s)
- Guowei Li
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Jingyi Zhang
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pamela S Douglas
- Duke University Clinical Research Institute, Duke University, Durham, NC, USA
| | - Yaoyao Wang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Graham L, Ngwa J, Ntekim O, Ogunlana O, Johnson S, Nadarajah S, Fungwe TV, Turner J, Ruiz MR, Khan J, Obisesan TO. The Role of Transportation in the Enrollment of Elderly African Americans into Exercise and Memory Study: GEMS Study. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01367-7. [PMID: 35931916 DOI: 10.1007/s40615-022-01367-7] [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: 02/24/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Understanding the factors driving recruitment and enrollment of African Americans (AA)s in clinical translational research will assure that underrepresented populations benefit from scientific progress and new developments in the diagnosis and treatment of Alzheimer's disease and related disorders. While transportation is pivotal to volunteers' ability to participate in research, its contribution to enrollment in exercise studies on AD is yet to be elucidated. Thus, this research focuses on identifying factors that influence the recruitment and enrollment of African Americans in biomedical studies and determining whether the availability of transportation motivates participation in time-demanding exercise studies on AD. METHODS We analyzed recruitment data collected from 567 volunteers ages 55 and older screened through various recruitment sources and considered for enrollment in our exercise and memory study. To determine whether transportation influenced the enrollment of African Americans (AA)s in biomedical studies, multiple logistic regression analysis was performed to identify significant factors that drive enrollment. Furthermore, the association of race and demographic factors on the availability of transportation was assessed. RESULTS Demographic factors, age at screening, education, gender, and cognitive scores were not significantly different among those enrolled compared to control (not-enrolled). In the relationship of enrollment to transportation, enrolled participants were more likely to have access to transportation (79.12%) than not-enrolled participants who had less access to transportation (71.6%); however, the association was not statistically significant. However, race differentially influenced the likelihood of enrollment, with elderly AAs being significantly less likely to have transportation (p = 0.020) than the Whites but more likely than "others" to have transportation. CONCLUSION Our findings suggest that access to transportation may be a key factor motivating enrollment in an exercise and memory study in a predominantly AA sample. Notably, AAs in our sample were less likely to have transportation than Whites. Other demographic factors and cognitive scores did not significantly influence enrollment in our sample. A larger sample and more detailed assessment of transportation are needed to further discern the role of transportation in clinical trials.
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Affiliation(s)
- Lennox Graham
- Department of Health Management, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Julius Ngwa
- Division of Cardiovascular Medicine, College of Medicine, Howard University, Washington, DC, 20059, USA
| | - Oyonumo Ntekim
- Department of Nutritional Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Oludolapo Ogunlana
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Steven Johnson
- Department of Nutritional Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Sheeba Nadarajah
- Department of Nursing, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Thomas V Fungwe
- Department of Nutritional Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Jillian Turner
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Mara Ramirez Ruiz
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Javed Khan
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Thomas O Obisesan
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
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Scarinci IC, Hansen B, Green BL, Sodeke SO, Price-Haywood EG, Kim YI. Willingness to participate in various nontherapeutic cancer research activities among urban and rural African American and Latinx healthy volunteers. Cancer Causes Control 2022; 33:1059-1069. [PMID: 35404020 DOI: 10.1007/s10552-022-01576-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Inclusion of racial/ethnic minorities in cancer research can reduce disparities in health outcomes; however, data regarding barriers and motivators to participation are sparse. This study assessed African American (AA) and Latinx healthy volunteers' perspectives regarding willingness to participate in noninvasive and invasive research activities. METHODS Using a 38-item questionnaire adapted from the Tuskegee Legacy Project Questionnaire, we assessed willingness to participate in 12 research activities, offering 27 possible barriers and 14 motivators. The sample was segmented into four subgroups by AA/Latinx and rural/urban. RESULTS Across five states and Puerto Rico, 533 participants completed questionnaires. Overall, participants were more willing to participate in noninvasive versus invasive procedures, although, all subgroups were willing to participate in research if asked. Rural AA were most willing to complete a survey or saliva sample, while rural Latinx were least willing. Urban AA were least willing to provide cheek swab, while rural counterparts were most willing. Self-benefit and benefit to others were among the top three motivators for all subgroups. Curiosity was a primary motivator for urban AA while obtaining health information motivated rural Latinx. Primary barriers included fears of side effects and being experimented on, lack of information, and lack of confidentiality. CONCLUSIONS Latinx and AAs are willing to participate in the continuum of nontherapeutic research activities suggesting their lack of participation may be related to not being asked. Inclusive enrollment may be achieved by assessing needs of participants during the design phase of a study in order to reduce barriers to participation.
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Affiliation(s)
- Isabel C Scarinci
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, 10360F, Birmingham, Albama, 35249, USA.
| | - Barbara Hansen
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, 10360F, Birmingham, Albama, 35249, USA
| | | | | | | | - Young-Il Kim
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, 10360F, Birmingham, Albama, 35249, USA
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Jackson CG, Moore KN, Cantrell L, Erickson BK, Duska LR, Richardson DL, Landrum LM, Holman LL, Walker JL, Mannel RS, Moxley KM, Queimado L, Cohoon A, Ding K, Dockery LE. A phase II trial of bevacizumab and rucaparib in recurrent carcinoma of the cervix or endometrium. Gynecol Oncol 2022; 166:44-49. [PMID: 35491267 PMCID: PMC10428664 DOI: 10.1016/j.ygyno.2022.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the tolerability and efficacy of combination bevacizumab rucaparib therapy in patients with recurrent cervical or endometrial cancer. PATIENTS & METHODS Thirty-three patients with recurrent cervical or endometrial cancer were enrolled. Patients were required to have tumor progression after first line treatment for metastatic, or recurrent disease. Rucaparib was given at 600 mg BID twice daily for each 21-day cycle. Bevacizumab was given at 15 mg/kg on day 1 of each 21-day cycle. The primary endpoint was efficacy as determined by objective response rate or 6-month progression free survival. RESULTS Of the 33 patients enrolled, 28 were evaluable. Patients with endometrial cancer had a response rate of 17% while patients with cervical cancer had a response rate of 14%. Median progression free survival was 3.8 months (95% C·I 2.5 to 5.7 months), and median overall survival was 10.1 months (95% C·I 7.0 to 15.1 months). Patients with ARID1A mutations displayed a better response rate (33%) and 6-month progression free survival (PFS6) rate (67%) than the entire study population. Observed toxicity was similar to that of previous studies with bevacizumab and rucaparib. CONCLUSIONS The combination of bevacizumab with rucaparib did not show significantly increased anti-tumor activity in all patients with recurrent cervical or endometrial cancer. However, patients with ARID1A mutations had a higher response rate and PFS6 suggesting this subgroup may benefit from the combination of bevacizumab and rucaparib. Further study is needed to confirm this observation. No new safety signals were seen.
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Affiliation(s)
- C G Jackson
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K N Moore
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L Cantrell
- Division of Gynecologic Oncology, University of Virginia, Department of Obstetrics and Gynecology; Charlottesville, VA, USA
| | - B K Erickson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota; Minneapolis, MN, USA
| | - L R Duska
- Division of Gynecologic Oncology, University of Virginia, Department of Obstetrics and Gynecology; Charlottesville, VA, USA
| | - D L Richardson
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L M Landrum
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L L Holman
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - J L Walker
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - R S Mannel
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K M Moxley
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L Queimado
- Department of Otolaryngology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - A Cohoon
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L E Dockery
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina; Chapel Hill, NC, USA.
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Sauer AB, Daher GS, Lohse CM, Glasgow AE, Habermann EB, Douse DM, Moore EJ, Ighodaro ET, Van Abel KM, Yin LX. Underreporting and Underrepresentation of Race and Ethnicity in Head and Neck Cancer Trials, 2010-2020: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2022; 148:662-669. [PMID: 35653143 DOI: 10.1001/jamaoto.2022.1028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is substantial evidence demonstrating racial disparities in the survival outcomes of patients with head and neck cancer. The reporting and representation of race and ethnicity in cancer trials is crucial for generalizability of trial results to patient care and reduction of racial health disparities in head and neck cancers. Racial disparities in oncologic outcomes across various therapeutic interventions may only manifest when diverse races are appropriately represented in trials. Objective To characterize the reporting and representation of race and ethnicity in head and neck cancer clinical trials. Evidence Review A systematic search of published trials and those available on ClinicalTrials.gov was conducted to identify 3973 studies from 2010 to 2020. Title, abstract, and full-text review yielded 155 trials for data extraction of patient demographics. Year of publication, type of intervention, publication source, and funding source were also collected. Race and ethnicity data were compared with Surveillance, Epidemiology, and End Results (SEER) Program cancer registry data. Findings Of the 155 included studies, only 89 (57%) reported race or ethnicity. Only 81 (52%) of the studies reported detailed classification of race or ethnicity per the US Census Bureau classification scheme. Race and ethnicity reporting varied considerably with year of publication, type of intervention, data source, and funding source. Studies in the latter half of the decade were more likely to report race or ethnicity (odds ratio, 2.78; 95% CI, 1.33-5.80), with the highest number in 2019 (24 of 30 [80%] trials), followed by 2020 (20 of 29 [69%] trials). Among the possible interventions, trials on therapeutic chemoradiation most frequently reported race or ethnicity (11 of 12 [92%]), followed by supportive drug trials (22 of 31 [71%]), and then therapeutic chemotherapy trials (28 of 48 [58%]). When compared with SEER data, race and ethnicity distribution in clinical trials showed fewer Black patients (10% vs 8%) and Asian or Pacific Islander patients (6% vs 2%). Conclusions and Relevance In this systematic review, nearly half of head and neck cancer trials in the past decade did not report the race or ethnicity of participants. Participation of Black and Asian or Pacific Islander patients does not adequately reflect the US population's head and neck cancer demographics, limiting the generalizability of trial results and adding to racial health disparities in patients with head and neck cancers.
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Affiliation(s)
- Adam B Sauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ghazal S Daher
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Amy E Glasgow
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Dontre' M Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Arring NM, Aduse-Poku L, Jiagge E, Saylor K, White-Perkins D, Israel B, Walker EM, Hinebaugh A, Harb R, DeWitt J, Molnar M, Wilson-Powers E, Brush BL. A Scoping Review of Strategies to Increase Black Enrollment and Retention in Cancer Clinical Trials. JCO Oncol Pract 2022; 18:614-632. [DOI: 10.1200/op.21.00863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To address health disparities faced by Black patients with cancer, it is critical that researchers conducting cancer clinical trials (CCTs) equitably recruit and retain Black participants, develop strategies toward this aim, and document associated outcomes. This narrative scoping literature review, as part of a larger study, aimed to identify, describe, and categorize strategies and interventions intended to improve the recruitment and retention of Black participants with breast, lung, prostate, colorectal, or multiple myeloma cancer into CCTs. We conducted comprehensive searches in PubMed, Embase, Cochrane Library, PsycInfo, CINAHL, Scopus, and Web of Science with three main concepts: Black persons, neoplasms, and clinical trial recruitment. The search resulted in 1,506 articles, of which 15 met inclusion criteria. Five main categories of recruitment and retention strategies and interventions were identified based on their specific population focus and type of approach: (1) participant identification, (2) provider awareness/resources, (3) focused research staff interventions, (4) patient and community–focused awareness strategies, and (5) participant-directed resources. Thirteen studies had recruitment acceptance rates of over 30%. Eight studies with acceptance rates of ≥ 50% reported implementing ≥ 5 strategies, with an average use of seven strategies across multiple categories. Five studies with acceptance rates ≥ 50% implemented strategies in ≥ 3 categories. Four studies reported retention rates ≥ 74%. Three studies with reported retention rates ≥ 74% used strategies in ≥ 3 categories, and all included strategies aimed at meeting participant needs beyond the study. Our results show that many efforts that aim to increase the recruitment and retention of Black participants into CCTs have great potential, but the most promising strategies use a multiprong approach.
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Affiliation(s)
| | | | | | - Kate Saylor
- University of Michigan Library, Ann Arbor, MI
| | | | - Barbara Israel
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | | | - Rayya Harb
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Maxim Molnar
- University of Michigan School of Nursing, Ann Arbor, MI
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Marshall C, Havis I, Herreshoff E, Lewis C, Kotagal V. Racial Differences in Trust and Risk Disclosure Preferences Among Older Registered Research Volunteers Screened for Prodromal Synucleinopathies. Gerontol Geriatr Med 2022; 8:23337214221094184. [PMID: 35601119 PMCID: PMC9121461 DOI: 10.1177/23337214221094184] [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: 01/20/2022] [Revised: 03/16/2022] [Accepted: 03/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background/Objectives The equitable enrollment of minority participants in synucleinopathy trials is an emerging public health concern. Differing views regarding risk disclosure may influence research involvement in at-risk adults. Methods We conducted a brief mailed survey, including questions about trust and hypothetical risk disclosure preferences, to 100 participants in the Healthier Black Elders Center cohort in Detroit, MI and 100 participants in the Claude D. Pepper Older Americans Independence Center Research Participant Program at the University of Michigan. Results 125 recipients without a diagnosis of a neurodegenerative disorder returned the survey, 52 (41.6%) of whom identified as being Black or African American. Black respondents reported less trust in medical providers (t=2.02, p=0.045) and medical researchers (t=2.52, p=0.013) and a greater desire to be informed about the presence of unchangeable risk factors for neurodegenerative disorders (t=2.02, p=0.045). Conclusions These findings have implications for the recruitment of representative populations in prodromal neurodegenerative research.
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Affiliation(s)
- Carly Marshall
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Isabelle Havis
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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Morris A, Shah KS, Enciso JS, Hsich E, Ibrahim NE, Page R, Yancy C. HFSA Position Statement The Impact of Healthcare Disparities on Patients with Heart Failure. J Card Fail 2022; 28:1169-1184. [PMID: 35595161 DOI: 10.1016/j.cardfail.2022.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 01/17/2023]
Abstract
Heart Failure (HF) remains a condition associated with high morbidity, mortality, and associated costs. Although the number of medical and device-based therapies available to treat HF are expanding at a remarkable rate, disparities in the risk for incident HF and treatments delivered to patients are also of growing concern. These disparities span across racial and ethnic groups, socioeconomic status, and apply across the spectrum of HF from Stage A to Stage D. The complexity of HF risk and treatment is further impacted by the number of patients who experience the downstream impact of social determinants of health. The purpose of this document is to highlight the known healthcare disparities that exist in the care of patients with HF, and to provide a context for how clinicians and researchers should assess both biologic and social determinants of HF risk in vulnerable populations. Furthermore, this document will provide a framework for future steps that can be utilized to help diminish inequalities in access and clinical outcomes over time, and offer solutions to help reduce disparities within HF care.
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Affiliation(s)
| | | | | | | | | | - Robert Page
- 1462 Clifton Road Suite 504, Atlanta GA 30322
| | - Clyde Yancy
- 1462 Clifton Road Suite 504, Atlanta GA 30322
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DeFilippis EM, Echols M, Adamson PB, Batchelor WB, Cooper LB, Cooper LS, Desvigne-Nickens P, George RT, Ibrahim NE, Jessup M, Kitzman DW, Leifer ES, Mendoza M, Piña IL, Psotka M, Senatore FF, Stein KM, Teerlink JR, Yancy CW, Lindenfeld J, Fiuzat M, O’Connor CM, Vardeny O, Vaduganathan M. Improving Enrollment of Underrepresented Racial and Ethnic Populations in Heart Failure Trials: A Call to Action From the Heart Failure Collaboratory. JAMA Cardiol 2022; 7:540-548. [PMID: 35319725 PMCID: PMC9098689 DOI: 10.1001/jamacardio.2022.0161] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Despite bearing a disproportionate burden of heart failure (HF), Black and Hispanic individuals have been poorly represented in HF clinical trials. Underrepresentation in clinical trials limits the generalizability of the findings to these populations and may even introduce uncertainties and hesitancy when translating trial data to the care of people from underrepresented groups. The Heart Failure Collaboratory, a consortium of stakeholders convened to enhance HF therapeutic development, has been dedicated to improving recruitment strategies for patients from diverse and historically underrepresented groups. Observations Despite federal policies from the US Food and Drug Administration and National Institutes of Health aimed at improving trial representation, gaps in trial enrollment proportionate to the racial and ethnic composition of the HF population have persisted. Increasing trial globalization with limited US enrollment is a major driver of these patterns. Additional barriers to representative enrollment include inequities in care access, logistical issues in participation, restrictive enrollment criteria, and English language requirements. Conclusions and Relevance Strategies for improving diverse trial enrollment include methodical study design and site selection, diversification of research leadership and staff, broadening of eligibility criteria, community and patient engagement, and broad stakeholder commitment. In contemporary HF trials, diverse trial enrollment is not only feasible but can be efficiently achieved to improve the generalizability and translation of trial knowledge to clinical practice.
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Affiliation(s)
- Ersilia M. DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Melvin Echols
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Richard T. George
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Eric S. Leifer
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martin Mendoza
- Office of Minority Health, US Department of Health and Human Services (HHS), Bethesda, Maryland
| | | | | | - Fortunato Fred Senatore
- Center for Drug Evaluation and Research, Food and Drug Administration, Division of Cardiovascular and Renal Products, Silver Spring, Maryland
| | | | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | | | - Mona Fiuzat
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Christopher M. O’Connor
- Inova Heart and Vascular Institute, Falls Church, Virginia
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Zanfardino S, Mazziotto V, Bodas P. Black Americans' willingness to participate in pediatric sickle cell clinical trials: A retrospective, systematic review. Pediatr Blood Cancer 2022; 69:e29580. [PMID: 35188337 DOI: 10.1002/pbc.29580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/19/2021] [Accepted: 12/31/2021] [Indexed: 11/07/2022]
Abstract
Black individuals are underrepresented in randomized clinical trials (RCTs). Willingness to participate is a frequently cited explanation. However, the few studies that have investigated willingness to participate demonstrated no difference between Black individuals and other groups. We sought to measure willingness to participate by focusing on sickle cell disease (SCD), in which approximately 90% of affected individuals are Black. We conducted an analysis of 17 RCTs. A level of clarity was defined and correlated with each article's transparency in reporting patient enrollment data. Calculated measures of acceptance ranged from 32% to 93.5%. Calculated completion rates ranged from 58.8% to 100%. Weighted measures of acceptance and completion were 59.1% and 83.8%, respectively. Our study is limited by focusing solely on studies pertinent to SCD and only a minority of publications reviewed provided sufficient patient enrollment data. Yet, our results suggest that decreased willingness to participate does not account for underrepresentation of Black individuals.
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Affiliation(s)
- Sara Zanfardino
- Department of Hematology and Oncology at Akron Children's Hospital, Akron, Ohio, USA
| | - Volha Mazziotto
- Department of Hematology and Oncology at Akron Children's Hospital, Akron, Ohio, USA
| | - Prasad Bodas
- Department of Hematology and Oncology at Akron Children's Hospital, Akron, Ohio, USA
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Accrual and Retention of Diverse Patients in Psychosocial Cancer Clinical Trials. J Clin Transl Sci 2022; 6:e45. [PMID: 35651964 PMCID: PMC9108002 DOI: 10.1017/cts.2022.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Minority and older adult patients remain underrepresented in cancer clinical trials (CCTs). The current study sought to examine sociodemographic inequities in CCT interest, eligibility, enrollment, decline motivation, and attrition across two psychosocial CCTs for gynecologic, gastrointestinal, and thoracic cancers. Methods: Patients were approached for recruitment to one of two interventions: (1) a randomized control trial (RCT) examining effects of a cognitive-behavioral intervention targeting sleep, pain, mood, cytokines, and cortisol following surgery, or (2) a yoga intervention to determine its feasibility, acceptability, and effects on mitigating distress. Prospective RCT participants were queried about interest and screened for eligibility. All eligible patients across trials were offered enrollment. Patients who declined yoga intervention enrollment provided reasons for decline. Sociodemographic predictors of enrollment decisions and attrition were explored. Results: No sociodemographic differences in RCT interest were observed, and older patients were more likely to be ineligible. Eligible Hispanic patients across trials were significantly more likely to enroll than non-Hispanic patients. Sociodemographic factors predicted differences in decline motivation. In one trial, individuals originating from more urban areas were more likely to prematurely discontinue participation. Discussion: These results corroborate evidence of no significant differences in CCT interest across minority groups, with older adults less likely to fulfill eligibility criteria. While absolute Hispanic enrollment was modest, Hispanic patients were more likely to enroll relative to non-Hispanic patients. Additional sociodemographic trends were noted in decline motivation and geographical prediction of attrition. Further investigation is necessary to better understand inequities, barriers, and best recruitment practices for representative CCTs.
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Hagström J, Woodford J, von Essen A, Lähteenmäki P, von Essen L. Opt-out rates and reasons for non-participation in a single-arm feasibility trial (ENGAGE) of a guided internet-administered CBT-based intervention for parents of children treated for cancer: a nested cross-sectional survey. BMJ Open 2022; 12:e056758. [PMID: 35365530 PMCID: PMC8977820 DOI: 10.1136/bmjopen-2021-056758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Difficulties with recruitment into clinical trials are common. An opt-out recruitment strategy, whereby potential participants can decline further contact about a study (opt-out), and non-responders are contacted, may facilitate participation. Primary objectives examined opt-out and consent rates, mode and time point of opt-out, and sociodemographic characteristics of those who opted out versus those who chose to participate in a single-arm feasibility trial (ENGAGE) of a guided, internet-administered, cognitive-behavioural therapy-based intervention for parents of children treated for cancer. Secondary objectives examined reasons for non-participation. DESIGN A cross-sectional survey nested within the ENGAGE feasibility trial. SETTING The intervention was delivered from Uppsala University, with parents located throughout Sweden. PARTICIPANTS Potential participants were recruited 3 months-5 years following their child ending treatment for cancer and were identified via their personal identification number (via the Swedish Childhood Cancer Registry and Swedish Tax Agency) and invited via postal invitation packs and could opt out via post, online, telephone or email. Those who did not opt out or consent, within 4 weeks, received up to five telephone calls and/or one postal reminder. RESULTS Of 509 invited, 164 (32.2%) opted out, 78 (47.6%) via post, 53 (32.3%) via telephone, 24 (14.6%) online, and 6 (3.7%) via email, 88 (53.7%) opted out after at least one telephone call and/or postal reminder. There was a trend for parents with lower educational levels to opt out. No need of psychological support, lack of time, and no interest in internet-administered self-help were frequently reported reasons for non-participation. CONCLUSIONS Results emphasise the importance of using different opt-out modes and suggest future research should consider how to widen study participation for parents with lower education levels. Self-identifying a need for psychological support and the acceptability of internet-administered self-help are important factors for participation and should be considered in future research to increase recruitment. TRIAL REGISTRATION NUMBER ISRCTN57233429.
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Affiliation(s)
- Josefin Hagström
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Agnes von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Päivi Lähteenmäki
- Department of Paediatrics and Adolescent Medicine, TYKS Turku University Hospital, Turku, Finland
- Pediatric Oncology and Pediatric Surgery, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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