Barriers to the participation of African‐American patients with cancer in clinical trials

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Abstract
BACKGROUND: African‐American patients have been under‐represented in oncology clinical trials. Better understanding barriers to African‐American participation may help increase the accrual of African‐American patients onto clinical trials.METHODS: Two hundred eighteen patients with malignant disease (72 African‐American patients and 146 white patients) were recruited from the Duke Cancer Clinic and from Duke Oncology Outreach Clinics (DOORS). Patients were interviewed using a standardized survey. Questions included patients' knowledge of cancer, religious/spiritual beliefs, satisfaction with medical care, knowledge of clinical trials, reasons for participating or refusing to participate in a clinical trial, financial/transportation issues, and demographic factors, such as age and education. Data on attitudes and belief were analyzed for group differences between African‐American patients and white patients as well as between patients who were treated at the Duke Cancer Clinic and patients who were treated at DOORS clinics.RESULTS: Willingness to participate in a clinical trial depended on both race and clinic site. Forty‐five percent of white patients, compared with 31% of African‐American patients, were willing to participate in a clinical trial (P = 0.05). white and African‐American patients who were treated at the Duke Cancer Clinic were more willing to participate in a trial compared with their counterparts who were treated at DOORS clinics (47% vs. 37%, respectively; P = 0.09). The greatest differences between groups (African‐American patients vs. white patients and Duke Cancer Clinic patients vs. DOORS patients) were education and income: Much greater percentages of African‐American patients and DOORS patients did not complete high school and had annual incomes < $15,000. In addition, more African‐American patients than white patients believed that God would determine whether they would be cured or would die from their disease. In a multivariate analysis, education, income, and belief that God would determine the patient's outcome also were correlated with a decreased willingness to participate in clinical trials.CONCLUSIONS: Factors associated with religion, education, and income, rather than race, may be major barriers to clinical trial participation. Interventions that target education and income may increase the recruitment of African‐American oncology patients onto clinical trials. Cancer 2003;97:1499–506. © 2003 American Cancer Society.DOI 10.1002/cncr.11213