Cancer center at Penn doubles percentage of Black participants in its clinical trials
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The multifaceted challenge of increasing diversity in clinical trial enrollment has become a major priority in oncology and is currently being approached from several angles by many institutions, advocacy groups and medical organizations.
One such effort involved a 5-year community outreach and engagement intervention at Abramson Cancer Center at University of Pennsylvania. The project has more than doubled the percentage of Black patients enrolled onto treatment clinical trials, from 12.2% to 23.9%, according to study results presented during the virtual ASCO Annual Meeting.
“In 2014, we found a major gap in care — specifically, that 16.5% of patients with cancer in our catchment area were Black, but only 11.1% of patients seen at Abramson Cancer Center were Black,” Robert H. Vonderheide, MD, DPhil, director of Abramson Cancer Center at University of Pennsylvania, said in an interview with Healio. “We found that change is possible. We didn’t solve the problem, but we now have a road map, and we know that change is possible with concerted effort.”
Researchers launched the center-wide community outreach and engagement program in 2014 — at which time Black participants comprised 12.2% of treatment trials, 8.3% of nontherapeutic interventional trials and 13% of noninterventional trials — with the goal of improving these enrollment rates. Essential elements of the initiative included culturally targeted marketing strategies, plans to bolster Black participant enrollment for each study protocol, partnerships with faith-based organizations to conduct educational events in Black communities, pilot programs for facilitating access to transportation and interpreter services, patient navigation and an enhanced informed-consent process.
After implementation of these strategies, total cancer clinical trial accrual rose from 9,308 patients in 2014 to 13,170 patients in 2018, a 41.5% increase.
The researchers observed a 1.9-fold increase in accrual of Black patients onto treatment trials, to 23.9%; a fourfold increase of Black patients onto nontherapeutic interventional trials, to 33.1%; and a 1.7-fold increase of Black patients onto noninterventional trials, to 22.5%.
Vonderheide spoke with Healio about the project’s success, its many components, and his hope that similar improvements can be made at institutions around the world.
Healio: What inspired you to undertake this project?
Vonderheide: We realized that Black members of our community who were diagnosed with cancer were not getting complete access to clinical trials. We decided it needed to be a cancer center priority to change that.
Healio: How did you go about studying this?
Vonderheide: We first established an Office of Outreach and Diversity within the cancer center in 2013, which is led by an amazing physician, Carmen E. Guerra, MD, MSCE, FACP. She garnered resources, including funding from the NCI, and assembled a team to begin engagement within the community. This engagement involved both community leaders and members of the community. We focused largely on Philadelphia, because patients from Philadelphia comprise about 22% of the patients with cancer we treat. There were dozens, if not hundreds, of events and engagements, some large, some small and some one-on-one. We estimated that we’ve reached more than 10,000 individuals in venues, churches, neighborhood blocks, local hotels and health centers. The most successful were educational events about different types of cancer.
We wanted to communicate how clinical trials work, that they are an option available to everyone and are potentially an important part of care.
We also established a group of navigators who would meet one-on-one with Black patients who were just diagnosed with cancer and guide them through their available options. For patients who did not speak English as a first language, we came up with several ways to translate the informed consent. We wanted to lower any barriers that may have been preventing the full conversation.
We’ve since had several patients who have been involved in clinical trials and now want to be peer educators for other patients. We call those individuals “peer-to-peer” clinical trial ambassadors.
Healio: How did your initiative address transportation barriers?
Vonderheide: During this work, we realized that some patients who had an opportunity for a clinical trial at Abramson Cancer Center couldn’t get to us because of transportation barriers.
Transportation is truly one of the biggest obstacles. It isn’t just the ride itself — it’s often the wait time that is incompatible with a busy person needing to go back to work or take care of their family. We found a way to offer rides for free that also had minimal wait times.
We formed a partnership with a company called Ride Health, which works with services like Uber and Lyft to arrange rides. Between this gigantic partnership with that company and the ride services, plus our philanthropic donors, we’ve been providing about 120 rides per month. There is such curation of the rides and such an effective ride management system, it’s almost like a family member picking them up and dropping them off.
Healio: Which aspects of your initiative had the most impact?
Vonderheide: Because it was a quality-improvement initiative, we continuously improved each component of the intervention and, thus, it is difficult to tease out the relative contribution of each of these steps. What we do know is that the combination of these efforts worked. We saw the results and now we’re trying to sustain that. The problem we identified in 2014 is the same problem that’s happening all over the country.
Healio: Did you address the problem at an institutional or clinician level?
Vonderheide: Absolutely. Years ago, we started educating the members of our cancer center about the cancer burden of the individuals who live in our catchment area, the people we serve.
Another aspect of the work we did was to reevaluate how we do clinical trials to educate our clinical investigators about disparities that need to be addressed.
Association of Community Cancer Centers developed a policy request that clinical trial investigators submit a plan for how they are going to enroll and reach minority populations. We sought out progress reports and ongoing approval to see if our goals were being reached, which had a major impact both in the community and within our clinic.
We also have provided information about the disparities faced by Black patients especially when it comes to cancer screening and care. Our investigators, once they were educated, have worked to direct many of their efforts toward solving these disparities. There have been huge efforts around colon cancer and breast cancer screening, but also in studies evaluating things like smoking cessation.
Educating our staff has been important. We’ve been talking very openly and frankly about implicit bias and recently required that all faculty and staff complete implicit bias training. That has added to the program in a very profound way.
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Guerra C, et al. Abstract 100. Presented at: ASCO Annual Meeting; June 4-8, 2021.
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