The document discusses barriers to minority patient enrollment in cancer clinical trials. It conducted a systematic literature review on barriers and found that minority populations experience systemic, institutional, and individual barriers. It also reviewed physician cultural sensitivity training programs and found they are insufficient. The document created a presentation on how patient navigators can help address these barriers by informing patients about clinical trials and assisting with the enrollment process. It recommends developing a community health worker/patient navigator program to recruit minority patients from community centers and guide them through cancer treatment and clinical trial enrollment at hospitals.

1. Internship Agency
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Barriers to Minority
Patient Enrollment in
Clinical Trials
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Introduction
• Cancer mortality rates are declining for
the majority of organ sites for all
population subgroups; however, racial/
ethnic minorities experience highest
cancer incidence and mortality rates1
• Between 2010-2030, the projected
increase in cancer incidence rate is 99%
for minorities, as compared to 45% for
the population-at-large. However, in
spite of increasing incidence, there is low
enrollment of minority of adults in clinical
trials2
• NCI recommends prioritizing new clinical
trials based on adequacy of sampling
specific ethnic groups rather than organ
sites2
Clinical Trials Office is a division at Memorial
Sloan-Kettering Cancer Center (MSKCC) that
focuses on seeking new methods to screen
for cancer, prevent cancer from growing, and
continually coming up with new knowledge
and technology to improve diagnosis and
treatment through clinical trials
Methods
• A systematic review was conducted on
PubMed using the following key terms:
(cancer clinical trials OR barriers to
clinical trial enrollment OR access to
clinical trials) AND (minority patients OR
non-english speaking patients).
• A literature review focusing on the
existing physician training-programs was
conducted using the following key terms:
(physician training programs OR public
health curriculum) AND (United States
Medical Schools).
• A PowerPoint presentation was created
using information gathered about patient
navigator programs by examining
literature, looking at hospital websites,
and calling hospitals about their existing
patient navigation programs in cancer
care management.
MPH Program
Competencies
Developed
• The systematic review of barriers to clinical
trials strengthened my ability to conduct
literature review using different resources
• By developing a strategy to engage minority
patients in CTs, I improved my program
planning, development, and implementation
skills
include specific
Literature Cited
1. Durant R, Wenzel J, Martin M, et al. Perspectives on barriers and facilitators to minority recruitment
for clinical trials among cancer center leaders, investigators, research staff, and referring clinicians:
enhancing minority participation in clinical trials (EMPaCT). Cancer (0008543X) [serial online]. April
2, 2014;120:1097-1105 9p
2. Heller C, Balls-Berry J, Kuo W, et al. Review: Strategies addressing barriers to clinical trial
enrollment of underrepresented populations: A systematic review. Contemporary Clinical Trials
[serial online]. November 1, 2014;39:169-182. Available from: ScienceDirect, Ipswich, MA.
Acknowledgements
Dafna Rebibo- Preceptor
Yelena Janjigian, MD- Preceptor
Barriers to Minorities Enrolling on Cancer Clinical Trials
Student: Tooba Imtiaz
Preceptor: Dafna Rebibo
Organization: Memorial Sloan-Kettering Cancer Center
Internship Project
The purpose was to find ways to increase
minority participation in cancer clinical trials
Activities
• Systematic review and presentation on
barriers to patient recruitment in clinical trials
• Report on physician training-programs on
cultural responsiveness
• PowerPoint presentation on patient
navigators in cancer care
Outcomes
• Minority populations experience barriers
in these areas (see figure 1):
• Systematic
• Institutional
• Individual
• Cultural sensitivity training for
physicians in medical schools is
insufficient. Training is limited to lectures
and workshops, and the modules are
not transferrable to real life scenarios
• Patient navigators can improve patient
care and increase minority enrollment in
clinical trials by:
• Informing patients about
clinical trials
• Helping patients with the
enrollment process
Discussion
• It is necessary to address multiple
barriers to increase minority participation
in clinical trials
• Most clinical trials still focus on disease
type rather than patient ethnic groups
who would benefit from enrollment in
trials
• Multiple opportunities to increase patient
engagement in CTs exist through the use
of patient navigators
• Patient navigators who act like liaisons
between community centers and cancer
hospitals have the potential to connect
minority adult patients to clinical trials
• Recommendation: Develop a community
health worker/patient navigator (CHW/
PN) program that recruits ethnic
populations from community centers and
navigates them during their treatment at
cancer hospitals, such as MSKCC.
Issues Patient
Navigators
Address
Figure 1