Why do cancer clinical trials matter for black health?
Health disparities in cancer exist based on race and ethnicity, socioeconomic status and age.
For nearly all forms of cancer, including breast, lung, colon, prostate and uterine cancers, black folks do worse.
“On the surface, that’s not fair,” Carol Brown, M.D., Associate Cancer Center Director for Diversity and Outreach at Memorial Sloan Kettering Cancer Center, tells the gathered crowd at the Black Health Matters Summit at Riverside Church in Harlem, New York, on a recent Saturday afternoon. “Why is that happening? Is it because of injustice or discrimination, or is there something about these cancers and how they work in black people that makes them more difficult to treat?”
Dr. Brown has spent nearly the last three decades trying to answer these questions.
Here’s what we know: Clinical research in underserved populations equals cancer health equity. Put simply, clinical trials are a crucial step to finding new and promising ways to improve treatment for cancer. Most medical advances have come as a result of clinical trials.
Yet, less than 3 percent of people with cancer nationwide enroll in clinical trials.
Despite what we know about the Tuskegee experiment from last century, the reasons why we have such low participation in clinical trials are varied:
- Mistrust in the medical community is a small part.
- We lack awareness about many clinical trials.
- We’re uninvited. We don’t participate because we aren’t asked. Often this is because “the doctor assumes we won’t understand, won’t want to participate or are too sick,” Dr. Brown says. In addition, she explains, “doctors are less likely to ask older people and people who aren’t white to participate in a clinical trial.”
- Our cultural beliefs dissuade us from joining a clinical trial.
- We don’t know the eligibility criteria.
- We are uninsured. Here’s a little-known fact: President Bill Clinton required all commercial insurance plans and Medicare to cover clinical trial costs. The downside? Medicaid does not cover these costs.
- Language differences account for some lack of participation.
- Physician awareness is also key. If your doctor doesn’t know about a clinical trial, he or she can’t invite you to participate.
Researchers at Memorial Sloan-Kettering in New York City have been working to overcome these challenges. According to Dr. Brown, 1 out of 3 patients who enter the facility’s doors enroll in a clinical trial.
“We empower our patients and get them access to cutting-edge, life-changing treatments,” she says.
Some therapies being studied right now at Memorial Sloan-Kettering include:
- Breast cancer. Black women have 10 percent lower cure rates. Currently, researchers have one targeted therapy plus hormone therapy clinical trial and four trials for women with the deadly triple-negative breast cancer.
- Colon cancer. Black patients have 8 percent lower cure rates, and the disease occurs 10 years earlier in blacks than in whites. It is also a more aggressive cancer in blacks. Right now there are four targeted therapy trials for this cancer, and one trial is focused on explaining the racial differences.
- Multiple myeloma. This bone marrow cancer happens at two times the rate in blacks as it does in whites, and the age at diagnosis is 10 years younger in black folks. Researchers have three targeted therapy plus steroid trials in the works.
Dr. Brown is a tireless clinical trials advocate. “Participating in cancer clinical trials is the best way to level the playing field for black people affected by cancer,” she says. “We’re not just talking about the best in terms of care, but access to the best in new therapies, access to new drugs and interventions before they are widely available. If the treatment is a success, you are among the first to benefit. Memorial Sloan-Kettering is leading the way to understanding racial and ethnical differences in cancer, allowing us to disseminate treatments that can end disparities.”
Click here to download Dr. Brown’s Presentation given at the 2018 Black Health Matters Summit.