Enrollment Matters: The Reality of Disparity and Pursuit of Equity in Clinical Trials

Winn, Robert A.

doi:10.1158/2159-8290.cd-22-0319

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…Clinical research must improve care for everybody . Minoritized and socioeconomically disadvantaged populations are underrepresented in clinical trials . This may reduce the generalizability of trial results and propagate health disparities .…”

Section: Introductionmentioning

confidence: 99%

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Analysis and Optimization of Equitable US Cancer Clinical Trial Center Access by Travel Time

Lee,

Bates,

Callier

et al. 2024

JAMA Oncol

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ImportanceRacially minoritized and socioeconomically disadvantaged populations are currently underrepresented in clinical trials. Data-driven, quantitative analyses and strategies are required to help address this inequity.ObjectiveTo systematically analyze the geographical distribution of self-identified racial and socioeconomic demographics within commuting distance to cancer clinical trial centers and other hospitals in the US.Design, Setting, and ParticipantsThis longitudinal quantitative study used data from the US Census 2020 Decennial and American community survey (which collects data from all US residents), OpenStreetMap, National Cancer Institute–designated Cancer Centers list, Nature Index of Cancer Research Health Institutions, National Trial registry, and National Homeland Infrastructure Foundation-Level Data. Statistical analyses were performed on data collected between 2006 and 2020.Main Outcomes and MeasuresPopulation distributions of socioeconomic deprivation indices and self-identified race within 30-, 60-, and 120-minute 1-way driving commute times from US cancer trial sites. Map overlay of high deprivation index and high diversity areas with existing hospitals, existing major cancer trial centers, and commuting distance to the closest cancer trial center.ResultsThe 78 major US cancer trial centers that are involved in 94% of all US cancer trials and included in this study were found to be located in areas with socioeconomically more affluent populations with higher proportions of self-identified White individuals (+10.1% unpaired mean difference; 95% CI, +6.8% to +13.7%) compared with the national average. The top 10th percentile of all US hospitals has catchment populations with a range of absolute sum difference from 2.4% to 35% from one-third each of Asian/multiracial/other (Asian alone, American Indian or Alaska Native alone, Native Hawaiian or Other Pacific Islander alone, some other race alone, population of 2 or more races), Black or African American, and White populations. Currently available data are sufficient to identify diverse census tracks within preset commuting times (30, 60, or 120 minutes) from all hospitals in the US (N = 7623). Maps are presented for each US city above 500 000 inhabitants, which display all prospective hospitals and major cancer trial sites within commutable distance to racially diverse and socioeconomically disadvantaged populations.Conclusion and RelevanceThis study identified biases in the sociodemographics of populations living within commuting distance to US-based cancer trial sites and enables the determination of more equitably commutable prospective satellite hospital sites that could be mobilized for enhanced racial and socioeconomic representation in clinical trials. The maps generated in this work may inform the design of future clinical trials or investigations in enrollment and retention strategies for clinical trials; however, other recruitment barriers still need to be addressed to ensure racial and socioeconomic demographics within the geographical vicinity of a clinical site can translate to equitable trial participant representation.

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Section: Introductionmentioning

confidence: 99%

“…1,2 Minoritized and socioeconomically disadvantaged populations are underrepresented in clinical trials. 3 This may reduce the generalizability of trial results and propagate health disparities. 4 Contributors to inequitable trial participation include individual-level factors and structural factors.…”

mentioning

confidence: 99%

Analysis and Optimization of Equitable US Cancer Clinical Trial Center Access by Travel Time

Lee,

Bates,

Callier

et al. 2024

JAMA Oncol

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show abstract

“…This limitation is consistent with the general underrepresentation of racial minorities in precision oncology studies broadly as well as genetic and genomic research. [18][19][20][21][22] This is a major public health concern as it precludes access to innovative and potentially active oncological treatments, limits scientific progress by underappreciating genetic diversity, and translates into significant health disparities of already marginalized racial minorities. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Studies of ethnic and geographic variability of gBRCA testing uptake and gBRCAm prevalence in PC are currently lacking.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21][22] This is a major public health concern as it precludes access to innovative and potentially active oncological treatments, limits scientific progress by underappreciating genetic diversity, and translates into significant health disparities of already marginalized racial minorities. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Studies of ethnic and geographic variability of gBRCA testing uptake and gBRCAm prevalence in PC are currently lacking. To the best of our knowledge, this aspect has only been described in the phase III POLO trial of maintenance olaparib in patients with advanced, platinum-sensitive PC carrying a gBRCAm.…”

Section: Introductionmentioning

confidence: 99%

“… 18 , 19 , 20 , 21 , 22 This is a major public health concern as it precludes access to innovative and potentially active oncological treatments, limits scientific progress by underappreciating genetic diversity, and translates into significant health disparities of already marginalized racial minorities. 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 …”

Section: Introductionmentioning

confidence: 99%

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A systematic review and meta-analysis of germline BRCA mutations in pancreatic cancer patients identifies global and racial disparities in access to genetic testing

Paiella¹,

Azzolina²,

Gregori³

et al. 2023

ESMO Open

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Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research

Warner,

Marron,

Peppercorn

et al. 2024

The Journal of Clinical Ethics

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Enrollment Matters: The Reality of Disparity and Pursuit of Equity in Clinical Trials

Cited by 4 publications

References 13 publications

Analysis and Optimization of Equitable US Cancer Clinical Trial Center Access by Travel Time

Analysis and Optimization of Equitable US Cancer Clinical Trial Center Access by Travel Time

A systematic review and meta-analysis of germline BRCA mutations in pancreatic cancer patients identifies global and racial disparities in access to genetic testing

Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research

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