Compared to all other racial and ethnic groups, Black men are significantly more likely to be diagnosed with prostate cancer and to die as a result of the disease. Despite evidence that this uneven burden of morbidity and mortality is due in part to race-based variations in tumor biology and underlying disease mechanisms, prostate cancer research historically has focused primarily on biology, diagnosis, and treatment of the disease among white men. A recent literature review of prostate cancer clinical trials in the U.S. since 1987 found that 96% of study participants are white, and the proportion of white participants has remained higher than 80% for the last three decades. As a result, most (if not all) prostate cancer therapies are targeted for white men and may have limited generalizability or effectiveness among underrepresented minority populations.
Several factors contribute to low participation among Black men in prostate cancer trials. Socioeconomic status and health care access are particularly significant barriers to participation. Several studies indicate that lower-income patients are less likely to participate in prostate cancer clinical trials due to financial concerns and lack of transportation to medical facilities conducting clinical trials.3,4 Additionally, higher rates of comorbidities among Black populations may limit their eligibility for participation in oncology clinical trials, which often exclude participants with comorbidities for fear of confounding health variables.5 Furthermore, Black people may be hesitant or unwilling to participate in clinical trials or discuss clinical trials with their physicians given the extensive, well-documented legacy of race-based discrimination, mistreatment, and prejudice in the U.S. health care system.6 Other factors in the participation decision-making process include lack of knowledge about clinical trials, negative interactions with providers, and concern about trial side effects.7
Fortunately, researchers are working to develop interventions to improve minority participation in prostate cancer clinical trials. The Partnering Around Cancer Clinical Trials (PACCT) study protocol is designed to increase the accrual of Black men for prostate cancer trials by systematically improving physician-patient communication about clinical trials, including trial availability, the application process, and informed consent. Physicians will receive extensive training about patient-centered communication and the importance of a diverse participant population. The intervention is underway, and results are anticipated as early as 2021.8
Another study protocol will leverage the power of online platforms to facilitate recruitment of Black men into prostate cancer clinical trials. Although Black people may have limited access to recruitment at academic medical centers and research institutions, research indicates that smartphone and internet access among medically underserved populations (including Black people) is equivalent to access among the general U.S. population. Consequently, internet-based recruitment platforms are more inclusive and equitable than in-person efforts to accrue participations for clinical trials. The ongoing study aims to develop an online tool that uses health information to quickly match individuals with prostate cancer clinical trials for which they are most eligible.9
Equitable representation in clinical trials represents a critical early step towards mitigating the disproportionate burden of prostate cancer among Black men. Going forward, minority participation in clinical trials for all health conditions must remain a top priority in the research community.
1 Jemal A ,Ward EM, Johnson CJ, et al. (2017). Annual report to the nation on the status of cancer, 1975-2014, featuring survival. Journal of the National Cancer Institute, 109(9).
2 Rencsok EM, Bazzi La, McKay RR, et al. (2020). Diversity of enrollment in prostate cancer clinical trials: Current status and future directions. Cancer Epidemiology Biomarkers and Prevention, 29(7).
3 Unger JM, Gralow JR, & Albain KS. (2016). Patient income level and cancer clinical trial participation: A prospective survey study. JAMA Oncology, 2(1):137-139.
4 Gilbert SM, Pow-Sang JM, & Xiao H. (2016). Geographical factors associated with health disparities in prostate cancer. Cancer Control, 23(4):401-408.
5 Langford AT, Resnicow K, Dimond EP, et al. (2013). Racial/ethnic differences in clinical trial enrollment, refusal rates, ineligibility, and reasons for decline among patients at sites in the National Cancer Institute’s Community Cancer Centers Program. Cancer, 120(6):877-884.
6 Senft N, Hamel LM, Manning MA, et al. (2020). Willingness to discuss clinical trials among Black versus White men with prostate cancer. JAMA Oncology.
7 Wenzel JA, Mbah O, Xu J, et al. (2015). A model of cancer clinical trial decision-making informed by African-American cancer patients. Journal of Racial and Ethnic Health Disparities, 2(2):192-199.
8 Eggly S, Hamel LM, Heath E, et al. (2017). Partnering around cancer clinical trials (PACCT): Study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials. BMC Cancer, 17:807.
9 Borno HT, Bakke BM, Kaplan C, et al. (2019). A step towards equitable clinical trial recruitment: A protocol for the development and preliminary testing of an online prostate cancer health information and clinical trial matching tool. Pilot and Feasibility Studies, 5:123.