By Linda Carroll

(Reuters Health) – – Clinical trials need diverse patients to show whether a new treatment is likely to work in the broader population, but researchers’ biases may be one reason minority participation in trials is generally low, a study suggests.

A survey of healthcare professionals involved in U.S. clinical trials found minority patients often were not considered “optimal” choices, researchers report in Cancer.

“In a way I was surprised,” said lead author Soumya Niranjan of the School of Health Professionals at the University of Alabama, Birmingham. “As a scientist, though, it is what I thought I would find. But I was hoping it wouldn’t be.”

For minority participation to improve, people need to acknowledge there is bias, Niranjan said. “Then to move forward, there need to be systemic interventions that can be implemented to help out with the personal biases that seem to bubble up.”

Part of the problem is that healthcare professionals tend to be overloaded with work and that makes them pursue potential participants who look like they will take up less time, Niranjan said.

When time is short, biases come to the fore, she said. Some survey respondents said they didn’t think minorities would follow study protocols. Some felt language barriers would get in the way of counseling participants.

To better understand perspectives on minority participation among those involved in running clinical trials, Niranjan and colleagues surveyed 91 individuals, including cancer center leaders, principal investigators of clinical trials, referring clinicians and research staff at five U.S. cancer centers.

Minorities were viewed by some as being more difficult to deal with. For example, one respondent said, “If someone can’t communicate well, how am I sure that they’re not sick from the medication? If they get sick in the middle of the night and needed to call and no one was around, how would I be able to take care of them if I don’t speak their language or understand them culturally?”

Others thought minorities couldn’t be counted upon to follow study protocols. One responded: “Is it going to be worth the risk to that patient’s life if they’re not able to meet in the clinic on a routine basis or follow very, sometimes, complicated drug or medication instructions?”

Some expressed blatant biases. One, for example, said: “I notice Hispanic women are much more willing to do exactly what they are told to do. Whereas African Americans are kind of like, ‘I know you told me not to take Tylenol, but my head hurt so I took that Tylenol.'”

It’s unfortunate and embarrassing that clinical trials are still not enrolling an adequate number of minorities, said Dr. Robert Ferris, director of the UPMC Hillman Cancer Center. It’s not just minorities, Ferris said. “If you look at clinical trials it seems they are almost intentionally avoiding people over 70,” he added.

Systemic changes may lead to improvements, Ferris said. For example, the Hillman Cancer Center has 60 satellite sites. “So, someone doesn’t have to come to the mother ship to get access to a new drug,” he said.

Further, the center has added African American ambassadors to the staffs of sites in predominantly African American neighborhoods, Ferris said.

Including minorities can have unanticipated benefits, Ferris notes. He points to a trial sponsored by a U.S. and a Japanese company that mandated a certain percentage of Japanese participants be included.

“When we broke out how the Japanese participants did compared to the Caucasian participants, the Japanese experienced a dramatically better benefit,” Ferris said. “We never would have known if we hadn’t made the effort to enroll Japanese participants.”

SOURCE: Cancer, online March 9, 2020.