Reply to A. Surbone et al

Abstract

We read with interest the letter by Surbone and Kagawa-Singer entitled, “Culture Matters As Well.” We share their enthusiasm for the promotion of “nondiscriminatory referring clinician practices,” as well as greater exploration of the impact of anthropology and ethnography on patients’ decisions regarding cancer care and clinical trial involvement. However, we have no evidence in the early-phase setting that these factors are more important than, for example, objective measures of fitness and comorbidities. Improving cancer clinical trial access for all patients requires greater understanding of the social, cultural, physical, and emotional barriers that patients face. We are reminded by Unger et al not to overlook the importance of aspects of trial design and possible toxicity in patients’ decisions to participate. They demonstrated that choosing not to participate in a clinical trial was more likely to be motivated by such clinical considerations than by cost or convenience. Now that we have demonstrated a disparity in referrals for earlyphase trials between the least and most affluent patients in our catchment area, we are motivated to explore causality. At present, we can only speculate on the relative importance of factors such as culture, comorbidity, and referrer bias. James Spicer King’s College London; and Guy’s & St Thomas’ National Health Service Foundation Trust, London, United Kingdom