CTA: What about breast cancer trials in particular? Was the disparity in clinical trial participation more or less pronounced for breast cancer than other patient populations?
Dr Duma: We observed a decrease in the amount of breast cancer trials over the past 14 years when compared with other malignancies like lung and pancreatic cancer. This likely has to do with the availability of efficacious standard of care and needs for better therapy for lung and pancreatic cancer.
Regarding minority recruitment, Hispanic patients were less likely to be enrolled in breast cancer trials followed by Native American/Alaskan Native when compared with non-Hispanic Caucasians.
While a subgroup analysis is necessary to generate detailed conclusions, minorities were more likely to be enrolled in trials designed for metastatic breast cancer and less likely in neoadjuvant and adjuvant trials.
Investigator-initiated breast cancer trials were more likely to enroll African Americans and Hispanics compared to industry-sponsored trials. We are still trying to find the reason why.
CTA: What can breast cancer centers and hospitals do to improve the situation?
Dr Duma: Recognizing the problem is the first step; you cannot fix a problem before you come to realize it’s a real issue.
Language is a key factor when trying to recruit minorities. Several studies suggest that patients are more likely to enroll in clinical trials if they have a provider or recruiter that speaks their native language. Trials should include the hiring of multilingual staff in their budgets and list of priorities.
Other options include minorities outreach — bringing trials to community hospitals, translating research consents, and so on. We can improve minority recruitment by targeting the unique cultural, perceptive, and cognitive characteristics of African American, Hispanic, and Native American/Alaskan Native patients.
CTA: What about how breast cancer and other clinical trials are reported?
Dr Duma: In our review, we found that only 31% of the trials reported ethnicity.
We would like to bring attention to the responsibility the journals have to require investigators to present and publish the racial background of all patients recruited in trials.
Data derived from a predominantly Caucasian population are commonly and perhaps inappropriately extrapolated for clinical use in other ethnicities.
- Duma N, Aguilera JV, Paludo J, et al. Representation of minorities in oncology clinical trials: review of the past 14 years. J Clin Oncol. 2017;35(suppl; abstr 2533).