Diversity Lacking in Referrals to Early Phase Trials in the UK

Patients from non-white backgrounds were underrepresented in referrals to early phase clinical trials at a United Kingdom tertiary referral center, according to a poster presented at the 2021 European Society for Medical Oncology Congress.

Early phase trials are designed to evaluate safety and efficacy of new treatments. In order to accurately capture potential differences in responses and toxicities, these trial cohorts should represent the diversity of patients that make up the overall population.

In this study, researchers retrospectively analyzed 1,375 referrals to the Experimental Cancer Medicine Team (ECMT) at the Christie National Health Service Foundation Trust from January 2018 to December 2019. Of these referrals, 247 patients were enrolled onto clinical trials.

Ethnicity was recorded for 1,060 of the referred patients and 231 of the patients enrolled onto a trial. The majority of patients (93%) referred to ECMT were white British, compared to 78% of the population of England, 85% of the population in the North West, and 77% of the population in Greater Manchester (P<0.001).

Patients’ residential postcodes were used to generate indices of multiple deprivation, with 1 being the most deprived and 10 the least deprived. In a univariate analysis, patients in indices of multiple deprivation deciles 4-10 had a significantly lower median overall survival (OS) than those in deciles 1-3 (7.7 months vs. 14.3 months; P = 0.001). In a multivariable analysis that adjusted for response, this association between deprivation decile and OS was not seen. After adjusting for deprivation deciles, data showed that the higher the living environment decile the worse the overall survival (P = 0.004).

“Further work is required to study the association between indices of multiple deprivation, its constituent domains such as living environment and overall survival,” the researchers concluded.