Barriers to recruiting underrepresented populations to cancer clinical trials: A systematic review

Authors

  • Jean G. Ford MD,

    Corresponding author
    1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    2. Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E6650, Baltimore, MD 21205
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    • Fax: (443) 287-2044.

  • Mollie W. Howerton PhD, MPH,

    1. Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
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  • Gabriel Y. Lai MHS,

    1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Tiffany L. Gary PhD, MHS,

    1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Shari Bolen MD, MPH,

    1. Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
    2. Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland
    3. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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  • M. Chris Gibbons MD, MPH,

    1. Urban Health Institute, Johns Hopkins University, Baltimore, Maryland
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  • Jon Tilburt MD, MPH,

    1. Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
    2. Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland
    3. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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  • Charles Baffi PhD, MPH,

    1. Cancer Prevention Fellowship Program, Office of Preventive Oncology, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
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  • Teerath Peter Tanpitukpongse BA,

    1. Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
    2. Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland
    3. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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  • Renee F. Wilson MS,

    1. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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  • Neil R. Powe MD, MPH, MBA,

    1. Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
    2. Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland
    3. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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  • Eric B. Bass MD, MPH

    1. Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
    2. Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland
    3. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Abstract

Racial and ethnic minorities, older adults, rural residents, and individuals of low socioeconomic status are underrepresented among participants in cancer-related trials. The authors conducted a systematic review to determine the barriers to participation of underrepresented populations in cancer-related trials. Their search included English-language publications that reported original data on the recruitment of underrepresented groups to cancer treatment or prevention trials between 1966 and December 2005 in multiple electronic databases. They also hand-searched titles in 34 journals from January 2003 to December 2005 and they examined reference lists for eligible articles. Titles and abstracts were reviewed to identify relevant studies. Data on barriers to participation were synthesized both qualitatively and based on statistically significant associations with trial enrollment. Of 5257 studies that were cited, 65 studies were eligible for inclusion in the current analysis, including 46 studies on recruitment into cancer therapeutic trials, 15 studies on recruitment into prevention trials, and 4 studies on recruitment into both prevention and treatment trials. Numerous factors were reported as barriers to participation in cancer-related trials. However, only 20 of the studies reported statistically significant associations between hypothesized barriers and enrollment. The available evidence had limitations in quality regarding representativeness, justification of study methods, the reliability and validity of data-collection methods, potential for bias, and data analysis. The results indicated that underrepresented populations face numerous barriers to participation in cancer-related trials. The current systematic review highlighting the literature on recruitment of underrepresented populations to cancer trials and may be used as the evidence base toward developing an agenda for etiologic and intervention research to reduce the disparities in participation in cancer-related trials. Cancer 2008. © 2007 American Cancer Society.

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