Addressing Underrepresentation in Oncology Clinical Trials: Barriers and Solutions

Mariam F. Eskander, MD, MPH, assistant professor of surgery and a gastrointestinal surgical oncologist at the Rutgers Cancer Institute, and Coral O. Omene, MD, PhD, an associate professor of medicine, breast medical oncologist, and program director for breast cancer disparities research at Rutgers Cancer Institute, discuss which populations are seen as the most underrepresented in oncology clinical trials and why they think that is.

Transcription:

0:10 | If you want to the most underserved, I think the official remains Black patients. I think the Black community still lags behind all other racial ethnic groups. Actually, this translates, unfortunately, to their poor survival in many instances and in many different cancer subtypes. Speaking for breast cancer for instance, there is a survival curve from the CA database that shows that compared [with] all other ethnic groups, [that] the survival curve lags behind all of them. When you compare it to the White population, there is a tragic number of 41% per survival compared [with] White patients. Unfortunately, that population is still very underserved in our healthcare system.

1:11 | Yes, and I think to add to that, depending on what other cancers you look at, other underrepresented populations include Hispanic patients, Asian Pacific Islander patients, Native American, Alaskan native patients, and then from a socioeconomic diversity lens, patients who are uninsured or underinsured, patients who live in socially vulnerable neighborhoods, rural populations, patients who receive care at community hospitals, as opposed to academic medical centers and people who are incarcerated. So, it is a long list of disparities that we have.

1:56 | There are several, they are interconnected, and they are at different levels that you can try to decipher them both from the patient level, structural system level, provider level. I mean, there are just a slew of barriers that contribute to the problem that we have. To boil it down to, let's say 1 big thing, I would say it is education, and this is education that is at the patient level, right? And where is that problem stemming from? From the issues of deep mistrust that has gone on for generations that then impacts them getting the right information, more updated information, because they just mistrust the system. It comes from somewhere, right? It's from our history. And this all goes to the same thing with the provider level, right? They are not educated on many things, like the cultural sensitivities you need to have, the implicit biases that they have, that they may not be aware they have, not even just a lack of awareness. So, that education umbrella can hit at several levels that all contribute, and there are others as well, obviously.

3:18 | Yeah, I completely agree with Dr. Omene on the education piece. I think, in my mind, the main problem is that not every patient who walks into the door of every hospital, no matter where that hospital is, is hearing about clinical trials that might be available to them. I think that if that happens, the messaging around clinical trials would change as a first line opportunity to get new, potentially life saving treatment before it's available to everyone. It stops becoming kind of a last resort, and starts becoming more first resort and an opportunity, rather than a later down the line, kind of last ditch effort, which I think a lot of people view it as, and then, like Dr. Omene was saying, if every provider talked about it and every and every patient heard about it, then it would take away some of those provider biases, or like patient education, like patient selection kind of problems that we have.