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Changing the Game

People sitting and talking to one another.
Community-based efforts are critical to increased inclusion of diverse groups in clinical trials.

Cancer centers design strategies to include more diversity in clinical trials

by Dawn Brazell

Not one size fits all, and nowhere does that show up more than in cancer trial recruitment of racial and ethnic minorities, says Hollings Cancer Center researcher Marvella E. Ford, Ph.D., associate director of population sciences and cancer disparities at MUSC Hollings Cancer Center. She was part of a study involving eight cancer centers looking at best practices and providing recommendations for how these populations can best be engaged in clinical trials.

“This is a major focus of the National Cancer Institute, and it’s very important because we need to make sure that at the end of the day the research results can be generalized across multiple population groups,” she says. “We can’t use a one-size-fits-all approach and use the same recruitment strategies in every single group. We really have to tailor the recruitment strategies to the needs of the group.”

The study identified that African Americans, who represent 13% of the general U.S. population, comprise 5% of patients enrolled in clinical trials, with Asian Americans and Hispanics comprising only about 3%.

Ford says researchers must take a different tack with racial and ethnic minority groups. “We can’t recruit all groups the same because different groups have different relationships, histories and past abuses with the health care system and with the federal government.”

Though minority enrollment in clinical trials tends to be low in general, it’s particularly an issue in cancer, where advances in research are driving a paradigm shift in precision medicine. It’s important that the development of personalized medicines that account for biologic factors, such as genetics, gender, race and ethnicity, have a diverse pool of participants.

A key component in increased inclusion is the development of trust in the community. One tactic Hollings Cancer Center uses is its MOVENUP Program, which takes a train-the-trainer approach in rural communities that are medically underserved. The program is now being expanded in a new partnership with the Seventh Episcopal District of the African Methodist Episcopal Church, with monthly programs planned, including modules on clinical trials, to reach its more than 400 churches spread across the state.

Though research is about data, the core of it is about people, Ford says.

“We want to bring in community members and talk to them and bring in key people from the community who can advocate for the trials that we’re conducting. Communities want a relationship with the people who are conducting the trial. They don’t want a nameless, faceless entity. That doesn’t mean anything to them,” she says.