Scott T. Tagawa, MD, Professor of Medicine and Urology at Weill Cornell Medicine, and Attending Physician at New York-Presbyterian – Weill Cornell Medical Center, discusses under-enrollment of African American men in prostate cancer clinical trials and the impact of COVID-19 on cancer research and care.
DocWire News: Data shows African-American men are under enrolled in prostate cancer clinical trials, and this can impact drug efficacy, so what are your thoughts on this?
Scott Tagawa, MD: It’s a problem in, I would say, clinical trials as a general rule across the United States, whether we’re talking about cancer or other. One issue specific to prostate cancer is that, as a general rule, African-Americans are a higher risk for developing prostate cancer and that cancer might be more aggressive. So that’s why I’d say that this is an amplified problem that we have. Some of the data that we have from clinical trials, even though the numbers and percent is lower, those that enter clinical trials, and there’s also some data outside of clinical trials, those that get optimal therapy might do as well and/or is better. So I think it’s an issue that has to do partly with clinical trial enrollment, whether that is access or other issues, but also just access to good care.
So I think there are several potential solutions. I suspect based on the data that I’ve seen, one of the best long-term solutions is to increase the researcher/clinical care demographics and have it matching demographics. So if we have a larger percentage of African-American physicians and physician researchers, then I think that the numbers of African-American patients, this is probably even outside of prostate cancer, but also with prostate cancer, will increase. Because there’s some data that would say across different racial and ethnic different populations that it, whether it’s socioeconomic or something else, that people tend to be drawn more to people that are like them. So in one way, we like to have everyone equal regardless of how they look and gender, et cetera, but there are some factors that I think can lead to better care, and certainly also an increase in clinical trial representation. So anyway, I think that’s one aspect.
Another aspect is to make sure that we have access to the clinical trials across different areas. So not just at a major cancer center that may serve a very specific population, but to have some clinical trials that are also available at private practices or community centers that would allow a broader population of patients to have access across socioeconomic divides.
DocWire News: How has COVID-19 impacted clinical trials for people with prostate cancer?
Scott Tagawa, MD: Broadly speaking, I think it’s affected care in and outside of clinical trials, but somewhat differently depending on region and depending on what kind of outbreaks are in individual regions. So in New York, certainly we’re one of the earliest places to have major peaks. And many of our major hospitals, all of a sudden the doctors that used to be treating cancer were now treating patients that happened to be infected with SARS-CoV-2 or diagnosed with COVID-19. So care shifted in general, and so did the available people.
So clinical trials at many places, not all places, but many places, either shut down or for slow down as personnel were shifted to care for other diseases, or were shifted to not coming into work and working from home. That has changed, at least in New York, where most clinical trials, particularly what we call therapeutic trials, so trials that might lead to a benefit for an individual, we call research subject, a patient’s enrolled in a clinical trial. So those are pretty widely open at all places across New York. There are some sorts of research studies that have a lower chance of a benefit to the individual person or patient, and it’s more of a societal and intellectual benefit. So some of those, if they require extra visits, we’re not doing those as actively as we have in the past.
But certainly, if we look at the numbers across the board, whether it’s prostate cancer or other trials, there’s a major dip when we look at the numbers just of enrollments across the whole country, there’s a major dip in enrollment, March, April, May, picking up in June. And then most of the places are close to the numbers of enrollments from the pre-pandemic numbers. But it’s clearly moving target as the numbers of patients or people being diagnosed and exposed is going up and down in different areas. And we’re all quite hopeful for the vaccines that hopefully will be coming out soon.