Barriers to recruiting underrepresented populations to cancer clinical trials: A systematic review

Abstract

they examined reference lists for eligible articles. Titles and abstracts were reviewed to identify relevant studies. Data on barriers to participation were synthesized both qualitatively and based on statistically significant associations with trial enrollment. Of 5257 studies that were cited, 65 studies were eligible for inclusion in the current analysis, including 46 studies on recruitment into cancer therapeutic trials, 15 studies on recruitment into prevention trials, and 4 studies on recruitment into both prevention and treatment trials. Numerous factors were reported as barriers to participation in cancer-related trials. However, only 20 of the studies reported statistically significant associations between hypothesized barriers and enrollment. The available evidence had limitations in quality regarding representativeness, justification of study methods, the reliability and validity of data-collection methods, potential for bias, and data analysis. The results indicate that underrepresented populations face numerous barriers to participation in cancer-related trials. The current systematic review highlighting the literature on recruitment of underrepresented populations to cancer trials and may be used as the evidence base toward developing an agenda for etiologic and intervention research to reduce the disparities in participation in cancer-related trials. Cancer ;112:228-42. 2008

Engaging diverse populations in biospecimen donation: results from the Hoy y Mañana study

“…Diverse medically underserved communities are less aware of opportunities to participate in biospecimen donation for cancer research as shown in our study and by others that have focused on recruiting underrepresented populations to cancer clinical trials (Ford et al 2008); however, this lack of awareness did not translate to a lack of interest in participating in the research. As shown in similar studies, the use of a community-based education/outreach program facilitated engagement of diverse community participants and provided them with information on a novel opportunity to participate in cancer research through biospecimen donation (Dash et al 2014;Gao et al 2014;Hagiwara et al 2014).…”

Diversity of participants in clinical trials in an academic medical center

“…2,7 Research and interventions have sought to address patient and community factors that impede the recruitment of diverse study participants; it is also important to address clinic-based and provider factors that impede accrual to clinical trials.…”

Barriers to Participation in a Randomized Controlled Trial of Qigong Exercises Amongst Cancer Survivors: Lessons Learnt

“…Cultural and languagebarriers have often been implicated as reason for low recruitment and poor retention of cancer participants (Ford et al, 2008;Gul and Ali, 2010;Symonds et al, 2012 our Qigong trial, language was not the major barrier but cultural issues may well be a key contributor to the attrition rate as we observed a pattern in the different ethnic groups. A recent study by Hui and colleagues (2012) showed that high cancer patients attrition were associated with various patient characteristics and a high baseline symptom burden such as dyspnea (OR, 1.06; p=0.01), fatigue (OR, 1.08; p=0.01), Hispanic race (OR, 1.87; p=0.002), higher level of education (p=0.02), longer study duration (p=0.01), and outpatient studies (p=0.05).…”

“…Participants' adherence to behavioral interventions like Qigong trial is often challenging, particularly in trials of complex interventions, or interventions which involve multiple visits (Courneya et al, 2005), require behavioral changes (Oh et al, 2010), or the involvement of engagement of multilingual, multicultural groups with varying educational level (Ford et al, 2008;Loh, 2009). Therefore, 'multiple difficulties in recruitment, retention of trials patients, and recruitment of cancer patients to trials have been reported (Melinda et al, 2008).…”

“…In ensuring internal and external validity, selection of a study sample representative of the target population is essential (Gordis, 2004). Inability to achieve calculated sample size is a key factor in premature termination of trials leading to low statistical power to detect significant effects (Courneya et al, 2005;Ford et al, 2008;Spaar, et al, 2009).…”