LACK of diversity in pancreatic cancer clinical trials means that many minority patients remain conspicuously absent from consideration and cannot access the latest treatments. A study recently conducted by researchers at the Virginia Commonwealth University (VCU) Massey Cancer Centre, USA, and the University of Florida Health, USA, searched the clinicaltrails.gov database for pancreatic cancer treatment trials completed from 2005–2020.
Over the 15 years, the number of studies reporting participants race and ethnicity steadily increased with a bump in 2017 when reporting became federally required. However, the actual inclusion of racial and ethnic minorities has not shown similar trends with rates stuck at the same disproportionately low rates for more than a decade.
“If we don’t have good diversity in clinical trials, how will we ever know whether we have certain drugs that work better in some populations than others?” argued senior study author Jose Trevino, Surgeon-in-Chief, VCU Massey Cancer Centre and Chair of Surgical Oncology, VCU School of Medicine. “We could be throwing away a really good treatment option for racial and ethnic minority patients.”
The research found that over the study period only 8.0% of pancreatic cancer clinical trial participants were black compared to the 12.0% of pancreatic cancer cases that occur within the Black community. Similarly, only 6.0% of trial participants were Hispanic, 2.0% were Asian, and 0.3% were Indigenous Americans compared with pancreatic cancer cases within the ethnic groups, which represented 9.0%, 3.0%, and 0.4% of cases, respectively.
The lack of diversity was attributed to range of factors, including a mistrust of the medical establishment, implicit clinician bias, a lack of diversity in recruiting clinicians, and strict clinical trial inclusion criteria. For instance, the authors challenged the premise that hypertension, diabetes, and HIV diagnosis should automatically exclude a patient from participating in a cancer trial, when all three of these diseases are more common within Black, Hispanic, and Indigenous American communities.
“There are a ton of obstacles to get these patients into clinical trials,” states Trevino. “But this is how we’re going to understand the disease better. And its critically important for the future of cancer health disparities.”