Community-Based Initiative Doubles Accrual Rate of Black Participants in Cancer Trials

Lauren Massaro

An initiative launched with the intent to deliver equitable cancer care improved the enrollment rates of Black participants in cancer clinical trials by focusing on community outreach and engagement.

A 5-year initiative to encourage the enrollment of Black participants in cancer clinical trials was associated with improved accrual rates at the Abramson Cancer Center at the University of Pennsylvania (ACC), according to research published during the 2021 Annual Meeting of the American Society of Clinical Oncology.

Using targeted community outreach and engagement strategies, the effort aimed to addressed the broader issue of underrepresentation of Black participants in cancer research—nationwide, only 5% of Black patients with cancer are enrolled in clinical trials, despite making up 13.4% of the population.

In 2014, baseline findings of the 12-county catchment area near Philadelphia showed that while Black residents comprised 19% of the population and 16.5% of cancer cases, only 11% of ACC patients were Black. Rates of enrollment in treatment, non-therapeutic interventional, and non-interventional trials by Black participants were 12.2%, 8.3%, and 13.0%, respectively.

The ACC launched the community-based engagement initiative to address these gaps. The program implemented culturally tailored marketing strategies for cancer clinical trials; protocol-specific plans to facilitate Black participant enrollment; new partnerships with faith-based organizations serving Black communities to conduct educational events about clinical trials; and pilot programs with Lyft and Ride Health to address transportation barriers. It also promoted patient education by nurse navigators regarding cancer and clinical trials and established an improved informed consent process.

Using formats ranging from educational forums to wellness fairs, the program reached more than 10,000 individuals in venues such as churches, neighborhoods, community parks and centers, and health centers.

By 2018, the impact of the program had become clear, with findings showing that the percentage of Black patients treated at the ACC had increased to 16.2%, an approximate 5% increase from 2014, and matching the percentage of Black cancer patients in the areas around the hospital.

Other findings showed:

  • The number of Black participants enrolled in cancer clinical trials rose to 13,170, up 41.5% from 2014.
  • There was a 1.7- to 4.0-fold increase in enrollment rates in the 3 types of clinical trials, with accrual rates in treatment, non-therapeutic interventional, and non-interventional trials at 23.9%, 33.1%, and 22.5%, respectively.

The results of the program suggest that gaps in accessibility to cancer centers exacerbate issues of underrepresentation of the Black community in cancer research, said the authors, who noted that further research should take into account the effect of Medicaid expansion, which was happening during the 5 years of the study in the states served by the ACC.

“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 in the community, close gaps in disparities, and sustain trust,” senior author Robert H. Vonderheide, MD, DPhil, director of the ACC and vice president for Cancer Programs in the University of Pennsylvania Health System, said in a statement. “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.”

Reference

Guerra CE, Sallee V, Hwang W, et al. Accrual of Black participants to cancer clinical trials following a five-year prospective initiative of community outreach and engagement. J Clin Oncol 2021; 39: (suppl 15; abstr 100). DOI: 10.1200/JCO.2021.39.15_suppl.100