Health disparities in cancer still exist for African American and Latino communities, a problem that Jennifer Cunningham-Erves, Ph.D., has devoted much of her career to addressing.
With approximately 4 percent of minorities participating in clinical trials, removing barriers to trial participation is both a key scientific and ethical imperative, said Cunningham-Erves, Associate Professor of Health Policy at Vanderbilt University Medical Center, who recently began exploring the use of culturally targeted health educational programs to promote participation in cancer clinical trials among underrepresented populations.
“Low awareness about research and opportunities is one of the most commonly cited barriers for lack of participation in clinical trials among African Americans and Latinos,” Cunningham-Erves said.
A Call to Action
Despite advances across-the-board in early detection and treatment, African Americans continue to have the lowest survival rates for many cancers. Additional trends point to a growing cancer burden and health disparities in certain cancers among Hispanics/Latinos.
In 2022, the American Society of Clinical Oncology and the Association of Community Cancer Centers published a joint research statement recommending that trial sponsors, researchers and trial sites form long-standing partnerships with patients, patient advocacy groups, and community leaders to increase equity, diversity and inclusion, and address barriers to cancer clinical-trial recruitment.
“Few educational, yet culturally appropriate interventions on cancer clinical trials have been specifically designed to meet the needs of racial and ethnic minoritized groups,” Cunningham-Erves said.
Designing Targeted Programs
Cunningham-Erves explained that cultural targeting can be an effective way to customize health information to a group’s unique characteristics.
“When designing a program, our goal is to maximize ‘fit’ of information to a community’s specific characteristics grounded in strategies that are evidential, socio-cultural, peripheral, and linguistic,” she said. “The interconnected relationships within communities and their influence on decision-making also promotes familiarization with clinical trials.”
Recognizing medical history and the enduring skepticism towards researchers and hospital systems are important factors to consider when developing culturally focused programs, Cunningham-Erves added.
“Trust in medical researchers and the process plays a critical role in the successful inclusion of minoritized groups in clinical trials, and building trust can take several years,” she said.
A Pilot Study
While these health educational interventions remain in development, early data looks promising.
A pilot study by Cunningham-Erves and her team examined the effect of a culturally appropriate educational program on level of knowledge, trust in medical researchers, and intent for clinical trial participation among African Americans and Latinos in Middle Tennessee.
According to the findings, the educational program showed positive results for short-term clinical trial-related outcomes. However, further studies are needed to determine the longer-term impact on research participation.
“Study participants were more knowledgeable about cancer clinical trials, had greater trust in researchers, and were more willing to participate in these trials, post-intervention,” Cunningham-Erves said.
The findings serve as preliminary data for a larger, well-powered randomized controlled trials to assess longer-term behaviors related to actual research participation, she added.
Future Directions
While many barriers continue to impede minority groups from participating in cancer trials, the implementation of culturally specific health educational interventions could have a significant impact on health disparities.
“With continued commitment from diverse stakeholders, we have the potential to make equitable high-quality care accessible to all individuals with cancer with clinical trials being an avenue to receive pioneering treatments not accessed by the general public,” Cunningham-Erves said.
