Few minorities participate in clinical trials

Lack of trust pervasive

Mistrust of the medical and science communities may be discouraging non-Caucasian cancer patients from enrolling in clinical trials, a research group has discovered.

Several studies in recent years have borne out researchers’ anecdotal knowledge that non-Caucasian cancer patients are less likely than their Caucasian counterparts to enroll in clinical trials, so a team at the Hospital of the University of Pennsylvania in Philadelphia conducted research to find out in what ways the two groups differ in their views on clinical study.

Charles Wood, MD, a radiation oncologist at the Hospital of the University of Pennsylvania in Philadelphia, led a study that found non-Caucasians and Caucasians are equally interested in learning about clinical trials and their outcomes, but non-Caucasians are less likely to enroll in a trial unless the chances are high that it would benefit them.

He presented the findings of his group’s study at the American Society for Therapeutic Radiology and Oncology (ASTRO) annual meeting last October.

"By identifying attitudes affecting enrollment, I’m hopeful that physicians will be able to better overcome barriers that would otherwise keep patients from enrolling in clinical trials," Wood says.

Enrollment of adult cancer patients in clinical trials is low for all groups, but particularly for minority populations. Only 2%-3% of all patients diagnosed with a particular disease enroll in clinical trials; therefore, Wood points out, the information gathered may not be generalizable to the entire population.

Wood’s team surveyed 166 cancer patients in 2003 at two radiation oncology clinics about their attitudes toward clinical trials. Sixty-five percent of the patients surveyed were Caucasian, and African Americans made up the majority of the other 35%.

Researchers found that while both Caucasians and minorities were interested in learning about clinical trials, Caucasian patients were more likely to gather information on trials from the Internet (31% vs. 11%) and were more apt to talk with their doctors about clinical trials (50% vs. 34%). Non-Caucasian patients were more likely to talk about clinical trial enrollment with other patients (25% vs. 12%). In addition, more minority patients believe they have been subjected to a clinical trial without their knowledge (22% vs. 9%).

Patients also differed on their expectations of clinical trials. More minority patients indicated that they would need a greater than 50% chance of benefiting from the trial (64% vs. 45%); however, there were no differences between the two groups on their outlook on potential side effects from the treatment.

Wood’s team theorizes that minority patients may have an increased level of mistrust toward the medical and scientific community, and this may in turn affect their willingness to enroll in clinical trials. To combat this atmosphere of mistrust, Woods says, physicians need to improve their abilities to explain the realities, risks, and benefits of clinical trial enrollment to all of their patients.

"The manner in which enrollment in clinical trials is discussed with patients of all races must be sensitive to particular patient’s underlying fears, concerns, and potential distrust of the medical community," according to Wood. "Non-classical methods of enrollment on clinical trials may need to be employed to ensure that there are adequate numbers of minority patients studied."

ASTRO is the largest radiation oncology society in the world, with more than 7,500 members who specialize in treating patients with radiation therapies.


  • Charles Wood, MD, Radiation Oncologist, Hospital of the University of Pennsylvania, Philadelphia.