Cancer Clinical Trials Accrual: Missed Opportunities to Address Disparities and Missed Opportunities to Improve Outcomes for All

Abstract

Stewart et al. 1 have implemented a clever strategy for documenting the underrepresentation of racial/ethnic minorities and older patients in surgical oncology clinical trials. Their approach involved calculation of an ‘‘enrollment fraction’’ (EF) for various subsets of the American cancer patient population. Individual EFs were computed as the ratio of National Cancer Institute (NCI)-generated data on cooperative group clinical trial accrual compared with Surveillance, Epidemiology, and End Results Program-derived cancer incidence data. The disappointing (but not necessarily surprising) results from these analyses demonstrated that EFs were substantially lower for African American, Hispanic/Latino American, and Asian/Pacific Islander cancer patients (0.48%, 0.54%, and 0.59%, respectively) when compared with white Americans (0.72%). Cancer patients age 75 years and older had an EF of 0.14%, in contrast to an EF of 1.8% for patients aged 21 to 54, and 0.91% for those aged 55 and 64. Race/ethnicity- and age-related disparities in surgical oncology clinical trial accrual are potent examples of inequities the current American health care system. The clinical trial mechanism represents the most powerful weapon that the oncology community possesses in the effort to improve the standard of care as well as survivorship for cancer patients. Diet, comorbidities, lifestyle/culture, and socioeconomic resources are all features that vary between and