A five-year community outreach and engagement effort by the Abramson Cancer Center at the University of Pennsylvania (ACC) to increase enrollment of Black patients into cancer clinical trials more than doubled the percentage of participants, improving access and treatment for a group with historically low representation in cancer research.
The percentage of patients enrolled into a treatment clinical trial, for example, increased from 12 to 24 percent. A significant increase was also observed in non-therapeutic interventional and non-interventional trials.
The findings were published today in an abstract to be presented at the American Society of Clinical Oncology annual meeting on June 5.
An important goal of the Abramson Cancer Center is to serve and engage our community --and that includes improving access to clinical trials for all patients. Aligning the number of Black patients with cancer we care for with the number enrolled in our trials is how we can help bring more equitable care to the community, close gaps in disparities, and sustain trust. There's more work to be done to improve access and inclusion of minority groups, and the impact of this outreach and engagement effort is an important step forward."
Robert H. Vonderheide, MD, DPhil, Study Senior Author and Director of ACC and Vice President for Cancer Programs, University of Pennsylvania Health System
Despite making up 13.4 percent of the U.S. population, only five percent of Black patients with cancer are enrolled in clinical trials. Of 8,700 patients who participated in trials nationwide related to the 28 oncology drugs approved by the U.S. Food and Drug Administration in 2018 and 2019, only 4 percent were Black, according to FDA Drug Trial Snapshot reports.
In 2014, Black residents comprised 19 percent of the population and 16.5 percent of cancer cases in the 12-county catchment area surrounding Philadelphia, but only 11.1 percent of ACC patients were Black. The percentages of Black participants accrued into treatment, non-therapeutic interventional, and non-interventional trials at the ACC were 12.2 percent, 8.3 percent, and 13.0 percent, respectively.
To address these gaps, the ACC established a center-wide program with community guidance and engagement that included: culturally tailored marketing strategies; new partnerships with faith-based organizations serving Black communities to conduct educational events; establishment of an ACC community Advisory Board and community educational forums; pilot programs with Lyft and Ride Health to address transportation barriers; and patient education by nurse navigators regarding cancer and clinical trials.
The efforts reached more than 10,000 individuals in churches, neighborhoods, community parks and centers, and health centers with formats ranging from educational forums to wellness fairs. In addition, ACC promoted clinical trials that address the cancer burden in Black residents of the catchment area, required that each protocol have a minority accrual plan to obtain approval, and increased access to language-tailored consent forms and translation services for patients.
By 2018, the researchers found that the percentage of Black patients seen at ACC had increased to 16.2 percent. The percentages of Black participants accrued onto treatment, non-therapeutic interventional, and non-interventional trials were 23.9 percent, 33.1 percent, and 22.5 percent, respectively -- a 1.7- to 4.0-fold increase and higher than the percentage of Black patients seen at the ACC.
As part of its long-term strategy to improve access, the ACC has also collaborated with the Lazarex Cancer Foundation to implement its IMPACT program (IMproving Patient Access to Cancer Clinical Trials), a first-of-its-kind effort at the ACC combining financial reimbursement for travel related expenses, outreach, and educational programs to help patients with cancer learn about and access advanced treatment in clinical trials. Reimbursement covers plane tickets, hotels, gas, tolls, cabs, and parking for the patient, and a companion.
"We've shown here that a multifaceted, community-based engagement initiative works to improve access to cancer clinical trials by Black patients with cancer," said first author Carmen E. Guerra, MD, MSCE, FACP, an associate professor of Medicine and associate director for Diversity and Outreach in the ACC. "We will continue to work with collaborators such as Lazarex that share in our vision to increase participation of underrepresented patients in trials, while at the same time engage with the community to develop strategies that address needs and barriers, from different social determinants of health to solidifying their trust."