Clinical trials play a key role in advancing cancer treatment, especially for Black Americans who face higher death rates and experience inequalities in access to health care. We must understand the unique barriers Black patients in the U.S. encounter concerning availability and enrollment in clinical trials.
A survey study in partnership with the Association of Community Care Centers (ACCC), Oncology Research Institute (ACORI), and the American Society of Clinical Oncology (ASCO), aimed to identify these barriers and explore strategies to overcome these obstacles.
Barriers to enrolling Black Americans in clinical trials
The Barriers to Clinical Trial Implementation Among Community Care Centers study revealed the key factors that influence patient enrollment in clinical trials as well as recommendations for improving practices to help boost clinical trial enrollment.
This study’s recommendations align with FDA guidance to improve clinical trial enrollment among minority groups. The study also revealed the additional barriers to clinical research trial enrollments:
Wavering patient participation
The majority of enrollments in clinical trials come directly from patient requests for inclusion. However, despite being proactive, patients change their minds about participation for a variety of reasons. These can include lack of communication with their doctor, fear of negative side effects, concerns based on hearsay or previous experience, whether the trials are culturally appropriate for Black people and financial or logistical issues.
Because of this, it’s important to capitalize on patients’ proactive behavior by supporting patient-driven programs like the Clinical Trials Matching Service, which from 2007 to 2010 resulted in an 11 percent improvement in clinical trial enrollments.
Staffing and accessibility concerns at community center sites
For community care sites not engaged in clinical trial research – six site contacts out of the 58 that responded to the survey – limited staffing was the most common reason for non-participation. This highlights a need to develop a better infrastructure to ensure that proper resources and support are in place to expand clinical research trial participation efforts.
Another barrier to enrollment, according to the study, was the lack of doctor participation. The study found that some doctors prefer to work with established cancer therapies, while others noted that they simply lacked the time or incentive to discuss trials with their patients. Recommendations presented to combat these challenges include improving eligibility criteria for enrollment and emphasizing reimbursement options to sites performing trials.
Doctors require resources to assist them in finding clinical trials for their patients; one such resource – The Canadian Cancer Trials Network – was developed for this purpose. Introducing similar navigation platforms would enhance health care professionals' capacity to discuss clinical trials with their patients.
Geographical considerations and clinical trial availability
Study results show that location can affect trial availability. Centers with a smaller number of patients and those in rural or suburban areas have fewer industry-sponsored clinical trials in comparison to their urban counterparts. To boost clinical trial enrollment, expanding early-phase trials to rural and suburban areas and highlighting industry-sponsored trial enrollment in centers with fewer patients, is key.
How are clinical trials beneficial in medicine?
Clinical trials provide health care professionals with important insight into patient care and treatment with each phase, clinical trials help increase knowledge to assist medical teams in ongoing treatment plans. Research gained from these trials – performed in a structured and controlled environment – can have a significant impact on not only current patients but also, future patients facing similar conditions and diseases.
Clinical trials provide patients access to therapies and treatments that otherwise may be unavailable through standard care. The goal of these trials is to improve the effectiveness of treatment with minimal side effects, with hopes of improving patient quality of life.
How do clinical trials benefit Black Americans with cancer?
For Black cancer patients, participating in a research trial comes with the knowledge that not only are they potentially treating their disease, but they’re also helping the medical industry and developing potential cutting-edge treatments that could improve the lives of other Black Americans.
Historically, clinical trials have lacked the diversity and inclusion necessary to ensure treatments align with the unique needs of Black patients facing numerous disparities in comparison to their non-Black counterparts.
To promote medical equity, clinical trials must reflect the groups impacted by the conditions or diseases being treated and studied. Because Black Americans are disproportionately diagnosed with certain late-stage cancers, clinical trials are of utmost importance.
Factors such as race, socioeconomic status, and location not only affect a person’s risk of developing certain types of cancers, but they can also be a factor in treatment and their chances of survival. With more Black cancer patients participating in clinical trials, more data on how to care for Black patients specifically becomes available.
To learn more about clinical trials, discover our Clinical Trials Resource Center.