Disparity in cancer trials

UM researchers find minorities are underrepresented

July 09, 2008|By David Kohn | David Kohn,SUN REPORTER

Across the state, minorities and residents of rural areas are under-represented in cancer trials, according to a new study from University of Maryland researchers. And the study found that rates of participation among African-Americans are dropping.

"Everyone should have an equal chance of participating in a trial. That does not happen," said Shiraz I. Mishra, an associate professor at the School of Medicine and one of the study's authors.

Outside researchers praised the report. "It's a very strong study. It's doing what needs to be done," said Dr. Worta McCaskill-Stevens, a cancer specialist at the National Cancer Institute who has studied disparities in cancer trials.

The study, which appears in the current Journal of Clinical Oncology, looked at 2,240 Maryland cancer patients enrolled in National Cancer Institute-sponsored clinical trials from 1999 to 2002.

Researchers found that Allegany and Washington counties in Western Maryland and St. Mary's and Charles County in Southern Maryland had lower participation rates than they should have, given the number of cancer patients from these locales.

Other areas with lower than expected participation were Baltimore City, Prince George's County and Howard County. The first two regions have large black populations.

Experts say broad participation in studies is important because it helps ensure that the findings apply to all ethnic and geographic groups. If some minorities don't take part in studies, the results may not apply to their groups.

"The studies may not be generalizable to those patients," said the Maryland report's lead author, Dr. Claudia R. Baquet, a professor of medicine and director of the school's Center for Health Disparities Research and Outreach.

Baquet said there are many reasons for cancer trial disparities, which are a nationwide problem. Most trials take place in urban academic medical centers, which makes it less likely that rural patients will take part. African-American patients have less access to care overall and so are less likely to end up in a study.

Many African-Americans also remain suspicious of medical studies, a legacy of the Tuskegee syphilis study and other research that exploited subjects without providing any medical benefits.

Baquet also noted that African-Americans often lack awareness of cancer studies, and if they do, they frequently have an intense, fatalistic fear of of the disease. That results in an unwillingness to take part in trials because they believe that any treatment will make little difference.

Over the course of the study, particpation among African-Americans decreased from 24 percent to 18 percent of the cancer trial patients in Maryland.

One reason may be that many cancer trials exclude patients with diseases other than cancer. Baquet said African-Americans are more likely than whites to have multiple ailments, such as diabetes and high blood pressure.

Since 1999, Baquet has helped run the Eastern Shore Cancer Research Network, a program to increase both ethnic and geographic diversity in clinical trials. Between 1999 and 2004, the number of trials available to the Eastern Shore increased from two to 62.


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