By Robert Levy
Above all else, clinical research is about action – moving promising findings from the lab to patient care. The same can now be said about addressing disparities in clinical trial participation: that such disparities exist is well documented; the question going forward is how to reduce them.
The 11th annual Cancer Research Disparities Symposium organized by Dana-Farber/Harvard Cancer Center (DF/HCC) focused squarely on what's being done – and needs to be done – to increase racial and ethnic minority enrollment in cancer clinical trials. Participants in the May 10 online event spoke from their experience as researchers, patients, and clinicians in advancing trial equity.
In her opening remarks, Karen Burns White, MS, deputy associate director of Cancer Equity and Community Engagement at DF/HCC, described inclusivity in trial participation as not only as a matter of equity but of ensuring that trial results are broadly relevant.
"Diversity in clinical trials is essential to ensure that everyone benefits from medical advances and is a key factor in eliminating health care disparities across populations," she said. "Acknowledgement of disparities is just the beginning of the solution. Let's move beyond awareness and confront areas such as the role of systems and structural issues and be open to recognizing that racism can and does perpetuate underrepresentation."
The event's keynote speaker, Robert Winn, MD, director and Lipman Chair in Oncology at VCU Massey Comprehensive Cancer Center, spoke directly to that challenge. Noting that racial and ethnic inequities in health care have been studied since the early 1900s, he asked, "How is it that we've known and recognized these inequities all this time and they still stand?"
Disparities have persisted even in the face of research showing that biology often plays a smaller role than access to quality health care in patient outcomes, he remarked. "I grew up thinking that because I'm an African American – because of my biology – I was destined to have a poorer outcome from prostate cancer than my white classmates." That such concerns were misplaced became particularly clear in a 2022 study that found, "given equal access to care in the Veterans Administration system, outcomes for Black men with prostate cancer were no worse than for white men."
While one's DNA plays an indisputable role in treatment outcomes, "your ZNA – Zip code Neighborhood Association, the type of neighborhood you're from – is also key driver of your response to treatment," Winn remarked. And while scientific advances have narrowed the gap between Black and white patients' outcomes, "they aren't sufficient to eliminate it."
Noting that "poverty in itself is a carcinogen," Winn described his efforts to broaden participation in cancer drug trials. He launched a scholarship program that seeks to build bridges between those who develop clinical trials and those who do community outreach.
"What if we take people who design and implement high-impact trials but also train them in the science of outreach," he asked. "What if, in designing a trial, they get together with people who know how to communicate with a specific community?"
The Robert A. Winn Diversity in Clinical Trials Award Program seeks to do just that. Scholarship recipients pursue a two-year program in clinical trial design and implementation at VCU Massey Comprehensive Cancer Center. "The goal is to train a new generation of clinical trialists who not only know how to develop a trial but also have the tools to engage with the community," Winn said.
Discussing Diversity
The symposium also included a conversation between Brenda Lormil-Raymond, CNP, an equity nurse practitioner at Massachusetts General Hospital, and two African American patients about their clinical trial experiences. That was followed by a panel discussion with Dana-Farber's Glenn Hanna, MD, Andrew Hantel, MD, and Ivy Tillman, EdD, executive director of Public Responsibility in Medicine and Research, a non-profit organization that provides educational services for research ethics professionals, on institutional barriers and opportunities in greater access to trial participation.
“Everyone is looking for the magic solution to improve access to clinical trials for marginalized communities. In fact, what it takes is a willingness to engage communities where they are and a commitment to eliminating known barriers," said Christopher Lathan, MD, MS, MPH, chief clinical access and equity officer, who helped lead the symposium. "The question is whether cancer centers have the will to change. Time will tell.”