A recent publication in the New England Journal of Medicine highlights the need for inclusive cancer trials and treatment guidelines to address structural racism affecting individuals with the Duffy null phenotype. Researchers, led by Dr. Stephen Hibbs from the Wolfson Institute of Population Health, are calling for changes in clinical trial design and treatment protocols to ensure equitable access and outcomes for this population. The Duffy null phenotype is a genetic trait predominantly found in people of African or Middle Eastern descent.
The primary concern arises from the use of absolute neutrophil counts (ANC) as eligibility criteria in clinical trials. Individuals with the Duffy null phenotype often have naturally lower ANC levels, leading to their exclusion from these trials. This exclusion not only limits their access to potentially life-saving treatments but also skews the data, making it less representative of diverse populations.
Further analysis of prescribing guidelines for first-line cancer treatments reveals that Duffy null individuals face increased risks of treatment delays, dose reductions, or therapy discontinuations. The lack of acknowledgment of natural variations in ANC levels across populations within treatment guidelines exemplifies structural racism in healthcare, according to the researchers.
To address these discriminatory practices, Dr. Hibbs and his co-authors propose several strategies:
- Eliminating the use of ANC-based criteria when clinically unnecessary. This would allow individuals with the Duffy null phenotype to participate in trials without being unfairly excluded.
- Routine testing for the Duffy null phenotype during cancer trial screening. This would identify individuals who may require dose modifications or alternative treatment strategies.
- Including dose modifications for people with Duffy null in new clinical trials. This would ensure that these individuals receive appropriate treatment without experiencing increased toxicity or reduced efficacy.
The researchers also recommend expanding collaborations with clinicians and researchers in regions where the Duffy null phenotype is most prevalent, such as sub-Saharan Africa and the Arabian Peninsula. These collaborations would provide valuable insights into the safety and logistics of implementing specific dose modifications for these patients.
The call for inclusive cancer trials and treatment guidelines represents a crucial step towards addressing health disparities and ensuring that all individuals, regardless of their genetic background, have access to the best possible cancer care.
