Black History Month: Reflecting on Why Representation in Clinical Trials is Important | Christina Washington, MD
Christina Washington, MD
As we all take the month of February to reflect on the contributions and achievements made by Black/African Americans, we must also think about all the work that needs to be carried out to improve cancer health disparities within Black/African American communities. There is a vast amount of heterogeneity within Black Americans, a category that includes people who were born in the United States or immigrated here and can trace their ancestry to racial groups in Africa and the African Diaspora. This heterogeneity leads to differences in the incidence and outcomes of cancer within its subgroups.1
The origins of cancer health disparities are multifaceted and are a result of unfavorable social and built environmental factors that influence increased incidence, more advanced stage at diagnosis, and higher mortality rates from cancer. Disparities in healthcare continue to exist and structural barriers, discriminatory policies, and systemic inequities continue to maintain cancer health disparities.
Black individuals experience the burden of cancer disproportionately despite the progress made in reducing disparities.2 It was estimated that Black Americans made up 11.4% of new cancer diagnosis and 25.6% of cancer related deaths in 2022. However, Black Americans only account for 5% of clinical trial participants.3 Barriers that limit participation of racial and ethnic minorities in clinical trials has been explored in a number of studies, which have revealed a range of societal injustices and structural barriers at both the individual and systemic level.4 Despite the known benefits of clinical trials, low enrollment remains, due to a host of reasons including mistrust of the health care system, fear of clinical trials, lack of understanding of cancer clinical trials, and not being informed about clinical trials available to them.1,5 Clinical trial participants should accurately reflect the patients that will be using the treatment being tested; lacking such representation in clinical trials decreases our ability to generalize outcomes to all populations.
Outcomes from clinical trials help to inform our understanding of cancer, build tomorrow’s standard of care, and improve survival for people with a cancer diagnosis; therefore, it is imperative that we actively develop multidimensional approaches, including policy initiatives and education, to ensure that new treatments are applicable to their intended population. As a non-traditional African American medical student, trainee, and now faculty member, I hope to improve clinical trial participation of underrepresented patients. I plan on achieving this by continuing my professional development in ways to increase diversity in clinical trials with the goal of creating equitable care for all patients.
References
1. Research, A.A.f.C. AACR Cancer Disparities Progress Report 2022; Available from: http://www.CancerDisparitiesProgressReport.org/.
2. Siegel, R.A.-O., et al., Cancer statistics, 2022. (1542-4863 (Electronic)).
3. Alegria, M., et al., Reporting of Participant Race, Sex, and Socioeconomic Status in Randomized Clinical Trials in General Medical Journals, 2015 vs 2019. JAMA Network Open, 2021. 4(5): p. e2111516-e2111516.
4. Kahn, J.A.-O., et al., Strategies to improve diversity, equity, and inclusion in clinical trials. (1097-0142 (Electronic)).
5. Hernandez, N.A.-O., et al., African American Cancer Survivors’ Perspectives on Cancer Clinical Trial Participation in a Safety-Net Hospital: Considering the Role of the Social Determinants of Health. (1543-0154 (Electronic)).
Christina Washington, MD is currently an Assistant Professor in the department of OBGYN, Division of Gynecologic Oncology at the University of Oklahoma Health Sciences Center. Washington is a recipient of the Robert A. Winn Diversity in Clinical Trials Career Development Award, funded by Bristol Myers Squibb Foundation. Her interests also include developing trials to improve outcomes in patients with gynecologic cancers.