Tackling cancer care racial disparities in the US

20 Apr 2009

Enhancement of recruitment of African-Americans to national oncology trials

African-Americans tend to have worse cancer outcomes and their enrollment in clinical trials continues to lag due to barriers of mistrust and communication, as well as lack of knowledge and access to the trials. However, researchers at Meharry Medical College and Vanderbilt Ingram Cancer Center believe they have found a way to overcome those barriers.

“Our research staff at Nashville General Hospital at Meharry is dedicated and permanent. We do not refer African-Americans to another center for clinical trial enrollment. We offer clinical trial participation right here as part of our best medical practices if an appropriate trial is available,” said Debra Wujcik, director of the Cancer Clinical Trials Office. Working with colleagues in the Meharry/Vanderbilt Cancer Partnership, and funded by a grant from the National Cancer Institute, Wujcik and colleagues sought to determine if they could increase the enrollment of African-Americans in clinical trials at their own center. The current national average for enrollment is about 2.5 percent.

Researchers established a procedure to identify every patient eligible for a clinical trial at the time of confirmed diagnosis. Prior to participation in the study, each clinician was offered training on how best to identify eligible patients and discuss the clinical trial option. No financial incentives were offered to the patient or the clinician.

“Most of the time, the clinical trial option is offered as an afterthought, which contributes to mistrust because African-Americans view themselves as part of an experiment that may not be to their benefit,” said Wujcik. From 2001 to 2004, researchers screened 569 patients, of whom 164 were eligible for a study (29 percent) and 95 agreed to enroll (17 percent). Overall, during this time period, 58 percent of those who were offered a study agreed to participate. Of the patients who did not enroll in a study, 66 percent were ineligible due to additional medical conditions. Only 3 percent refused because it was research. From 2005 to 2007, researchers refined their techniques and screened 556 patients of whom 172 (32 percent) were eligible for a study and 138 (25 percent) agreed to participate. During this current interval, 80 percent of patients offered a clinical trial participated. Since 2001, 1,125 patients have been screened, 30 percent of whom had a study available and 21 percent have enrolled.

“What that means is that 68 percent of patients who were eligible agreed to participate,” said Wujcik. “This model is definitely replicable at a hospital with a permanent and consistent staff, adequate resources to conduct clinical trials and a patient-oriented, culturally sensitive environment.”