An article in the November
2011 issue of CancerDiscovery, the journal of the American Association for Cancer Research,
defines the problems and outlines strategies for recruiting minority groups and
seniors for Clinical Trials.
Although about one third of
the US
Minority groups and the
elderly are at higher risk of being diagnosed with cancer than the population
as a whole. So when there is low participation in trials from any group of
cancer patients, the trial results may not be as applicable to those groups.
And the low participation can also delay final approval of beneficial drugs. In
order for us to know how to best treat all Americans with cancer, we need all
Americans to be represented in clinical trials.
Several groups are now
focusing on providing basic clinical trial education using DVDs to these
groups—in several languages when appropriate.
Another direction is to
provide additional training to nurses and doctors to help them better
understand the issues in recruiting and the possibilities of participation in
clinical trials for their patients.
And in some locations
patient ‘navigators’ are being trained to provide one on one information,
answer questions, and help potential participants fill out application
materials.
When you compare the demographics of participants on cancer clinical trial to the demographics of the general population, you are comparing apples to oranges, and making erroneous assumptions about the representativeness of some groups.
ReplyDeleteThe demographics of cancer patient differs significantly from the demographics of the general population. Look at who actually gets cancer, and not the rate of cancer within a particular race. You'll find that people with cancer are disproportionately White. This is because the biggest risk factor for cancer is old age. Who is old? Look at the demographics of baby boomers.
So yes, minorities and women ARE generally underrepresented on cancer clinical trials, but often not to the degree that you think. We need to look at comparable populations in order to assess the extent of under-representation, and to set achievable and reasonable recruitment goals.
BTW, the next wave of oldsters? Hispanics. Let's talk about how we can ready our systems and infrastructures to address the next mainstream population :-)
Lynne -
ReplyDeleteYou make a good point - but it's even a bit more complicated than that. It is true that age is a major risk factor for some cancers but not for all cancers. It is also true that minority populations is on average younger - they are growing as a share of the overall population. Having said that, minorities are often underrepresented in clinical trials even after correcting for these demographic factors. Further, to the extent that we believe that clinical trial results are valid primarily for populations in which they studies were carried out, the shortage of minority participants in clinical trials remains an important problem. The bigger issue, of course, is overall participation in clinical trials, which for adults with cancer, is very low regardless of background.
Elderly are at higher risk of developing cancer, but in recent studies ever younger generation are more diagnosed with cancer. It is better to spread awareness of cancer.
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