Abstract B26: Cancer prevention clinical trials: Assessing for disparities in recruitment in Hawaii

Abstract

Abstract A key concern of clinical trials of cancer is improving the participation rates of minority populations that are often underrepresented and have high rates of disease. In particular, identifying the underlying factors that contribute to the underrepresentation of minorities is essential for developing improved recruitment strategies—this is especially important for prevention trials of cancer that may ultimately translate to reducing the burden of disease in the population. To identify disparities in cancer prevention trials in Hawaii, we compared participation rates across racial/ethnic groups for breast and prostate cancer prevention trials. We then examined the methods of recruitment for each trial. The following four prevention trials were included in our assessment: the Breast Cancer Prevention Trial (BCPT), the Prostate Cancer Prevention Trial (PCPT), and the Study of Tamoxifen and Raloxifene (STAR). We identified gender differences in the participation rates of Native Hawaiians. Among 272 female participants in the STAR and BCPT trials, 10.3% (n = 28) were Native Hawaiian. In contrast, among 213 male participants in the SELECT and PCPT studies, only 5.2% (n = 11) were Native Hawaiian. The ethnic breakdown of the state during the approximate time of recruitment (2000) was as follows: African American 2.4%, Caucasian 24.3%, Chinese 7.4%, Filipino 16.5%, Hawaiian 19.8%, Japanese 18.9%, Korean 2.4%, Other ethnicities 8.4% (US Census, 2000). In these trials differing recruitment strategies were used. For example, in the SELECT trial a targeted direct mailing campaign to men 50 years of age or older (27.6% of sample), whereas in the STAR trial physician referral was the primary source of participation (59.0%). While these analyses do not speak to what specific strategies were most beneficial for a given racial/ethnic group, it is important to note that there was a higher likelihood of recruiting Native Hawaiian women when they were referred to the trial by their physician. Understanding the importance of the relationship between the study participant and the referral agent is just one strategy that will be examined in our future work. Researchers attempting to recruit African Americans at a rate of 20% for clinical trials (Cook at al., 2005) found that a diligent effort aimed at expanding the eligibility recruitment for African American men and the provision of more resources to particularly target this group were strategies that helped decrease disparities in recruitment. Given the multi-ethnic and multi-cultural nature of Hawai'i there are a wide range of practices and beliefs that need to be considered and incorporated in clinical trial recruitment. Our ultimate goal is to improve the participation rates of Native Hawaiians in clinical trials of cancer prevention. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B26.