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Myers RE, Hallman MH, Shimada A, DiCarlo MA, Davis KV, Leach WT, Chambers CV. Primary care patient interests in joining a planned multi-cancer early detection clinical trial. Cancer Med 2024; 13:e7312. [PMID: 38785202 PMCID: PMC11117448 DOI: 10.1002/cam4.7312] [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: 08/04/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Clinical trials are being conducted and are being planned to assess the safety and efficacy of multi-cancer early detection (MCED) tests for use in cancer screening. This study aimed to determine the feasibility of primary care patient outreach in recruiting participants to a planned MCED clinical trial, assess patient interest in trial participation, and measure decisional conflict related to participation. METHODS The research team used the electronic medical record of a large, urban health care system to identify primary care patients 50-80 years of age who were potentially eligible for a planned MCED trial. We mailed information about the planned MCED trial to identified patients and then contacted the patients by telephone to obtain consent and administer a baseline survey. Subsequently, we contacted consented patients to complete an interview to review the mailed information and elicit perceptions about trial participation. Finally, a research coordinator administered an endpoint telephone survey to assess patient interest in and decisional conflict related to joining the trial. RESULTS We randomly identified 1000 eligible patients and were able to make contact with 690 (69%) by telephone. Of the patients contacted, 217 (31%) completed the decision counseling session and 219 (32%) completed the endpoint survey. Among endpoint survey respondents, 177 (81%) expressed interest in joining the MCED trial and 162 (74%) reported low decisional conflict. CONCLUSIONS Most patients were contacted and about a quarter of those contacted expressed interest in and low decisional conflict about joining the planned MCED trial. Research is needed to determine how to optimize patient outreach and engage patients in shared decision-making about MCED trial participation.
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Affiliation(s)
- Ronald E. Myers
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Mie H. Hallman
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental TherapeuticsThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Melissa A. DiCarlo
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Kaitlyn V. Davis
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - William T. Leach
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Christopher V. Chambers
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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Miller YM, Bakhtary S, Chou ST, Hailu B, Reik RA, Richard RH, Spencer BR, Witherspoon R, Delaney M. Involvement of Diverse Populations in Transfusion Medicine Research. Transfus Med Rev 2023; 37:150766. [PMID: 37993382 PMCID: PMC11032214 DOI: 10.1016/j.tmrv.2023.150766] [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: 05/19/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 11/24/2023]
Abstract
Communities of color and diverse communities (eg, race, socioeconomic status, language, sexual orientation etc.) have not been recruited and enrolled equitably to participate in research studies in transfusion medicine. The exclusion of diverse communities in transfusion research can lead to health disparities lack of access to approved therapeutics and unequal allocation of interventions, resulting in missed opportunities to optimize health for individuals and communities. Involvement of diverse populations in research goes beyond inclusion as research subjects. Strategies should include specific studies on health conditions of importance to diverse communities with stable funding sources and specific funding announcements to develop projects led by diverse researchers, mentorship of diverse researchers, and openness to various ways of communicating research plans. Qualitative approaches and interdisciplinary collaboration should be supported to enhance inclusivity.
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Affiliation(s)
| | - Sara Bakhtary
- Transfusion Medicine, Department of Laboratory Medicine, University of California San Francisco, USA
| | - Stella T Chou
- Division of Transfusion Medicine, The Children's Hospital of Philadelphia University of Pennsylvania School of Medicine, USA
| | | | | | - Raven Hardy Richard
- National Institutes of Health (NIH) National Human Genome Research Institute (NHGRI), USA
| | | | | | - Meghan Delaney
- Division of Pathology & Laboratory Medicine Children's National Hospital, The George Washington University, USA
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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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Ezeife DA, Padmore G, Vaska M, Truong TH. Un accès équitable aux soins contre le cancer pour les personnes noires au Canada. CMAJ 2023; 195:E51-E55. [PMID: 36623855 PMCID: PMC9829072 DOI: 10.1503/cmaj.212076-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Doreen A Ezeife
- Départements d'oncologie (Ezeife, Padmore, Vaska) et de chirurgie oncologique (Padmore), Université de Calgary, Centre de cancérologie Tom Baker; Département d'oncologie pédiatrique (Truong), Université de Calgary, Hôpital pour enfants de l'Alberta, Calgary, Alb.
| | - Greg Padmore
- Départements d'oncologie (Ezeife, Padmore, Vaska) et de chirurgie oncologique (Padmore), Université de Calgary, Centre de cancérologie Tom Baker; Département d'oncologie pédiatrique (Truong), Université de Calgary, Hôpital pour enfants de l'Alberta, Calgary, Alb
| | - Marcus Vaska
- Départements d'oncologie (Ezeife, Padmore, Vaska) et de chirurgie oncologique (Padmore), Université de Calgary, Centre de cancérologie Tom Baker; Département d'oncologie pédiatrique (Truong), Université de Calgary, Hôpital pour enfants de l'Alberta, Calgary, Alb
| | - Tony H Truong
- Départements d'oncologie (Ezeife, Padmore, Vaska) et de chirurgie oncologique (Padmore), Université de Calgary, Centre de cancérologie Tom Baker; Département d'oncologie pédiatrique (Truong), Université de Calgary, Hôpital pour enfants de l'Alberta, Calgary, Alb
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Ezeife DA, Padmore G, Vaska M, Truong TH. Ensuring equitable access to cancer care for Black patients in Canada. CMAJ 2022; 194:E1416-E1419. [PMID: 36280246 PMCID: PMC9616139 DOI: 10.1503/cmaj.212076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Doreen A Ezeife
- Departments of Oncology (Ezeife, Padmore, Vaska) and Surgical Oncology (Padmore), University of Calgary, Tom Baker Cancer Centre; Department of Oncology and Pediatrics (Truong), University of Calgary, Alberta Children's Hospital, Calgary, Alta.
| | - Greg Padmore
- Departments of Oncology (Ezeife, Padmore, Vaska) and Surgical Oncology (Padmore), University of Calgary, Tom Baker Cancer Centre; Department of Oncology and Pediatrics (Truong), University of Calgary, Alberta Children's Hospital, Calgary, Alta
| | - Marcus Vaska
- Departments of Oncology (Ezeife, Padmore, Vaska) and Surgical Oncology (Padmore), University of Calgary, Tom Baker Cancer Centre; Department of Oncology and Pediatrics (Truong), University of Calgary, Alberta Children's Hospital, Calgary, Alta
| | - Tony H Truong
- Departments of Oncology (Ezeife, Padmore, Vaska) and Surgical Oncology (Padmore), University of Calgary, Tom Baker Cancer Centre; Department of Oncology and Pediatrics (Truong), University of Calgary, Alberta Children's Hospital, Calgary, Alta
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Obi ON, Saketkoo LA, Russell AM, Baughman RP. Sarcoidosis: Updates on therapeutic drug trials and novel treatment approaches. Front Med (Lausanne) 2022; 9:991783. [PMID: 36314034 PMCID: PMC9596775 DOI: 10.3389/fmed.2022.991783] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous inflammatory disease of unknown etiology. It affects the lungs in over 90% of patients yet extra-pulmonary and multi-organ involvement is common. Spontaneous remission of disease occurs commonly, nonetheless, over 50% of patients will require treatment and up to 30% of patients will develop a chronic progressive non-remitting disease with marked pulmonary fibrosis leading to significant morbidity and death. Guidelines outlining an immunosuppressive treatment approach to sarcoidosis were recently published, however, the strength of evidence behind many of the guideline recommended drugs is weak. None of the drugs currently used for the treatment of sarcoidosis have been rigorously studied and prescription of these drugs is often based on off-label” indications informed by experience with other diseases. Indeed, only two medications [prednisone and repository corticotropin (RCI) injection] currently used in the treatment of sarcoidosis are approved by the United States Food and Drug Administration. This situation results in significant reimbursement challenges especially for the more advanced (and often more effective) drugs that are favored for severe and refractory forms of disease causing an over-reliance on corticosteroids known to be associated with significant dose and duration dependent toxicities. This past decade has seen a renewed interest in developing new drugs and exploring novel therapeutic pathways for the treatment of sarcoidosis. Several of these trials are active randomized controlled trials (RCTs) designed to recruit relatively large numbers of patients with a goal to determine the safety, efficacy, and tolerability of these new molecules and therapeutic approaches. While it is an exciting time, it is also necessary to exercise caution. Resources including research dollars and most importantly, patient populations available for trials are limited and thus necessitate that several of the challenges facing drug trials and drug development in sarcoidosis are addressed. This will ensure that currently available resources are judiciously utilized. Our paper reviews the ongoing and anticipated drug trials in sarcoidosis and addresses the challenges facing these and future trials. We also review several recently completed trials and draw lessons that should be applied in future.
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Affiliation(s)
- Ogugua Ndili Obi
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States,*Correspondence: Ogugua Ndili Obi,
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States,University Medical Center—Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States,Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA, United States,Department of Undergraduate Honors, Tulane University School of Medicine, New Orleans, LA, United States
| | - Anne-Marie Russell
- Exeter Respiratory Institute University of Exeter, Exeter, United Kingdom,Royal Devon and Exeter NHS Foundation Trust, Devon, United Kingdom,Faculty of Medicine, Imperial College and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati, Cincinnati, OH, United States
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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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Kumar G, Kim J, Farazi PA, Wang H, Su D. Disparities in awareness of and willingness to participate in cancer clinical trials between African American and White cancer survivors. BMC Cancer 2022; 22:983. [PMID: 36109780 PMCID: PMC9479408 DOI: 10.1186/s12885-022-10082-9] [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: 10/28/2021] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cancer clinical trials (CCTs) are essential for cancer care, yet the evidence is scarce when it comes to racial disparities in CCT participation among cancer survivors in the Midwest. This study aimed to 1) assess disparities in the awareness of and willingness to participate in CCTs between African American and White cancer survivors; and 2) compare perceptions about CCTs between the two racial groups. Methods The study was based on cross-sectional data from the survey “Minority Patient Participation in Cancer Clinical Trials” that collected information from 147 Black and White cancer survivors from Nebraska between 2015 and 2016. Chi-square tests and logistic regressions were used to assess differences between Black and White cancer survivors regarding their awareness, willingness, and perceptions associated with CCT participation. Results After adjusting for the effects of socio-demographic, health status, and psychosocial variables, Black cancer survivors were much less likely than White cancer survivors to be aware of CCTs (AOR 0.26; CI 0.08–0.81), to express willingness to participate in CCTs (AOR 0.03; CI 0.01, 0.32) and to actually participate in CCTs (AOR 0.13; CI 0.04–0.38). Black cancer survivors reported a lower level of trust in physicians and were less likely than White cancer survivors to believe that CCTs make a significant contribution to science. Conclusions Relative to White cancer survivors, Black cancer survivors had much lower awareness of and willingness to participate in CCTs. Part of these differences might be related to the differential perception of CCTs, psychosocial factors, and trust in physicians between the two groups.
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Oyer RA, Hurley P, Boehmer L, Bruinooge SS, Levit K, Barrett N, Benson A, Bernick LA, Byatt L, Charlot M, Crews J, DeLeon K, Fashoyin-Aje L, Garrett-Mayer E, Gralow JR, Green S, Guerra CE, Hamroun L, Hardy CM, Hempstead B, Jeames S, Mann M, Matin K, McCaskill-Stevens W, Merrill J, Nowakowski GS, Patel MI, Pressman A, Ramirez AG, Segura J, Segarra-Vasquez B, Hanley Williams J, Williams JE, Winkfield KM, Yang ES, Zwicker V, Pierce LJ. Increasing Racial and Ethnic Diversity in Cancer Clinical Trials: An American Society of Clinical Oncology and Association of Community Cancer Centers Joint Research Statement. J Clin Oncol 2022; 40:2163-2171. [PMID: 35588469 DOI: 10.1200/jco.22.00754] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A concerted commitment across research stakeholders is necessary to increase equity, diversity, and inclusion (EDI) and address barriers to cancer clinical trial recruitment and participation. Racial and ethnic diversity among trial participants is key to understanding intrinsic and extrinsic factors that may affect patient response to cancer treatments. This ASCO and Association of Community Cancer Centers (ACCC) Research Statement presents specific recommendations and strategies for the research community to improve EDI in cancer clinical trials. There are six overarching recommendations: (1) clinical trials are an integral component of high-quality cancer care, and every person with cancer should have the opportunity to participate; (2) trial sponsors and investigators should design and implement trials with a focus on reducing barriers and enhancing EDI, and work with sites to conduct trials in ways that increase participation of under-represented populations; (3) trial sponsors, researchers, and sites should form long-standing partnerships with patients, patient advocacy groups, and community leaders and groups; (4) anyone designing or conducting trials should complete recurring education, training, and evaluation to demonstrate and maintain cross-cultural competencies, mitigation of bias, effective communication, and a commitment to achieving EDI; (5) research stakeholders should invest in programs and policies that increase EDI in trials and in the research workforce; and (6) research stakeholders should collect and publish aggregate data on racial and ethnic diversity of trial participants when reporting results of trials, programs, and interventions to increase EDI. The recommendations are intended to serve as a guide for the research community to improve participation rates among people from racial and ethnic minority populations historically under-represented in cancer clinical trials. ASCO and ACCC will work at all levels to advance the recommendations in this publication.
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Affiliation(s)
- Randall A Oyer
- Penn Medicine Lancaster General Health Ann B Barshinger Cancer Institute, Lancaster, PA
| | | | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, MD
| | | | - Kathryn Levit
- American Society of Clinical Oncology, Alexandria, VA
| | - Nadine Barrett
- Duke Clinical and Translational Science Institute, Raleigh, NC
| | - Al Benson
- Northwestern University, Evanston, IL
| | | | - Leslie Byatt
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | | | - Kyle DeLeon
- American Cancer Society Cancer Action Network, Washington, DC
| | - Lola Fashoyin-Aje
- US Food and Drug Administration Oncology Center of Excellence, Silver Spring, MD
| | | | | | - Sybil Green
- American Society of Clinical Oncology, Alexandria, VA
| | - Carmen E Guerra
- University of Pennsylvania Raymond and Ruth Perelman School of Medicine, Philadelphia, PA
| | - Leila Hamroun
- ChristianaCare Oncology Patient Advocates for Clinical Trials, Newark, DE
| | - Claudia M Hardy
- University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, AL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eddy S Yang
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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