Internship Agency

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Barriers to Minority Patient Enrollment in

Clinical Trials

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Introduction •  Cancer mortality rates are declining for

the majority of organ sites for all population subgroups; however, racial/ethnic minorities experience highest cancer incidence and mortality rates1

•  Between 2010-2030, the projected increase in cancer incidence rate is 99% for minorities, as compared to 45% for the population-at-large. However, in spite of increasing incidence, there is low enrollment of minority of adults in clinical trials2

•  NCI recommends prioritizing new clinical trials based on adequacy of sampling specific ethnic groups rather than organ sites2

Clinical Trials Office is a division at Memorial Sloan-Kettering Cancer Center (MSKCC) that focuses on seeking new methods to screen for cancer, prevent cancer from growing, and continually coming up with new knowledge and technology to improve diagnosis and treatment through clinical trials

Methods •  A systematic review was conducted on

PubMed using the following key terms: (cancer clinical trials OR barriers to clinical trial enrollment OR access to clinical trials) AND (minority patients OR non-english speaking patients).

•  A literature review focusing on the existing physician training-programs was conducted using the following key terms: (physician training programs OR public health curriculum) AND (United States Medical Schools).

•  A PowerPoint presentation was created using information gathered about patient navigator programs by examining literature, looking at hospital websites, and calling hospitals about their existing patient navigation programs in cancer care management.

MPH Program Competencies

Developed •  The systematic review of barriers to clinical

trials strengthened my ability to conduct literature review using different resources

•  By developing a strategy to engage minority patients in CTs, I improved my program planning, development, and implementation skills

include specific Literature Cited

1.  Durant R, Wenzel J, Martin M, et al. Perspectives on barriers and facilitators to minority recruitment for clinical trials among cancer center leaders, investigators, research staff, and referring clinicians: enhancing minority participation in clinical trials (EMPaCT). Cancer (0008543X) [serial online]. April 2, 2014;120:1097-1105 9p

2.  Heller C, Balls-Berry J, Kuo W, et al. Review: Strategies addressing barriers to clinical trial

enrollment of underrepresented populations: A systematic review. Contemporary Clinical Trials [serial online]. November 1, 2014;39:169-182. Available from: ScienceDirect, Ipswich, MA.

Acknowledgements Dafna Rebibo- Preceptor Yelena Janjigian, MD- Preceptor

Barriers to Minorities Enrolling on Cancer Clinical Trials Student: Tooba Imtiaz Preceptor: Dafna Rebibo Organization: Memorial Sloan-Kettering Cancer Center

Internship Project The purpose was to find ways to increase minority participation in cancer clinical trials

Activities •  Systematic review and presentation on

barriers to patient recruitment in clinical trials •  Report on physician training-programs on

cultural responsiveness •  PowerPoint presentation on patient

navigators in cancer care

Outcomes •  Minority populations experience barriers

in these areas (see figure 1): •  Systematic •  Institutional •  Individual

•  Cultural sensitivity training for physicians in medical schools is insufficient. Training is limited to lectures and workshops, and the modules are not transferrable to real life scenarios

•  Patient navigators can improve patient care and increase minority enrollment in clinical trials by:

•  Informing patients about clinical trials

•  Helping patients with the enrollment process

Discussion •  It is necessary to address multiple

barriers to increase minority participation in clinical trials

•  Most clinical trials still focus on disease type rather than patient ethnic groups who would benefit from enrollment in trials

•  Multiple opportunities to increase patient engagement in CTs exist through the use of patient navigators

•  Patient navigators who act like liaisons between community centers and cancer hospitals have the potential to connect minority adult patients to clinical trials

•  Recommendation: Develop a community health worker/patient navigator (CHW/PN) program that recruits ethnic populations from community centers and navigates them during their treatment at cancer hospitals, such as MSKCC.

Issues Patient Navigators

Address

Figure 1