New strategies for promoting diversity, inclusion, equity and access in clinical cancer research trials have been outlined in the blood advances journal.

A new study from the American Oncology Network has highlighted significant racial disparities in clinical cancer research. Between 2008-2018, only 7.8% of clinical cancer research trials documented the four main racial groups (white, Asian, Black, and Hispanic) in the USA.

Racial disparity is evident in clinical cancer research

The study argues that racial disparities in cancer care are persistent due to structural racism in the housing, education, employment, and criminal justice systems. These racial gaps are present in scientific research, as well as in health care. The concern is that a lack of diversity in clinical cancer research trials could yield misleading and ungeneralisable results. Furthermore, many people with cancer receive treatment through clinical cancer research trials, meaning a lack of representation in trials may affect patient outcomes.

“There are things we can do today that can change the trajectory of minority patient inclusion in clinical trials that do not require legislation. They are actions that are within our immediate reach,” said study author Ruemu Birhiray MD, a clinical oncologist at the Hematology Oncology of Indiana Division of the American Oncology Network.

Frustrated by the lack of diversity in clinical cancer research trials, Dr Birhiray and his daughter Maya developed a novel strategy to increase inclusion in clinical cancer research trials. They came up with the following five-step acronym:

D: Diversity officer for clinical research studies

R: Ranking of clinical studies for diversity

I: Individual diversity, equity, inclusion, and access plan

V: Verification of study diversity

E: Elevate and enhance training of minority investigators and research team members

Each step of DRIVE was informed by previous research; for example, the recommendation to include a diversity offer in each trial was based on existing recommendations for safety and monitoring boards to oversee all major trials. DRIVE strategies also considered existing guidelines from the Association for Cancer Research, and examples from other fields, such as the economic rating index used by the World Bank.

Dr Birhiray was keen to highlight the ‘R’ in DRIVE, his idea for ranking clinical trials based on the diversity of the participants.

“We believe that ranking can change the way researchers behave,” said Dr. Birhiray. “We live in a country where everybody wants to win, and keeping score motivates people. No one wants their study to have a low ranking. Beyond study ranking, we also know the value of scientific presentations in the research field. If you have a limited number of podium presentations, and we require you to prioritise the presentation of studies that represent everyone, I think it will force our research community to innovate.”

Making DRIVE a reality

The Birhirays intend to continue their outreach strategies, with a focus on advocacy. In the coming months they will host a summit at the Indy Hematology Education, Inc.19th Annual Meeting. They have also begun work on a new piece they refer to as a ‘Black Paper’: a white paper based on improving the representation of marginalised identities in clinical cancer research. They hope this article will bring medical societies together to agree on a set of policies that can make DRIVE a reality and an industry standard.

“It’s important to communicate that tangible things are being done to make medicine more applicable to everyone. We want people to know that medicine is a field open to everyone and that our community values them.” Said Ms Birhiray.


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