Diversity in Clinical Trials | City of Hope

Extending access to the best cancer care to all

April is Minority Cancer Awareness Month, a time set aside to bring national attention to the deficit that exists in access to care and treatment among minority populations, and the dearth of participation among this group in clinical trials.
 
Ethnicity matters when it comes to cancer. Research shows it is a major factor determining risk both of developing disease and of dying from it. The variation in cancer risk among ethnicities highlights important health disparities among ethnic groups in the United States. For example, African American men are the most likely to be diagnosed with advanced and incurable prostate cancer, and they have a 111% higher risk of dying from it than other ethnic groups. Latinas account for only 36 genomic studies and clinical trials related to breast cancer out of about 1,100 tumors diagnosed each year, which means only 3% of those participating in these studies are Latina. African Americans, overall, face the highest risk of death from cancer.
 
City of Hope has taken bold steps to bring down barriers to the screening, detection and treatment of patients’ needs regardless of ethnicity, socioeconomic background and even geography. We are creating a game-changing new model of health care delivery that is focused on democratizing cancer care and bringing innovative breakthroughs to even more patients, families and communities. Here are a few ways we are doing that:

Improving Access to Clinical Trials

Access to care, economics, education, cultural differences and genetic variances all play a role in diagnoses and outcomes. One way to overcome disparities is to increase diversity in research and clinical studies so researchers can identify and address the sources of these differences.
 
Kimlin Ashing
Kimlin Tam Ashing, Ph.D.
City of Hope researchers like Kimlin Tam Ashing, Ph.D., are working to identify solutions to the problems of very low minority participation in cancer clinical trials. Ashing and other scientists throughout the enterprise are addressing key factors that are inhibiting minority access, participation and engagement.
 
“The causes of cancer health disparities are complex, with root causes stemming from genetic susceptibility, stress and immune function, and family history, as well as health care system factors, including preventive care access and utilization, quality care, and diagnostic and therapeutic care delays,” she said. “Emotional, cognitive, social and systemic barriers, such as a lack of sufficient referrals from primary care providers, also continue to contribute to the issue.”
 
By taking a holistic and interdisciplinary approach toward inclusion, City of Hope is increasing representation of different races, ethnicities, sexual orientation, generations and genders. More on that here.

It’s About Engagement

With both City of Hope’s comprehensive cancer center and support from the Patient-Centered Outcome Research Institute (PCORI), we partnered with a multiethnic coalition to increase community capacity to influence and guide biomedical research for greater community responsiveness and public benefit. Organizations include the Filipino American Nurses Association, the Korean American Nurses Association, Herald Chinese Cancer Association, Charles Drew University and other community organizations.
 
The Eugene Washington PCORI Engagement award provided added support for City of Hope’s Partnered for Action in Research initiative to train more than 100 multiethnic persons as community research navigators. Serving as credible community-based educators and resources, these navigators increase community awareness, acceptance and participation in medical research including clinical studies.
 
With increased collaboration with community partners and securing more minority-focused grant funding, City of Hope is making a concerted effort to have better patient communication, education and activation.  Whether through targeted ethnic traditional and social media campaigns or by partnering with leading community organizations, City of Hope is committed to providing more information about cancer care and providing it regardless of ZIP code.

A Whole Person Approach

Additionally, researchers at City of Hope have found a method to better understand and offer solutions to integrating a socioecological model within clinical practice and research, one that considers the complex interplay between individual, relationship, community and societal factors.
 
Christopher Sistrunk bio
Christopher Sistrunk, Ph.D.
“We still struggle with how to measure and attend to adverse societal determinants of health,” Ashing said. “We’ve developed a 33-point survey on these social aspects in their communities that has been integrated into the patient medical record. We are now able to more efficiently prioritize interventions to manage specific issues that are stress and anxiety triggers for some patients.” The survey captures information that allows scientists to understand the range of concerns and the risk factors that need to be met head on.
 
As a community outreach specialist, Christopher Sistrunk, Ph.D., is charged with helping underserved, minority populations get healthier, in part by increasing screening rates for cancer and other serious diseases.
“Improving the health of the community is not without its obstacles. Chief among them is the lack of trust in the health care system that Ashing described,” Sistrunk said.

Building Trust From Within

“If you’re going to do community-based research, it helps to be a part of the community, to have that shared experience,” Sistrunk maintained. He has invested time and energy building relationships in minority communities, spending time at health fairs, in churches and offering screenings for early detection of disease.
 
“When someone with cancer does get access and engages with a comprehensive cancer center and research hub like City of Hope, where those cancers are dealt with on a frequent basis, those health care disparities can disappear,” he said.
 
Angela L. Talton, City of Hope’s chief diversity, equity and inclusion officer, is crafting City of Hope’s diversity, equity and inclusion strategy to align with our founding principles of providing equitable treatment for all.
 
Angela L. Talton
Angela L. Talton
“Diversity, equity and inclusion is part of our DNA,” she said. “We recognize different races, ethnicities, ages and cultures have varying physical, genetic and environmental factors and vulnerabilities that come into play with diseases. It is important to have researchers, scientists and clinicians who understand a medication may affect patients of different races, ethnicities or even ages/generations differently.”
 
Talton explained that it is through programs like cohort or cluster hires and partnerships with historically Black colleges and universities and other minority serving institutions that City of Hope is making progress to recruit more diverse research faculty who have demonstrated a commitment to research that engages diverse communities.
 
“Additionally, City of Hope’s commitment to diversity, equity and inclusion seeks to augment the stellar research we’re doing today by cultivating the next generation of diverse physicians and scientists who understand the intrinsic issues that exist in diverse communities and can advocate for them to improve access and, in the long run, cancer outcomes. That’s the vision.”