Work Needed to Improve Racial/Ethnic Minority Group Representation in Prostate Cancer Trials

Black and Hispanic men are underrepresented in U.S. clinical trials of prostate cancer, according to a meta-analysis published in JAMA Oncology.

Researchers led by Irbaz Bin Riaz, MBBS, of Dana-Farber Cancer Institute, wanted to evaluate disparities in the inclusion of racial/ethnic minority groups and of older adults in prostate cancer clinical trials.

All phase 2/3 randomized clinical trials of prostate cancer were eligible for the age analysis. Trials that recruited exclusively from the United States were eligible for the racial/ethnic disparity analysis.

In all, 286 trials were included. Of these, 40.2% were trials that exclusively recruited from outside the U.S. and 22.7% were US-only trials.

They identified 9,552 participants in the trials that reported race. Of these, 10.8% were African American/Black, 1.5% were Asian/Pacific Islanders, and 78.5% were White. Sixty-five U.S. trials were examined, and 69.2% of these reported on race. However, only 13.8% reported data on all 5 U.S. racial categories (White, Black, American Indian/Alaska Native, Asian, Pacific Islander).

The separate analysis of global trials revealed that about one-quarter (26.2%) reported on the proportion of older adults enrolled. Outcomes by race were reported in 3.1% of trials and by age in 15.0% of trials.

An analysis of enrollment incidence ratios revealed that Black and Hispanic patients were both significantly underrepresented in U.S. trials.

“The representation of Black patients has consistently remained low and is significantly worse in larger trials, highlighting the ineffectiveness of efforts to improve health care equity in prostate cancer,” the researchers wrote. “This, coupled with the fact that less than 10% of trials report clinical outcomes by race and ethnicity, is an indication of the collective failure to account for differential health outcomes in historically marginalized populations.”

No disparity in older adult representation was found.

The researchers recommended “a practical framework to mandate a level of racial and ethnic minority group accrual to studies necessary to establish clinical validity of the overall trial results for those populations.”

Reference

Disparities in the Inclusion of Racial and Ethnic Minority Groups and Older Adults in Prostate Cancer Clinical Trials: A Meta-Analysis