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Overcoming Barriers: Evidence-Based Strategies to Increase Enrollment of Underrepresented Populations in Cancer Therapeutic Clinical Trials—a Narrative Review

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Abstract

Disparities in cancer incidence and mortality rates among racial and ethnic minorities (African Americans, Asian Americans, Pacific Islanders, American Indians, and Latinos/Hispanic Americans) in the USA are well documented. Enrollment of underrepresented populations in cancer therapeutic clinical trials, however, is very low. This is true despite federal mandates to ensure accrual rates adequate for analyses and the evidence that the effectiveness of specific therapies and medications varies across ethnic and racial groups. Consequently, cancer clinical decision-making is based on research studies where the majority of research participants are white males, despite the disproportionate cancer burden in racial and ethnic minority groups. To date, there have been multiple reviews detailing the barriers to enrollment for these populations in cancer clinical trials, but a notable lack of research on possible strategies to overcome them. The aim of this narrative review is to summarize the current evidence for effective approaches to increase enrollment of underrepresented minorities in cancer therapeutic clinical trials. These approaches include (1) cultural and linguistic adaptations of marketing materials, (2) the use of patient navigators, and (3) building ongoing community partnerships. The majority of studies reviewed employ multiple improvement strategies simultaneously. Identifying effective approaches to increase enrollment of underrepresented populations in cancer clinical trials is a critical step in reducing persistent disparities in cancer incidence and mortality among racial and ethnic populations.

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Funding

This work was supported by the University of Wisconsin Carbone Cancer Center Support Grant P30 CA014520; Wisconsin Partnership Program at the University of Wisconsin School of Medicine and Public Health AAC5927, American Cancer Society Physician Training Award in Cancer Prevention PTAPM-17-196-01; Wisconsin Medical Alumni Association Perlson Scholarship Award.

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Authors and Affiliations

  1. Carbone Cancer Center, Cancer Health Disparities Initiative, School of Medicine and Public Health, University of Wisconsin – Madison, 610 Walnut Street, 370 WARF, Madison, WI, 53726, USA

    Iris Vuong, Joshua Wright, Amanda Eggen, Erin Bailey & Rick Strickland

  2. Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin – Madison, 610 Walnut Street, 1032 WARF, Madison, WI, 53726, USA

    Margaret B. Nolan

  3. Department of Medicine, School of Medicine and Public Health, University of Wisconsin – Madison, 1111 Highland Avenue, 3103 WI Institute Medical Research, Madison, WI, 53705, USA

    Anne Traynor

  4. Department of Urology, School of Medicine and Public Health, University of Wisconsin – Madison, 8007 Excelsior Drive, 3223 UW Medical Foundation, Madison, WI, 53717, USA

    Tracy Downs

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  1. Iris Vuong
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  2. Joshua Wright
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  3. Margaret B. Nolan
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Correspondence to Joshua Wright.

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Appendix

Appendix

Table 1 Summary of reviewed studies by population, strategy, and measured outcome
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Vuong, I., Wright, J., Nolan, M.B. et al. Overcoming Barriers: Evidence-Based Strategies to Increase Enrollment of Underrepresented Populations in Cancer Therapeutic Clinical Trials—a Narrative Review. J Canc Educ 35, 841–849 (2020). https://doi.org/10.1007/s13187-019-01650-y

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