Overview
Clinical trial participation in the United States faces significant challenges, particularly for historically marginalized populations, with racial and ethnic inequities persisting over time. This study aimed to quantify these inequities in cancer clinical trial participation and assess whether social determinants of health (SDOH) contribute to these inequities, to aid in efforts to increase diversity in cancer clinical trials trials.
Researchers assessed over 250,000 patients across the 22 most common cancer types and found Black and Latinx patients were less likely to participate in clinical trials for 19 of 22 cancer types examined and in consequence, Black and Latinx patients were adequately represented in trials for only 4 and 5 cancer types examined respectively. Black and Latinx patients were more likely to reside in economically and socially marginalized areas. Among several factors, neighborhood racial/ethnic composition—used as a proxy for segregation—emerged as the strongest mediator, accounting for one-third of the inequities between Black, Latinx, and White patients.
Why this matters
While many studies exist quantifying structural, clinical, and patient/physician barriers, this study focuses on the role of SDOH in racial/ethnic inequities to trial participation. Understanding substantial mediators to trial participation can inform decision makers on future investments to address this issue. As trial sponsors consider recent FDA mandates to improve diversity in trial participation, this study's findings can guide future strategies. For example, it could be extrapolated that persistent underinvestment in healthcare systems serving segregated communities of color can hinder patient access to facilities offering investigational cancer therapies, worsening structural barriers to trial participation for Black and Latinx patients.