Black People are Dramatically Underrepresented in Clinical Trials

What doctors can do right now to increase participation among minority groups

• In studies for 24 of the 31 cancer drugs approved between 2015 and 2018, less than 2% of participants were Black
• Some doctors assume that minorities don’t want to enroll in clinical trials, which is untrue
• The simplest way to enroll more Black people in studies is to simply ask them

Black people have the highest death rates and shortest survival of any racial or ethnic group in the United States. Yet they are significantly underrepresented in studies evaluating the drugs that might improve their prognosis. A ProPublica analysis found that, in trials for 24 of the 31 cancer drugs approved between 2015 and 2018, less than 2% of participants were Black, even though Black Americans make up 13% of the population.

Though some doctors might assume that Black people don’t want to enroll in clinical trials, that assumption is neither fair nor true, says Dr. Karen Winkfield, radiation oncologist at Meharry-Vanderbilt Alliance in Nashville, TN. “In fact, Black people do want to engage in cancer clinical trials. They’re just not asked enough,” she tells SurvivorNet.

That the majority of clinical trial participants are white makes a difference. “We know that different communities respond differently, not only to treatments, but also perhaps to the way that their bodies react and have side effects,” Dr. Winkfield says. “We need to have inclusive participation in cancer research.”

Often people in minority groups are excluded from trials because of comorbidities such as high blood pressure, cardiovascular disease, and diabetes. Even when cities that house cancer research institutions have diverse populations, those groups aren’t enrolling in studies.

“Perhaps sponsors need to think about other ways to build capacity so that we can actually make sure that cancer treatment trials are actually done in diverse populations,” says Dr. Winkfield. “But you know what a simple thing would be to change what’s happening right now in the cancer clinical trials? Simply asking.”

She encourages doctors to do their part to ensure that all of their patients who qualify for clinical trials can participate in them. “Right now, at places where clinical trials are happening, why not make it a culture?” she asks. “Make sure that we are doing our job and asking patients who are eligible to enroll in clinical trials.”