Community-Based Engagement Initiative Yields Higher Percentage of Black Participants in Cancer Trials

A multifaceted, community-based engagement initiative to encourage clinical trial enrollment among Black people yielded an improved percentage of Black participants in clinical cancer trials. These findings, which will be to be presented at the American Society of Clinical Oncology annual meeting on June 5,  suggest that gaps in access to cancer centers are a key factor driving access to clinical trials, the researchers noted.

At the initiation of this study in 2014, Black residents of Philadelphia comprised 19% of the population and 16.5% of cancer cases in the city, but only 11.1% of cancer trial patients from the Abramson Cancer Center at the University of Pennsylvania (ACC) were Black.

The Effort to Change a Troubling Trend

To change these troubling trends, a team of investigators from the University of Pennsylvania School of Medicine established a center-wide program with community guidance to address these gaps. They noted that elements of the program included: 1) culturally tailored marketing strategies for cancer clinical trials; 2) plans for each protocol to facilitate Black participant enrollment; 3) new partnerships with faith-based organizations serving Black communities to conduct educational events about clinical trials; 4) pilot programs with Lyft and Ride Health to address transportation barriers; 5) patient education by nurse navigators regarding cancer and clinical trials; and 6) an improved informed consent process.

Overall, the initiative reached more than 10,000 venues including churches, neighborhoods, community parks and centers, and health centers.

Encouraging Results

Encouragingly, after re-assessing the metrics in 2018, the percentage of Black patients seen at ACC had increased to 16.2%, matching the percentage of Black cancer patients among all cancer cases in the study area (16.5%). The researchers wrote that: “Total cancer clinical trial accrual had increased from 9,308 participants in 2014 to 13,170 in 2018 (41.5% increase). The percentages of Black participants accrued onto treatment, non-therapeutic interventional, and non-interventional trials were 23.9%, 33.1%, and 22.5%, respectively – a 1.7- to 4.0-fold increase in five years and higher than the percentage of Black patients seen at the ACC.”

“An important goal of the Abramson Cancer Center is to serve and engage our community –and that includes improving access to clinical trials for all patients,” said senior author Robert H. Vonderheide, MD, DPhil, director of the ACC and vice president for Cancer Programs in the University of Pennsylvania Health System via a press release about the study. “Aligning the number of Black patients with cancer we care for with the number enrolled in our trials is how we can help bring more equitable care to the community, close gaps in disparities, and sustain trust. There’s more work to be done to improve access and inclusion of minority groups, and the impact of this outreach and engagement effort is an important step forward.”

 

“We’ve shown here that a multifaceted, community-based engagement initiative works to improve access to cancer clinical trials by Black patients with cancer,” said first author Carmen E. Guerra, MD, MSCE, FACP, an associate professor of Medicine and associate director for Diversity and Outreach in the ACC. “We will continue to work with collaborators such as Lazarex that share in our vision to increase participation of underrepresented patients in trials, while at the same time engage with the community to develop strategies that address needs and barriers, from different social determinants of health to solidifying their trust.”