A new study indicates that efforts to increase diversity in cancer clinical trials, specifically for head and neck cancers, have not only fallen short but have regressed over the last 10 years. The research, conducted by Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC), reveals a concerning trend of decreasing racial and ethnic diversity in these trials, exacerbating existing inequities in cancer treatment access and outcomes.
The study, published in the journal Head & Neck, reviewed a repository of clinical trials maintained by the National Institutes of Health's National Library of Medicine. The researchers focused on head and neck cancer due to its high mortality rate and significant racial disparities in outcomes. By examining patient demographics in these trials, the team assessed whether diversity was improving over time.
Worsening Trends in Diversity
"We looked at how the patients enrolled in the studies changed over time, to see if racial, ethnic and gender diversity was improving over time. We were surprised to find that it was actually worsening," said Heather Ann Edwards, MD, FACS, FRCSC, senior author and associate professor of otolaryngology-head & neck surgery at Boston University Chobanian & Avedisian School of Medicine.
The findings suggest that current approaches to promote diversity in clinical trials are not effective. This is particularly alarming given the ongoing efforts by major national organizations, including the U.S. Food and Drug Administration and the National Cancer Institute, to ensure that new cancer treatments are developed for the diverse populations that will use them.
The Impact of Inequity
"Tragically, we live in a time when things like your race and gender impact how likely you are to survive your cancer," Dr. Edwards stated. This underscores the urgent need to address these inequities and provide all patients with equal opportunities to access effective treatments.
A Model for Improvement
Despite the overall negative trend, the head and neck cancer team at BMC has implemented successful initiatives to improve access to clinical trials for underrepresented populations. These efforts have resulted in 58% of head and neck cancer clinical trial participants being from underrepresented groups, significantly higher than the national average of 7-12% for Black or Hispanic participants.
The researchers are now analyzing these successful initiatives to identify effective strategies that can be replicated in other settings. Their goal is to contribute to the development of alternative approaches that can reverse the current trend and promote greater diversity in cancer clinical trials.
Call to Action
"Our study highlights the continued need for greater diversity in head and neck cancer clinical trial populations. We aim to inspire clinical trial administrators and participating physicians to prioritize inclusivity, ultimately leading to treatments that improve quality of life for all head and neck cancer patients," said Melani Zuckerman, BA, corresponding author and fourth-year medical student at the school.
