Q&A With Narjust Duma, MD: Minority Patient Participation in Breast Cancer Clinical Trials

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In this question-and-answer session, Cancer Therapy Advisor asked Dr Duma about her team’s study and minority patient representation in breast cancer studies.
In this question-and-answer session, Cancer Therapy Advisor asked Dr Duma about her team’s study and minority patient representation in breast cancer studies.

Narjust Duma, MD, is a hematologist/oncologist at the Mayo Clinic in Rochester, Minnesota. She was lead author of a study of ethnic minorities' representation in cancer clinical trials over the past 14 years, which was presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.1

In this question-and-answer session, Cancer Therapy Advisor asked Dr Duma about her team's study and minority patient representation in breast cancer studies.

Cancer Therapy Advisor (CTA): What prompted your study of minority participation in cancer clinical trials?

Dr Duma: A few months ago I was meeting an African American patient with newly diagnosed lung cancer. During our conversation the patient asked me very specific questions regarding the proposed treatment plans: Was this regimen studied in African American patients? Do you know the response rate in ‘patients like me?'

Sadly, many of my answers were: ‘they were a few African American patients in these trials' (usually 3 to 10 patients); therefore we are lacking data that could answer your questions.

That prompted even more questions. How do we know if these regimens are applicable to all races/ethnicities?

Then I started reviewing a few published clinical trials. Later that number became 1000 clinical trials. I was surprised by the low enrollment of minorities.

CTA: Overall, you found that minorities participate at significantly lower rates in cancer clinical trials than non-Hispanic Caucasian patients — and that minority participation has declined over recent years. Why might that be? What factors might explain this trend?

Dr Duma: While studying minority recruitment in clinical trials we have divided the problem into ‘old' and ‘new' challenges. 

Old challenges: 

  • Language barriers: 17% physicians reported not feeling comfortable discussing clinical trials with patients with low English proficiency.
  • Socioeconomic factors.
  • Medical provider bias: physicians are more likely to present trial options to Caucasian patients due to the presumption that minority patients are less likely to comply with the protocol. This is a real challenge as the ultimate decision about when to offer a trial comes from the treating provider.

New challenges:

  • Our findings could be attributed to the increased complexity of clinical trials and mandatory molecular testing, as many minorities lack access to institutions with genetic testing capacity.
  • As new therapeutics are becoming more and more expensive, little money is left in the budget to hire multilingual research staff and minority outreach.
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