Barriers to participation by minorities in oncology clinical trials.

Abstract

68 Background: Clinical trial (CT) diversity remains low despite numerous countermeasures. We investigated barriers to CT participation in our racially/ethnically diverse cancer population while considering loco-regional differences. Methods: An IRB-approved 32-item survey was administered to eligible patients in English or Spanish depending on patient preference. Comparisons were made between groups with ANOVA for age and chi square tests for categorical variables using an alpha of 0.05. Results: 276 responses were analyzed. Spanish-speaking (“Spanish”) respondents were younger, with 29.5% between 31–49 yrs. [vs. 13.3% of English-speaking (“English”) respondents] and 15.8% were >70 yrs. (vs. 28.2%; p=0.004). 41.1% and 27.4% of Spanish respondents were single and married, respectively, compared to 19.9% and 49.7% of English respondents (p<0.001). 32.7% of Spanish respondents had attended and/or graduated college vs. 72.1% of English respondents. 79.6% of English respondents were born in one of the 50 US states (vs. 8.4% of Spanish respondents), while 58.9% of Spanish respondents were born in Puerto Rico. 4.2% of Spanish respondents preferentially spoke English at home. There was no association between CT awareness/invitation to participate and previous diagnosis of cancer, nor between CT awareness and place of birth. However, differences between English and Spanish respondents were observed (Table). Additionally, insurance coverage showed a significant difference among all respondents, with respondents on private insurance more likely to have heard about CT than those with public or no insurance (51.3% vs. 16.4%, resp.; p<0.001). Invitation to participate in CT was higher in the English group (p=0.002), although there was no difference among Hispanics who spoke English at home (p=0.420). Place of birth remained statistically significant for CT participation; 87.5% of those offered were US born (p=0.020). Conclusions: CT awareness continues to be higher in English-speaking cancer patients, and those with private insurance. Inequalities appear to be minimizing in Hispanics with certain acculturation degree. However, CT offering continues to exclude Hispanics, even those who have adopted English as primary language, regardless of place of birth. These findings support efforts to increase CT education in minority populations, and demonstrate certain healthcare bias for CT offering which will need to be addressed to guarantee CT diversity and health equity. Clinical trial (CT) awareness. Variable/characteristic English-speaking Spanish-speaking P value* Sample size 181 (65.6%) 95 (34.4%) --- CT awareness 153/161 (95.0%) 33/85 (38.8%) <0.001 CT awareness among Hispanics 11/14 (78.6%) 30/80 (37.5%) 0.007 *bold denotes statistically significant at p<0.05.