ASCO and ACCC Collaborate to Boost Racial/Ethnic Representation in Cancer Treatment Trials

Lori J. Pierce, MD, FASTRO, FASCO

A new collaboration between the American Society of Clinical Oncology (ASCO) and the Association of Community Cancer Centers (ACCC) aims to encourage the enrollment of more racially and ethnically diverse patients with cancer onto clinical trials, according to a recent announcement from ASCO.¹

Earlier research suggests a significant lack of diversity in clinical cancer trials, with only 4%-6% of participants being black and only 3%-6% being Hispanic; these numbers do not accurately reflect the percentage of these patients in the overall population of patients with cancer. Black patients comprise 15% of all cancer cases, while Hispanic patients comprise 13% of cases.^2,3

The ASCO-ACCC initiative was developed to determine and apply novel approaches and solutions for increasing the participation of underrepresented racial and ethnic minority populations on clinical trials in cancer. The initiative will be overseen by the ASCO-ACCC Steering Group.

“We are committed to providing evidence-based high-quality cancer care to every patient, every day, everywhere,” Lori J. Pierce, MD, FASTRO, FASCO, president of ASCO and co-chair of the ASCO-ACCC Steering Group, stated in a recent press release. “But, if clinical trials don’t represent the individuals we treat, including those from racial and ethnic minority populations, the state of science suffers and patients with life-threatening conditions may miss out on the best—perhaps only—treatment option for their condition.”

Part of addressing this challenge is to better understand the barriers that either prevent or dissuade racial and ethnic minorities from participating on clinical cancer trials. Barriers to participation can include provider bias in patients to approach, issues with study design, difficulties with access, insurance coverage, and expenses related to care. Additionally, a lack of awareness on the trials available and of trust with the healthcare system and clinical research overall; barriers with regard to language, culture, or literacy; and family and community engagement are also among the key challenges faced.

The ASCO and ACCC have issued a Request for Ideas (RFI) with the intent to compile new ideas to increase the participation of underrepresented populations in cancer treatment studies.⁴ All submissions will be reviewed by the ASCO-ACCC Steering Group and potentially combined, modified, and implemented, potentially through the ASCO Targeted Agent and Profiling Utilization Registry (TAPUR) Study (NCT02693535).

In the phase 2 basket study, investigators are examining the safety and antitumor activity of targeted agents that are commercially available for patients with advanced cancers who harbor specific genomic aberrations.⁵ This research effort provides investigators to gain valuable insight into the efficacy of specific therapies in real-world patients. The trial is currently ongoing, and 110 clinical sites are participating across the United States.

Proposed strategies and solutions could include tools, such as self-assessments and educational resources to increase cultural competency, as well as culturally sensitive and appropriate education and outreach materials designed to raise awareness on the benefits of clinical trials for patients and their families, according to the RFI.

The organizations additionally provided several real-world strategies that have performed well in clinical settings. For example, Duke Cancer Institute launched a health disparities and equity in cancer program, which housed initiatives such as the Community Health Ambassador Program, the “Just Ask” Minority Participation in Research Program, and the Diversity and Inclusion in Patient Care and the Workplace Program. Additionally, the Yuma Regional Medical Center Cancer Center enlisted Hispanic “promotoras” and community health workers to educate rural, migrant, and multicultural patients within the local area and improve their care.

Moreover, Benefis Sletten Cancer Institute has developed strategies to better serve the 3 American Indian reservations and 1 federally recognized landless tribe within the area who visit their institution for treatment. Specifically, they created a Native American Welcoming Center and developed culturally sensitive programs and services such as smudging ceremonies, to better serve this community. The Mary Bird Perkins Cancer Center has also made a commitment to improving early cancer detection and eliminate barriers to care in the underserved black American patient population through the implementation of culturally appropriate practices.

According to the RFI, proposed ideas will be reviewed and prioritized per the following criteria:

• Quality of a novel strategy or practical solution
• Ability to address barriers to racial/ethnic participation in cancer treatment trials
• Potential to replicate, disseminate, and implement
• Feasibility of the project
• Indications that the submitter is a program champion and has been shown to provide quality and equitable cancer care and dedication to addressing racial/ethnic disparities in trials

The RFI is open for participation through August 24, 2020. To learn more, click here.

References

1. ASCO & ACCC join forces to increase participation of racial and ethnic minority populations in cancer treatment trials. News release. American Society of Clinical Oncology. July 21, 2020. Accessed July 23, 2020. https://bit.ly/3g98yR2.
2. Loree JM, Anand S, Dasari A, et al. Disparity of race reporting and representation in clinical trials leading to cancer drug approvals from 2008 to 2018. JAMA Oncol. 2019;5(10):e191870. doi:10.1001/jamaoncol.2019.1870
3. Duma N, Aguilera JV, Paludo J, et al. Representation of minorities and women in oncology clinical trials: review of the past 14 years. J Oncol Pract. 2018;14(1):e1-e10. doi:10.1200/JOP.2017.025288
4. ASCO-ACCC Request for Ideas (RFI): novel strategies and practical solutions to increase participation of racial and ethnic minority populations in cancer treatment trials. ASCO-ACCC Steering Group. July 21, 2020. Accessed July 23, 2020. https://bit.ly/2BCttNq.
5. TAPUR: testing the use of Food and Drug Administration (FDA) approved drugs that target a specific abnormality in a tumor gene in people with advanced stage cancer (TAPUR) ClinicalTrials.gov. Updated March 3, 2020. Accessed July 27, 2020. https://bit.ly/2D58inv.