Results of a qualitative study of research and clinical professionals regarding their perspectives related to recruitment of minority patients for cancer clinical trials suggest that bias may contribute to the disproportionately low clinical trial enrollment of these patients. These findings were published in Cancer.
Of all adult patients with cancer in the United States who are candidates for participation in a clinical trial, less than 5% are enrolled. Furthermore, the proportion of patients belonging to a racial or ethnic minority enrolled in these cancer clinical trials is substantially lower than the proportion of these minority groups in the overall US population.
“A fundamental social determinant of health in the United States, race continues to shape access to important resources, including cancer clinical trials,” the study authors noted.
In contrast to previous studies that have evaluated the perspectives of physicians regarding patient- and study design-related factors that interfere with clinical trial enrollment, the aim of this study was to explore potential clinician/researcher-related barriers, such as bias, to enrollment of minority patients in cancer clinical trials.
This study was conducted during November and December 2010 at 5 National Cancer Institute (NCI)-designated cancer centers affiliated with the consortium for Enhancing Minority Participation in Clinical Trials (EMPaCT). Interviews were held with 4 groups of clinical trial “stakeholders” — principal investigators, research staff, referring clinicians, and cancer center leaders — regarding their attitudes and experiences with enrolling minority patients in cancer clinical trials. Transcripts of these sessions were analyzed for thematic content.
The 91 study participants included 34 principal investigators, 33 research staff, 16 referring clinicians, and 8 professionals in cancer leadership positions. In the overall study group, 67%, 11%, and 13% were white, African American, and Asian, respectively, and approximately three-quarters of participants identified as non-Hispanic.
Five themes emerged from these analyses:
- Interactions with potential minority participants were perceived to be challenging.
- Potential minority participants are not perceived to be ideal study candidates.
- A combination of clinic-based barriers and negative perceptions of minority study participants leads to providers withholding clinical trial opportunities from potential minority participants.
- When clinical trial recruitment practices were tailored to minority patients, addressing misconceptions to build trust was a common strategy.
- For some respondents, race was viewed as irrelevant when screening and recruiting potential minority participants for clinical trials.
Whereas taking a “race-neutral” approach to clinical trial recruitment was a common strategy cited by study participants, referring clinicians were generally found more likely than the other stakeholder groups to indicate that they take racial stereotypes into consideration when referring racial/ethnic minority patients for enrollment in a cancer clinical trial.
One study limitation was that the results may not be representative of practices at community-based institutions.
The study authors suggested that “bias may impede the willingness of some clinical and research professionals to offer clinical trial enrollment and may explain, in part, variations in participation in cancer clinical trials.”
They further added that “in contrast to a race-neutral approach to recruitment, we have suggested a tailored, nuanced recruitment strategy that may increase minority participation in cancer clinical trials.”
Niranjan S, Martin MY, Fouad MN, et al. Bias and stereotyping among research and clinical professionals: Perspectives on minority recruitment for oncology clinical trials [published online March 7, 2020]. Cancer. doi:10.1002/cncr.32755.
This article originally appeared on Oncology Nurse Advisor