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Ledesma BR, Thomas J, Ghomeshi A, Saltzman RG, Almatari A, White J, Arbelaez MCS, Ramasamy R. Exploring representation of underrepresented minority men in a restorative therapy clinical trial for erectile dysfunction: addressing barriers and promoting inclusion. Int J Impot Res 2024; 36:458-462. [PMID: 37516799 DOI: 10.1038/s41443-023-00747-9] [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: 05/31/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
This retrospective descriptive analysis explores underrepresented minority men in our clinical trial for restorative therapy for erectile dysfunction and to identify strategies to promote diversity and inclusion in the study population. Demographic data were collected from all participants and the prevalence in our population was compared to the source population. The proportion of individuals taking part in our clinical trial was compared to the overall disease population using the participation to prevalence ratio. Among the 61 participants enrolled in the Platelet-Rich Plasma for Erectile Dysfunction trial, 72.1% were Hispanic compared to 39.9% in the national source population. There were 27.9% non-Hispanic participants, and 41.2% non-Hispanic men in the local South Florida population. The racial composition of our study shows 80.3% of PRP participants identify as White, 16.4% as Black, and 3.4% as Asian. In the national source population, 61.8% of patients were White, 27.5% are black, and 1.5% are Asian. Through the implementation of strategies such as having Hispanic team members on the clinical trial staff and providing education and outreach materials both in Spanish and English, we were able to overcome barriers to participation in Hispanic men and potentially improve health outcomes for underrepresented minority men with erectile dysfunction.
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Affiliation(s)
- Braian R Ledesma
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jamie Thomas
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Armin Ghomeshi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Russell G Saltzman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abraham Almatari
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Joshua White
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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2
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Sinha A, Barwell L, Jeffery H, Peterson Z, Shifa B, Attia M, Badawy K, Purushotham A. Inclusivity of patients in early phase breast cancer clinical trials. J Cancer Policy 2024; 41:100494. [PMID: 39038736 DOI: 10.1016/j.jcpo.2024.100494] [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: 02/01/2024] [Revised: 05/14/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Studies have shown that certain groups of patients are underrepresented in clinical trials including non-Caucasian ethnicity, poor fluency in English, low socioeconomic status, older age, neurodivergence, and large Body Mass Index (BMI). There is a need to ensure adequate representation of these groups so that the results of any trial accurately reflect the population. The aim of this study was to review the pathway of patients recruited into two early phase breast cancer clinical and determine the inclusivity of patients from the aforementioned sub-groups. METHODS The Breast Cancer Research Database was reviewed, and the characteristics of all patients who were screened for eligibility in two early phase clinical trials was examined. The English Indices of Deprivation was used to populate the Index of Multiple Deprivation (IMD) for each patient using their postcode. RESULTS In total, 392 patients were eligible to participate, between September 2020 to May 2023. Of these, 144 (36.7%) were recruited to these two trials. In all, 100% of patients eligible for these trials were approached and screened for participation. Eligible patients had a mean age of 53.5 years. Recruited patients were younger on average than those not recruited (49.1 years vs 56.0 years, p<0.0001). Only one recruited patient required an interpreter, compared with 24 (9.7%%) of those who were not recruited (p<0.001). There was no difference in the IMD (p=0.38), BMI (p=0.34) and neurodiversity (p=0.10) between patients recruited into clinical trials and those who were not. CONCLUSION Older age and poor fluency in the English language remain barriers to participation in early-phase clinical trials despite implementing a clear pathway to trial recruitment. There is a pressing need to address these barriers by raising awareness, improve appropriate training and providing comprehensive trial information to patients in the language of their choice.
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Affiliation(s)
- A Sinha
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - L Barwell
- King's College London, London, United Kingdom
| | - H Jeffery
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Z Peterson
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - B Shifa
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - M Attia
- Guy's and St Thomas' NHS Foundation Trust, United Kingdom; Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - K Badawy
- King's College London, London, United Kingdom
| | - A Purushotham
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom.
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3
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Sheikh S, Bruno DS, Sun Y, Deng V, McClelland S, Obi E, Vinson V, Firstencel A, Lanese B, Lausin L, Dorth JA, Zaorsky NG, Hoy K, Krishnamurthi S. Impact of Clinical Trial Design on Recruitment of Racial and Ethnic Minorities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02440-x. [PMID: 38637443 DOI: 10.1007/s13187-024-02440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
Knowledge related to how oncology treatment trial design influences enrollment of racial and ethnic minorities is limited. Rigorous identification of clinical trial design parameters that associate favorably with minority accrual provides educational opportunities for individuals interested in designing more representative treatment trials. We identified oncology trials with a minimum of 10 patients at an NCI-Designated Comprehensive Cancer Center from 2010 to 2021. We defined a study endpoint of racial and ethnic minority accrual greater than zero. Multivariable logistic regression was used to determine whether co-variables predicted our study endpoint. P-values of less than 0.05 were considered significant. A total of 352 cancer trials met eligibility criteria. These studies enrolled a total of 7981 patients with a total of 926 racial and ethnic minorities leading to a median enrollment of 10%. Trials open in community sites (yes versus no) were more likely to have a minority patient (OR, 2.21; 95% CI, 1.02-4.96) as well as pilot/phase I studies compared to phase II/III (OR, 3.19; 95% CI, 1.34-8.26). Trials incorporating immunotherapy (yes versus no) were less likely to have a minority patient (OR, 0.47; 95% CI, 0.23-0.94). Trials open in community sites as well as early phase treatment studies were more likely to accrue minority patients. However, studies including immunotherapy were less likely to accrue racial and ethnic minorities. Knowledge gained from our analysis may help individuals design oncology treatment trials that are representative of more diverse populations.
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Affiliation(s)
- Saad Sheikh
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh PA, 15232, USA.
| | - Debora S Bruno
- Department of Hematology and Medical Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Yilun Sun
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Victoria Deng
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Shearwood McClelland
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Elizabeth Obi
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Valerie Vinson
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - April Firstencel
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Bob Lanese
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Loretta Lausin
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Jennifer A Dorth
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Kevin Hoy
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Smitha Krishnamurthi
- Department of Hematology and Medical Oncology, Case Comprehensive Cancer Center, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, 44195, USA
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Lee SS, Dinicu AI, Arthurs L, Shields D, Pothuri B, Lightfoot MDS. Demographic reporting and language exclusion in gynecologic oncology clinical trials. Am J Obstet Gynecol 2024; 230:73.e1-73.e14. [PMID: 37751830 DOI: 10.1016/j.ajog.2023.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Participation in clinical trials may help mitigate disparate cancer outcomes. Thus, ensuring equitable access to clinical trials is a major priority for national cancer organizations. OBJECTIVE This study aimed to examine clinical trial eligibility criteria that may adversely affect the enrollment of underrepresented groups and assess the availability of demographic information in published gynecologic oncology studies. STUDY DESIGN ClinicalTrials.gov was searched for gynecologic oncology studies conducted between 1997 and 2021. Each study's inclusion and exclusion criteria were reviewed to determine whether demographic factors were used for enrollment screening. For published studies, demographic variables that were reported were identified. The expected clinical trial enrollment based on disease incidence and mortality was compared with the observed trial enrollment based on race. RESULTS There were 1597 gynecologic oncology studies: 883 (55%) from ovarian cancer studies, 336 (21%) from cervical cancer studies, 262 (17%) from uterine cancer studies, and 116 (7%) from multisite gynecologic oncology studies. Of the 581 published studies, 554 (95%) reported age, 363 (63%) reported race, and 171 (29%) reported ethnicities. Cervical cancer studies were most likely to report demographic information, including race (P=.026) and ethnicity (P<.001). During the study period, 189 studies (12%) excluded patients based on the language spoken. Industry-sponsored trials (odds ratio, 0.07; 95% confidence interval, 0.02-0.30) and organization-sponsored trials (odds ratio, 0.40; 95% confidence interval, 0.22-0.73) were less likely to exclude patients because of language than investigator-initiated trials. A minority of patients (37%) in cervical cancer trials were of White race, compared with 85% of patients in uterine cancer trials and 82% of patients in ovarian cancer trials. CONCLUSION Over the last 3 decades, 1 in 10 gynecologic oncology trials excluded patients because of language. Race and ethnicity were reported in more than half of the available studies. Initiatives to increase transparency in recruiting underrepresented patients and reporting demographic data are urgently needed.
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Affiliation(s)
- Sarah S Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY
| | - Andreea I Dinicu
- Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Bhavana Pothuri
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY
| | - Michelle D S Lightfoot
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY.
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5
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Seixas A, Richards S, Moore JQ, Izeogu C, Hollimon LA, Jin P, Jean-Louis G. Precision Recruitment and Engagement of Individuals at Risk for Diabetes and Hypertension in Clinical Trials (PREDHICT): A Randomized Trial for an E-Persuasive Mobile Application to Inform Decision Making about Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7115. [PMID: 38063545 PMCID: PMC10706176 DOI: 10.3390/ijerph20237115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/23/2023] [Accepted: 11/04/2023] [Indexed: 12/18/2023]
Abstract
The primary objective of this randomized trial was to test the effectiveness of the PREDHiCT digital application, which provides educational and supportive navigation to increase willingness to participate in a future clinical trial. The second objective was to test whether PREDHiCT increased clinical trial literacy or enhanced psychological facilitators of clinical trial participation, such as altruism. To test these two objectives, we conducted a 1-month remote decentralized trial with 100 participants who either have a personal or family history of cardiometabolic health conditions, such as hypertension, diabetes, and obesity. Results indicated significant changes in altruism (mean: -2.94 vs. 0.83; p-value = 0.011) and clinical trial literacy (mean: 0.55 vs. 2.59; p-value = 0.001) from baseline to 1-month follow-up between the control and intervention groups. Additionally, participants exposed to personalized clinical trial navigation had greater clinical trial literacy at the end of the study relative to the individuals in the control arm of the study. Our findings indicate that tailored education, navigation, and access to clinical trials-three unique features of our PREDHiCT app-increased altruism and clinical trial literacy but not willingness to participate in a trial.
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Affiliation(s)
- Azizi Seixas
- Department of Informatics and Health Data Science, Miller School of Medicine, University of Miami, Miami, FL 33136, USA (L.A.H.)
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Shannique Richards
- Clinical Psychology, City College, City University of New York, New York, NY 10031, USA;
| | - Jesse Q. Moore
- Department of Informatics and Health Data Science, Miller School of Medicine, University of Miami, Miami, FL 33136, USA (L.A.H.)
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Chigozirim Izeogu
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Laronda A. Hollimon
- Department of Informatics and Health Data Science, Miller School of Medicine, University of Miami, Miami, FL 33136, USA (L.A.H.)
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Peng Jin
- Department of Population Health, NYU Grossmann School of Medicine, New York, NY 10016, USA
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
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Johnson RR, D'Abundo ML, Cahill TF, DeLuca DA. Understanding organizational perspectives from clinical research stakeholders involved in recruitment for biopharmaceutical-sponsored clinical trials in the United States: Recommendations for organizational initiatives to improve access and inclusivity in clinical research. Contemp Clin Trials Commun 2023; 33:101148. [PMID: 37313113 PMCID: PMC10258233 DOI: 10.1016/j.conctc.2023.101148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 06/15/2023] Open
Abstract
Background Equitable representation of racially and ethnically diverse subpopulations in clinical trials continues to be a problem, and trial participants do not always reflect the demographics of the population that the investigational product will be used to treat. The imperativeness of equitable representation of clinically relevant populations in clinical trials has implications for improving health outcomes, increasing knowledge about the safety and efficacy of new treatments across a wider population, and broadening access to innovative treatment options offered in clinical trials. Methods The purpose of this study was to understand organizational elements that are involved in the active implementation of racially and ethnically diverse inclusive recruitment practices for biopharmaceutical-funded trials in the United States. Semi-structured, in-depth interviews were used in this qualitative study. The interview guide was designed to explore the perceptions, practices and experiences of 15 clinical research site professionals related to recruiting diverse trial participants. Data analysis utilized an inductive coding process. Results Five themes were identified pertaining to the actual implementation of inclusive recruitment practices that provided explanations for organizational components: 1) provision of culturally appropriate, general disease and clinical trial education 2) organizational structure tailored for diverse recruitment 3) strong sense of mission related to improving healthcare through clinical research 4) culture of inclusion 5) inclusive recruitment practices evolving based on learning. Conclusion The findings from this study offer insight into improving access to clinical trials by focusing on organizational change initiatives.
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Affiliation(s)
- Rebecca R. Johnson
- Global Patient and Site Solutions, IQVIA, 100 IMS Drive, Parsippany, NJ, 07054, USA
| | - Michelle L. D'Abundo
- Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University, 123 Metro Boulevard, Nutley, NJ, 07110, USA
| | - Terrence F. Cahill
- Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University, 123 Metro Boulevard, Nutley, NJ, 07110, USA
| | - Deborah A. DeLuca
- Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University, 123 Metro Boulevard, Nutley, NJ, 07110, USA
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7
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Corneli A, Hanlen-Rosado E, McKenna K, Araojo R, Corbett D, Vasisht K, Siddiqi B, Johnson T, Clark LT, Calvert SB. Enhancing Diversity and Inclusion in Clinical Trials. Clin Pharmacol Ther 2023; 113:489-499. [PMID: 36628990 DOI: 10.1002/cpt.2819] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/01/2022] [Indexed: 01/12/2023]
Abstract
Women and people from most racial and ethnic groups in the United States have historically been under-represented in clinical trials of investigational medical products. Inadequate representation of these groups may lead to an incomplete understanding of the safety and efficacy of new drugs, devices, biologics, and vaccines, and limit the generalizability of trial findings. As a result, new medical products may not be beneficial to all people who need them, and existing inequities in outcomes among various population groups may remain unchanged or worsen, or new disparities may arise. Although much work has focused on study-level strategies, research organizations must make systemic changes to how clinical trials are envisioned and implemented to achieve sustainable support for diversity and inclusion in clinical trials. The Clinical Trials Transformation Initiative (CTTI) conducted interviews with leaders at institutions that conduct clinical trials to explore perspectives on organizational-level practices that promote diversity and inclusion in clinical trials. Leaders described motivations, such as an ethical and moral imperative; organizational practices, such as staff investment and resource allocation; perceived return on investments, such as better science; and deterrents, such as cost and time. The CTTI also convened an expert meeting to discuss the interview findings and provide guidance. We present the interview findings and expert guidance in a framework that describes four key areas-commitment, partnerships, accountability, and resources-on sustaining organizational-level approaches for improving diversity and inclusion in clinical trials, with the ultimate goal of advancing health equity. Institutions who conduct and support clinical trials should implement organizational-level approaches to improve equitable access and diverse patient participation in clinical trials.
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Affiliation(s)
- Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Duke University, Durham, North Carolina, USA
| | - Emily Hanlen-Rosado
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Richardae Araojo
- United States Food and Drug Administration, Silver Springs, Maryland, USA
| | - Dawn Corbett
- National Institutes of Health, Rockville, Maryland, USA
| | - Kaveeta Vasisht
- United States Food and Drug Administration, Silver Springs, Maryland, USA
| | - Bernadette Siddiqi
- Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | | | | | - Sara B Calvert
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Duke University, Durham, North Carolina, USA
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8
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Kaljo K, Ngui EM, Treat R, Rader JS. Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC): Diversifying the Clinical Cancer Research Workforce. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:370-377. [PMID: 35083731 PMCID: PMC9314452 DOI: 10.1007/s13187-021-02127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
A lack of diversity in the clinical cancer workforce causes undue burden limiting research and patient care advancements. Recruitment and retention of individuals underrepresented in medicine/research can enhance patient-provider concordance. The Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC) uniquely prepares underrepresented minority students to quickly transition into the clinical research workforce and seek advanced graduate degrees. Experiential learning theory and culturally responsive pedagogy ground SPARCC's rigorous competency-based curriculum incorporating cancer care, clinical trial development, social supports, and mentored research experiences. Concurrent mixed-methods analysis includes evaluations of workshops, clinical-practicums, and pre-, post-, and 6-month-post-knowledge, attitudes, and practices. Analysis of data included stepwise multivariate regression analysis, Spearman's rho correlations, and assessments of inter-item reliability via Cronbach's alpha (IBM® SPSS® 24.0). Inductive content analysis coded phrases and analytic patterns were distilled enhancing descriptions of experiences. From January 2019 to March 2019, 62% of applications came from underrepresented minorities. Ten students were accepted, 90% identified as underrepresented minority. All ten students completed the pre-, post-, and 6-month-post-evaluations. Overall scores increased significantly from pre-evaluation to 6-month-post-evaluation. Evaluation data came from 431 responses of 60 workshops, with a mean score of 9.1 (10-point scale). Students completed three clinical practicums, which received an overall mean score of 8.2 (10-point scale). A robust curriculum, structured recruitment, diverse faculty, and comprehensive evaluations made SPARCC a compelling strategy for supporting underrepresented minority students to seek immediate employment as clinical research professionals or application to advanced graduate degree programs.
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Affiliation(s)
- Kristina Kaljo
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53202, USA.
| | - Emmanuel M Ngui
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Robert Treat
- Office of Academic Affairs, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Janet S Rader
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
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9
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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: 18] [Impact Index Per Article: 9.0] [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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10
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An evaluation of race-based representation among men participating in clinical trials for prostate cancer and erectile dysfunction. Contemp Clin Trials Commun 2022; 29:100986. [PMID: 36092973 PMCID: PMC9450121 DOI: 10.1016/j.conctc.2022.100986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Inclusion of ethnic/racial minorities in clinical trials is essential to fully assess therapeutic efficacy. It is well-known that populations respond dissimilarly to interventions. Our objective is to analyze the inclusion of minority men in clinical trials for erectile dysfunction (ED). Methods We searched ClinicalTrials.gov for the disease keyword: "Erectile Dysfunction" and used "Prostate Cancer" for comparison. Completed trials which reported demographic data were included for analysis. Literature was reviewed to determine the prevalence of ED and prostate cancer (PC) among Hispanic, Black, White, and Asian men. The proportion of individuals of each group that participated in trials is divided by the proportion of each group in the disease population to calculate the "Participation to Prevalence Ratio" (PPR). PPRs between 0.8 and 1.2 indicates adequate representation, <0.8 is under-representation and >1.2 is over-representation. Results A total of 312 trials were assessed: 289 for prostate cancer and 23 for ED. Hispanic men comprised 11.8% of ED trial participants and 4.6% of prostate cancer trial participants, yet represented 18% of ED patients and 7.3% of PC patients. Black/African-American (AA) men accounted for 10.2% of ED trial participants and 9.4% of PC trial participants, but comprise 16% of ED patients, and 16.3% of PC patients. Hispanic and AA men are under-represented in trials for ED and Prostate Cancer (Hispanic ED PPR = 0.66; Hispanic PC PPR = 0.63; AA ED PPR = 0.64; AA PC PPR = 0.58). Conclusion Our analysis shows that both Hispanic and AA men are underrepresented in both ED and PC clinical trials.
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Key Words
- AA, Black/African American
- Andrology
- CBPR, Community Based Participatory Research
- Clinical Trials
- Diversity
- ED, Erectile Dysfunction
- FDA, United States Food and Drug Administration
- Generalizability
- Health equity
- ICD 10, International Classification of Disease, Tenth Revision
- NCI, National Cancer Institute
- NIH, United States National Institutes of Health
- PC, Prostate Cancer
- PPR, Participation to Prevalence Ratio
- RQ, Representation Quotients
- URM, Under-represented Minority
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11
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Hasson Charles RM, Sosa E, Patel M, Erhunmwunsee L. Health Disparities in Recruitment and Enrollment in Research. Thorac Surg Clin 2022; 32:75-82. [PMID: 34801198 PMCID: PMC8611804 DOI: 10.1016/j.thorsurg.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite advances in thoracic oncology research, the benefits of new discoveries are not universally experienced. A lack of representation of racial/ethnic minorities and individuals of low socioeconomic status in clinical trials and thoracic research contributes to persistent health care disparities. It is critical that improved racial, ethnic, and socioeconomic diversity is achieved in our trials and research, if we are to attain generalizability of findings and reduction of health care disparities. Culturally tailored and community-based approaches can help improve recruitment and enrollment of marginalized groups in thoracic research, which is an essential step toward achieving health equity and advancing medical science.
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Affiliation(s)
- Rian M. Hasson Charles
- Dartmouth-Hitchcock Medical Center Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756
| | - Ernesto Sosa
- City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte CA 91010
| | - Meghna Patel
- City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte CA 91010
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12
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Stewart BA, Stewart JH. Disparities in Clinical Trial Participation: Multilevel Opportunities for Improvement. Surg Oncol Clin N Am 2021; 31:55-64. [PMID: 34776064 DOI: 10.1016/j.soc.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Current data demonstrate ongoing inequities in surgical oncology clinical trials and understanding these disparities is vital to creating a more just and equitable health care system. Analysis of participatory patterns in cooperative group surgical oncology trials demonstrates complex relationships between race, socioeconomic status, and participation in these trials at the patient level. Further analysis reveals that provider-level implicit bias plays a significant role in access to clinical trials by minority populations. Holistic approaches to addressing disparities in clinical trial participation include creating a more robust pipeline of minority surgeon-scientists, engaging in partnerships with community advocates, and promoting public policy.
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Affiliation(s)
- Brooke A Stewart
- Department of Psychology, Appalachian State University, Boone, NC, USA
| | - John H Stewart
- Louisiana State University, New Orleans School of Medicine; Louisiana State University New Orleans- Louisiana Children's Medical Center Cancer Center, New Orleans, Louisiana, USA.
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13
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Harnessing electronic health records to study emerging environmental disasters: a proof of concept with perfluoroalkyl substances (PFAS). NPJ Digit Med 2021; 4:122. [PMID: 34381160 PMCID: PMC8357930 DOI: 10.1038/s41746-021-00494-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/27/2021] [Indexed: 01/09/2023] Open
Abstract
Environmental disasters are anthropogenic catastrophic events that affect health. Famous disasters include the Seveso disaster and the Fukushima-Daiichi nuclear meltdown, which had disastrous health consequences. Traditional methods for studying environmental disasters are costly and time-intensive. We propose the use of electronic health records (EHR) and informatics methods to study the health effects of emergent environmental disasters in a cost-effective manner. An emergent environmental disaster is exposure to perfluoroalkyl substances (PFAS) in the Philadelphia area. Penn Medicine (PennMed) comprises multiple hospitals and facilities within the Philadelphia Metropolitan area, including over three thousand PFAS-exposed women living in one of the highest PFAS exposure areas nationwide. We developed a high-throughput method that utilizes only EHR data to evaluate the disease risk in this heavily exposed population. We replicated all five disease/conditions implicated by PFAS exposure, including hypercholesterolemia, thyroid disease, proteinuria, kidney disease and colitis, either directly or via closely related diagnoses. Using EHRs coupled with informatics enables the health impacts of environmental disasters to be more easily studied in large cohorts versus traditional methods that rely on interviews and expensive serum-based testing. By reducing cost and increasing the diversity of individuals included in studies, we can overcome many of the hurdles faced by previous studies, including a lack of racial and ethnic diversity. This proof-of-concept study confirms that EHRs can be used to study human health and disease impacts of environmental disasters and produces equivalent disease-exposure knowledge to prospective epidemiology studies while remaining cost-effective.
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14
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Awidi M, Al Hadidi S. Participation of Black Americans in Cancer Clinical Trials: Current Challenges and Proposed Solutions. JCO Oncol Pract 2021; 17:265-271. [PMID: 33974816 DOI: 10.1200/op.21.00001] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Low participation of Black Americans in cancer clinical trials is a well-established predicament. Many factors resulted in this current dilemma with racism being the fundamental unit. Here, we discuss some current challenges and proposed solutions to help in increasing the enrollment of Black Americans in cancer clinical trials. We suggest implementing the least acceptable race-specific percentage as a new bar that registrational clinical trials need to pass before cancer drugs approval. Clinical trials will continue to draw the future of cancer therapeutics in which we believe that a prompt improvement of Black Americans participation is warranted.
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Affiliation(s)
- Muhammad Awidi
- Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Samer Al Hadidi
- Department of Hematology and Oncology, Baylor College of Medicine, Houston, TX
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15
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Bea VJ, Taiwo E, Balogun OD, Newman LA. Clinical Trials and Breast Cancer Disparities. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Vuong I, Wright J, Nolan MB, Eggen A, Bailey E, Strickland R, Traynor A, Downs T. Overcoming Barriers: Evidence-Based Strategies to Increase Enrollment of Underrepresented Populations in Cancer Therapeutic Clinical Trials-a Narrative Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:841-849. [PMID: 31713103 DOI: 10.1007/s13187-019-01650-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Disparities in cancer incidence and mortality rates among racial and ethnic minorities (African Americans, Asian Americans, Pacific Islanders, American Indians, and Latinos/Hispanic Americans) in the USA are well documented. Enrollment of underrepresented populations in cancer therapeutic clinical trials, however, is very low. This is true despite federal mandates to ensure accrual rates adequate for analyses and the evidence that the effectiveness of specific therapies and medications varies across ethnic and racial groups. Consequently, cancer clinical decision-making is based on research studies where the majority of research participants are white males, despite the disproportionate cancer burden in racial and ethnic minority groups. To date, there have been multiple reviews detailing the barriers to enrollment for these populations in cancer clinical trials, but a notable lack of research on possible strategies to overcome them. The aim of this narrative review is to summarize the current evidence for effective approaches to increase enrollment of underrepresented minorities in cancer therapeutic clinical trials. These approaches include (1) cultural and linguistic adaptations of marketing materials, (2) the use of patient navigators, and (3) building ongoing community partnerships. The majority of studies reviewed employ multiple improvement strategies simultaneously. Identifying effective approaches to increase enrollment of underrepresented populations in cancer clinical trials is a critical step in reducing persistent disparities in cancer incidence and mortality among racial and ethnic populations.
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Affiliation(s)
- Iris Vuong
- Carbone Cancer Center, Cancer Health Disparities Initiative, School of Medicine and Public Health, University of Wisconsin - Madison, 610 Walnut Street, 370 WARF, Madison, WI, 53726, USA
| | - Joshua Wright
- Carbone Cancer Center, Cancer Health Disparities Initiative, School of Medicine and Public Health, University of Wisconsin - Madison, 610 Walnut Street, 370 WARF, Madison, WI, 53726, USA.
| | - Margaret B Nolan
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, 610 Walnut Street, 1032 WARF, Madison, WI, 53726, USA
| | - Amanda Eggen
- Carbone Cancer Center, Cancer Health Disparities Initiative, School of Medicine and Public Health, University of Wisconsin - Madison, 610 Walnut Street, 370 WARF, Madison, WI, 53726, USA
| | - Erin Bailey
- Carbone Cancer Center, Cancer Health Disparities Initiative, School of Medicine and Public Health, University of Wisconsin - Madison, 610 Walnut Street, 370 WARF, Madison, WI, 53726, USA
| | - Rick Strickland
- Carbone Cancer Center, Cancer Health Disparities Initiative, School of Medicine and Public Health, University of Wisconsin - Madison, 610 Walnut Street, 370 WARF, Madison, WI, 53726, USA
| | - Anne Traynor
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, 1111 Highland Avenue, 3103 WI Institute Medical Research, Madison, WI, 53705, USA
| | - Tracy Downs
- Department of Urology, School of Medicine and Public Health, University of Wisconsin - Madison, 8007 Excelsior Drive, 3223 UW Medical Foundation, Madison, WI, 53717, USA
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17
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Gopishetty S, Kota V, Guddati AK. Age and race distribution in patients in phase III oncology clinical trials. Am J Transl Res 2020; 12:5977-5983. [PMID: 33042473 PMCID: PMC7540092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
Background: Geriatric patients and minority patients are often under-represented in cancer clinical trials. The presence of multiple comorbidities makes geriatric patients ineligible for most clinical trials. Racial diversity may vary by geographical location and socio-economically backward areas may have a very different racial mix. The increase in cancer incidence in geriatric patients' raises the question of applicability of the results is such clinical trials. This study also explores the representation of different races in phase 3 clinical trials conducted in the past 10 years. Methods: Data about Phase III trials was extracted from the clinical trials.gov for 3 common solid organs and 3 hematological malignancies [breast, colon, lung, diffuse large B-cell lymphoma (DLBCL), acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL)]. The time period studied was for the past 10 years and included only adult patients (≥18 years). The age and race distribution of the patient population in these trials were extracted and analyzed. Results: Geriatric patients and minorities are under-represented in all phase III cancer clinical trials. The range of the proportion of geriatric patients varied from 10% to 40%. African American and Asian patients are under-represented in all phase III cancer clinical trials. Conclusions: The results of phase III clinical trials that are currently conducted on non-geriatric and Caucasian patient population may not meaningfully be applicable to geriatric patients and minorities. This study highlights the disparity of age and race for patients enrolled in clinical trials as against the patients seen in the real world.
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Affiliation(s)
- Swathi Gopishetty
- Medical Center of Central Georgia, Mercer UniversityMacon, GA 31201, The United States
| | - Vamsi Kota
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta UniversityAugusta, GA 30909, The United States
| | - Achuta K Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta UniversityAugusta, GA 30909, The United States
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Hamel LM, Dougherty DW, Albrecht TL, Wojda M, Jordan A, Moore TF, Senft N, Carducci M, Heath EI, Manning MA, Penner LA, Kim S, Eggly S. Unpacking Trial Offers and Low Accrual Rates: A Qualitative Analysis of Clinic Visits With Physicians and Patients Potentially Eligible for a Prostate Cancer Clinical Trial. JCO Oncol Pract 2020; 16:e124-e131. [PMID: 31790330 PMCID: PMC7587411 DOI: 10.1200/jop.19.00444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Cancer clinical trial accrual rates are low, and information about contributing factors is needed. We examined video-recorded clinical interactions to identify circumstances under which patients potentially eligible for a trial at a major cancer center were offered a trial. METHODS We conducted a qualitative directed content analysis of 62 recorded interactions with physicians (n = 13) and patients with intermediate- or high-risk prostate cancer (n = 43). Patients were screened and potentially eligible for a trial. We observed and coded the interactions in 3 steps: (1) classification of all interactions as explicit offer, offer pending, trial discussed/not offered, or trial not discussed; (2) in interactions with no explicit offer, classification of whether the cancer had progressed; (3) in interactions classified as progression but no trial offered, identification of factors discussed that may explain the lack of an offer. RESULTS Of the 62 interactions, 29% were classified as explicit offer, 12% as offer pending, 18% as trial discussed/not offered, and 39% as trial not discussed. Of those with no offer, 57% included information that the cancer had not progressed. In 68% of the remaining interactions with patients whose cancer had progressed but did not receive an offer, reasons for the lack of offer were identified, but in 32%, no explanation was provided. CONCLUSION Even in optimal circumstances, few patients were offered a trial, often because their cancer had not progressed. Findings support professional recommendations to broaden trial inclusion criteria. Findings suggest accrual rates should reflect the proportion of eligible patients who enroll.
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Affiliation(s)
- Lauren M. Hamel
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | | | - Mark Wojda
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | - Alice Jordan
- Johns Hopkins/Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Tanina F. Moore
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | - Michael Carducci
- Johns Hopkins/Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | - Mark A. Manning
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | - Louis A. Penner
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | - Seongho Kim
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | - Susan Eggly
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
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19
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Eggly S, Hamel LM, Heath E, Manning MA, Albrecht TL, Barton E, Wojda M, Foster T, Carducci M, Lansey D, Wang T, Abdallah R, Abrahamian N, Kim S, Senft N, Penner LA. Partnering around cancer clinical trials (PACCT): study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials. BMC Cancer 2017; 17:807. [PMID: 29197371 PMCID: PMC5712160 DOI: 10.1186/s12885-017-3804-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/21/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians. Partnering Around Cancer Clinical Trials (PACCT) involves a transdisciplinary theoretical model proposing that patient and physician individual attitudes and beliefs and their interpersonal communication during racially discordant clinical interactions influence outcomes related to patients' decisions to participate in a trial. The overall goal of the study is to test a multilevel intervention designed to increase rates at which African-American and White men with prostate cancer make an informed decision to participate in a clinical trial. METHODS/DESIGN Data collection will occur at two NCI-designated comprehensive cancer centers. Participants include physicians who treat men with prostate cancer and their African-American and White patients who are potentially eligible for a clinical trial. The study uses two distinct research designs to evaluate the effects of two behavioral interventions, one focused on patients and the other on physicians. The primary goal is to increase the number of patients who decide to enroll in a trial; secondary goals include increasing rates of physician trial offers, improving the quality of patient-physician communication during video recorded clinical interactions in which trials may be discussed, improving patients' understanding of trials offered, and increasing the number of patients who actually enroll. Aims are to 1) determine the independent and combined effects of the two interventions on outcomes; 2) compare the effects of the interventions on African-American versus White men; and 3) examine the extent to which patient-physician communication mediates the effect of the interventions on the outcomes. DISCUSSION PACCT has the potential to identify ways to increase clinical trial rates in a diverse patient population. The research can also improve access to high quality clinical care for African American men bearing the disproportionate burden of disparities in prostate and other cancers. TRIAL REGISTRATION Clinical Trials.gov registration number: NCT02906241 (September 8, 2016).
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Lauren M. Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Elisabeth Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Mark A. Manning
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Terrance L. Albrecht
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Ellen Barton
- Department of English, Wayne State University, 5057 Woodward Suite 9408, Detroit, MI 48202 USA
| | - Mark Wojda
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Tanina Foster
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Michael Carducci
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 1M59 Bunting –Blaustein Cancer Research Building, 1650 Orleans Street, Baltimore, MD 21287 USA
| | - Dina Lansey
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Ting Wang
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Rehab Abdallah
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Narineh Abrahamian
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Seongho Kim
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Nicole Senft
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Louis A. Penner
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
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Hamel LM, Penner LA, Albrecht TL, Heath E, Gwede CK, Eggly S. Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer. Cancer Control 2016; 23:327-337. [PMID: 27842322 PMCID: PMC5131730 DOI: 10.1177/107327481602300404] [Citation(s) in RCA: 288] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. METHODS Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor-patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. RESULTS Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. CONCLUSION To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.
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Affiliation(s)
- Lauren M Hamel
- Wayne State University, Karmanos Cancer Institute, Department of Oncology, Population Studies Disparities Research Program, Detroit, MI, USA.
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Ceballos R, Knerr S, Scott MA, Hohl S, Malen R, Vilchis H, Thompson B. Latino beliefs about biomedical research participation: a qualitative study on the U.S.-Mexico border. J Empir Res Hum Res Ethics 2014; 9:10-21. [PMID: 25747293 PMCID: PMC4474137 DOI: 10.1177/1556264614544454] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Latinos are under-represented in biomedical research conducted in the United States, impeding disease prevention and treatment efforts for this growing demographic group. We gathered perceptions of biomedical research and gauged willingness to participate through elicitation interviews and focus groups with Latinos living on the U.S.-Mexico border. Themes that emerged included a strong willingness to participate in biomedical studies and suggested that Latinos may be under-represented due to limited formal education and access to health information, not distrust. The conflation of research and clinical care was common and motivated participation. Outreach efforts and educational interventions to inform Latinos of participation opportunities and clarify harms and benefits associated with biomedical research participation will be essential to maintain trust within Latino communities.
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Affiliation(s)
- Rachel Ceballos
- Fred Hutchinson Cancer Research Center
- Department of Health Services, University of Washington
| | - Sarah Knerr
- Department of Health Services, University of Washington
| | - Mary Alice Scott
- Department of Anthropology, New Mexico State University
- Department of Public Health Sciences, New Mexico State University
| | | | | | - Hugo Vilchis
- Border Epidemiology & Environmental Health Center, New Mexico State University
| | - Beti Thompson
- Fred Hutchinson Cancer Research Center
- Department of Health Services, University of Washington
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Manders DB, Paulsen A, Richardson DL, Kehoe SM, Miller DS, Lea JS. Factors associated with clinical trial screening failures in gynecologic oncology. Gynecol Oncol 2014; 134:450-4. [DOI: 10.1016/j.ygyno.2014.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 12/26/2022]
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Chen MS, Lara PN, Dang JHT, Paterniti DA, Kelly K. Twenty years post-NIH Revitalization Act: enhancing minority participation in clinical trials (EMPaCT): laying the groundwork for improving minority clinical trial accrual: renewing the case for enhancing minority participation in cancer clinical trials. Cancer 2014; 120 Suppl 7:1091-6. [PMID: 24643646 DOI: 10.1002/cncr.28575] [Citation(s) in RCA: 309] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/06/2013] [Accepted: 08/26/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The National Institutes of Health (NIH) Revitalization Act of 1993 mandated the appropriate inclusion of minorities in all NIH-funded research. Twenty years after this act, the proportion of minority patients enrolled in cancer clinical trials remains persistently low. Clinical trials are vehicles for the development and evaluation of therapeutic and preventive agents under scientifically rigorous conditions. Without representation in trials, it is projected that disparities in the cancer burden for minorities will increase. METHODS For this review article, the authors counted the frequency with which minorities were the primary focus of National Cancer Institute-sponsored clinical trials, examined citations from the PubMed database focusing on the search terms "NIH Revitalization Act of 1993" and "enhancing minority accrual to cancer clinical trials," and supplemented the review with their expertise in NIH-funded research related to minority accrual in cancer clinical trials. RESULTS The reporting and analyses of data based on minorities in clinical trials remain inadequate. Less than 2% of the National Cancer Institute's clinical trials focus on any racial/minority population as their primary emphasis. The current review of the literature indicated that the percentage of authors who reported their study sample by race/ethnicity ranged from 1.5% to 58%, and only 20% of the randomized controlled studies published in a high-impact oncology journal reported analyzing results by race/ethnicity. Proportionately greater population increases in minorities, accompanied by their persistent and disproportionate cancer burden, reinforce the need for their greater representation in clinical trials. CONCLUSIONS Renewing the emphasis for minority participation in clinical trials is warranted. Policy changes are recommended.
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Affiliation(s)
- Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, California; Cancer Control, University of California, Davis Comprehensive Cancer Center, Sacramento, California
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Chen MS, Lara PN, Dang JHT, Paterniti DA, Kelly K. Twenty years post-NIH Revitalization Act: enhancing minority participation in clinical trials (EMPaCT): laying the groundwork for improving minority clinical trial accrual: renewing the case for enhancing minority participation in cancer clinical trials. Cancer 2014. [PMID: 24643646 DOI: 10.1002/cncr.28575.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The National Institutes of Health (NIH) Revitalization Act of 1993 mandated the appropriate inclusion of minorities in all NIH-funded research. Twenty years after this act, the proportion of minority patients enrolled in cancer clinical trials remains persistently low. Clinical trials are vehicles for the development and evaluation of therapeutic and preventive agents under scientifically rigorous conditions. Without representation in trials, it is projected that disparities in the cancer burden for minorities will increase. METHODS For this review article, the authors counted the frequency with which minorities were the primary focus of National Cancer Institute-sponsored clinical trials, examined citations from the PubMed database focusing on the search terms "NIH Revitalization Act of 1993" and "enhancing minority accrual to cancer clinical trials," and supplemented the review with their expertise in NIH-funded research related to minority accrual in cancer clinical trials. RESULTS The reporting and analyses of data based on minorities in clinical trials remain inadequate. Less than 2% of the National Cancer Institute's clinical trials focus on any racial/minority population as their primary emphasis. The current review of the literature indicated that the percentage of authors who reported their study sample by race/ethnicity ranged from 1.5% to 58%, and only 20% of the randomized controlled studies published in a high-impact oncology journal reported analyzing results by race/ethnicity. Proportionately greater population increases in minorities, accompanied by their persistent and disproportionate cancer burden, reinforce the need for their greater representation in clinical trials. CONCLUSIONS Renewing the emphasis for minority participation in clinical trials is warranted. Policy changes are recommended.
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Affiliation(s)
- Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, California; Cancer Control, University of California, Davis Comprehensive Cancer Center, Sacramento, California
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Uniting postcolonial, discourse, and linguistic theory to explore participation of African Americans in cancer research as an effect of social and historical race relationships. ANS Adv Nurs Sci 2014; 37:32-47. [PMID: 24469087 DOI: 10.1097/ans.0000000000000015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article uses a historical framework of postcolonialism; discourse analytic concepts (significance, identity, and relationships); and 5 social and cultural linguistic principles of emergence, positionality, indexicality, relationality, and partialness as a theoretical and methodological triangulation approach to data analysis of focus group discussion. Exemplars of focus group data from a study exploring African American participation in research demonstrate the application of this combined framework as a useful tool for analysis. This approach allows for examination of identity and interaction and generates a more rigorous and complete understanding of how individuals use language to construct identity as participants or nonparticipants in research.
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Doroshow JH. Timely completion of scientifically rigorous cancer clinical trials: an unfulfilled priority. J Clin Oncol 2013; 31:3312-4. [PMID: 23960175 DOI: 10.1200/jco.2013.51.3192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- James H Doroshow
- National Cancer Institute, National Institutes of Health, Bethesda, MD
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Feasibility of trials in ovarian cancer by line of therapy and platinum sensitivity. Int J Gynecol Cancer 2013; 23:481-7. [PMID: 23392404 DOI: 10.1097/igc.0b013e31828702f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To rapidly evaluate the significant numbers of novel therapies entering clinical development requires maximization of clinical trial capacity. To enable this, we evaluated the profile of patients with epithelial ovarian cancer (EOC) in clinical practice, compared with those targeted in clinical trials. METHODS Patients with EOC treated between March-September 2009 (cohort A, n = 115 patients) and January-July 2012 (cohort B, n = 109 patients), in the North West London Cancer Network with a catchment of 1.2 million, were identified. Patient characteristics were compared with phase II/III EOC studies identified using clinicaltrials.gov (85 trials; 54,603 patients). RESULTS In cohort A, comparing the proportion of patients in clinical practice with those in trials, 40% versus 55% (P = 0.0006) were chemotherapy-naive, 20% versus 9% (P < 0.0001) had platinum-resistant disease (platinum-free interval, <6 months), 16.2% versus 39% (P < 0.0001) were receiving second line, and 43.8% versus 5% (P < 0.0001) third-line chemotherapy or greater, respectively. Ninety-eight percent of treated patients had a performance status of 2 or less. These results were validated in cohort B, U.K. National Cancer Research Network and U.S. Gynecologic Oncology Group trial databases. CONCLUSIONS These results provide the data to enable EOC trial portfolios to be balanced to clinical practice and suggest an increase in emphasis on trials for patients with platinum-resistant disease and third-line chemotherapy or greater, to address an area of clinical need and maximize recruitment.
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Friedlander P, Balart L, Shores NJ, Cannon RM, Saggi B, Jan T, Buell JF. Racial disparity in New Orleans: a faith-based approach to an age-old problem. Surgery 2012; 153:439-42. [PMID: 23261027 DOI: 10.1016/j.surg.2012.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Paul Friedlander
- Department of Head and Neck Surgery, Tulane University, New Orleans, LA, USA
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