A Critical Review of the Enrollment of Black Patients in Cancer Clinical Trials

Abstract

Although clinical trials represent a vital opportunity for improvements in cancer treatment, data show that a small proportion of patients with newly diagnosed cancer participate in clinical research. Black patients continue to have a worse prognosis for most cancers compared with other patients of other races/ethnicities. Racial/ethnic- and age-related disparities in clinical trial accrual are also well documented. The recruitment and retention of minorities in these trials present an even greater challenge despite regulatory efforts and initiatives to increase representation. Treatment data from homogenous populations prevent us from understanding therapeutic response and the true safety profile of novel therapies. Patient-, physician-, and system-level factors that affect trial participation have been extensively studied. However, years of accrual data remain largely unchanged, suggesting the challenge lies in effectively addressing these factors. Furthermore, data showing that black patients tend to have more advanced stage cancers at the time of diagnosis in fact beg their overrepresentation on clinical trials. An inability to successfully enroll diverse populations in clinical trials only exacerbates racial/ethnic differences in cancer treatment and survivorship.