Call to action on oncology trials inequity

Australian cancer researchers have issued a ‘call to action’ on equity in clinical trial participation, saying there is a paucity of local information about barriers based on factors such as ethnicity and geography.

While an estimated 95,000 Australian patients will join a study in any given year, there are claims the local industry falls behind countries such as the UK on a per-capita basis.

Based on the limited available data, “Australian patients with cancer face similar barriers to clinical trial participation as those documented in other countries, such as inequity based on race, ethnicity, and geography,” said researchers from University of Queensland and Monash University in Melbourne.

Beyond that, little is known about which patients are being invited to participate and who is missing out, they wrote in Seminars in Oncology.

“We cannot ignore that a better understanding of the factors influencing oncology trial participation in Australia is needed,” the researchers wrote.

“By improving our understanding and with a concerted effort, the Australian clinical trial community can contribute further to best practice clinical care for oncology patients and their carers in their respective journeys, both nationally and internationally.”

They said they were aiming to perform a scoping review of the current literature on the topic, followed by a 3-round Delphi study including stakeholders.

“With this foundational backbone of knowledge, we can start to implement steps to improve trial participation, by designing interventions targeting the key barriers and assessing their efficacy,” they said.

The move comes after the American Society of Clinical Oncology (ASCO) and the Association of Community Cancer Centers (ACCC) called for systemic changes earlier this month to improve equity, diversity and inclusion in US cancer trials.

In recommendations published in the Journal of Clinical Oncology they said black and Hispanic patients currently represented only 4% and 6% of participants in US cancer trials respectively.

This was despite the fact that 15% of US patients diagnosed with cancer were black and 13% were Hispanic.

“Ensuring that every individual with cancer has an opportunity to participate in high-quality, equitable cancer research, will take a concentrated effort by all stakeholders,” said ASCO president Professor Lori Pierce.

“Removing barriers to enrolment and participation for people historically underrepresented in clinical trials is a critical scientific and ethical imperative for the entire cancer community.”

Recommendations included mandatory CPD on cross-cultural competency and bias mitigation for researchers involved in clinical trials and specific programs to remove barriers to participation for diverse groups.

Researchers should also collect and publish aggregate data on the racial makeup of trial participants, the organisations said.

Meanwhile, pharmaceutical company AstraZeneca has this week announced it will be conducting a review of diversity in its sponsored clinical trials.

The company’s head of oncology, David Fredrickson spoke at the World Economic Forum’s annual meeting in Davos, describing the process as applying an “equity lens” to every phase of a medicine’s lifecycle. According to the Guardian, he said there was a need to work towards better representation of women and people of colour, also noting that many cancer trial eligibility criteria excluded groups such as people with type 2 diabetes and people with obesity.

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