Non-White Patients Under-Represented in Precision Oncology Studies

By Lisa Rapaport

November 29, 2021

(Reuters Health) - The vast majority of participants in precision oncology studies for breast, prostate, lung and colorectal cancers are white, a group that is overrepresented in this research primarily at the expense of Black and Hispanic individuals, a new study suggests.

Researchers examined enrollment data from 93 precision oncology studies in the U.S. with a total of 5,867 participants. They compared the representation of white, Black, Asian, and Hispanic participants in these studies to cancer incidence by race and ethnicity based on records from the U.S. Census and the Surveillance, Epidemiology, and End Results (SEER) databases.

Overall, 4,826 patients (82.3%) were white, 587 (10%) were Black, and 238 (4.1%) were Asian.

Across all the studies, white patients were overrepresented by a ratio of 1.35 and Asian patients were overrepresented by a ratio of 1.46. Hispanic patients were underrepresented (ratio 0.24), as were Black (0.49) and American Indian and Alaska Native participants (0.43), the study team reports in JAMA Network Open.

"It is concerning that there is a lack of diversity in these studies, as many biomarkers and potential new biological targets for therapies are derived from such research," said senior author Dr. Sophia Kamran of Massachusetts General Hospital and Harvard Medical School in Boston.

"All precision oncology appears to be derived from studies dominated by individuals of European ancestry or self-reported white race, and it is unclear whether our current precision medicine or novel targeted therapies can be broadly applicable to, or safe for, our diverse cancer population," Dr. Kamran said by email.

One limitation of the study is the potential for some cancer research to be missing from the analysis because the inclusion criteria required studies to be registered in Clinicaltrials.gov, the authors note.

Another limitation is that researchers lacked data on multiracial or multiethnic participants, and it's also possible that participants reported as one race in studies might actually have multiple racial or ethnic identities.

Even so, the results underscore the importance of reporting race and ethnicity in more studies because more than half of studies don't collect this data, Dr. Kamran said. Beyond this, it's incumbent on the medical and scientific communities to identify barriers to enrollment among diverse populations and determine strategies to overcome these obstacles, Dr. Kamran said.

"We firmly believe that a multi-pronged approach is necessary to increase diverse enrollment onto precision oncology studies, as there may be even more barriers to enrollment for these individuals onto these types of studies than regular clinical trials," Dr. Kamran said.

More research is needed to fully understand all barriers and fears surrounding study recruitment, Dr. Kamran added.

"But more generally, patient education surrounding study goals, potential benefits, genetics and genetic counseling is critical, as well as using unique trial designs, ensuring education for all involved with the trials to combat bias, and increasing racial and ethnic diversity among scientists, biomedical researchers, physicians, and clinical trialists can help to increase trust among patients from minoritized groups," Dr. Kamran said.

SOURCE: https://bit.ly/3nP8JqR JAMA Network Open, online November 8, 2021.

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