Diversity In Clinical Trials: Overcoming Barriers to Revolutionize Cancer Care

Only about 6% of cancer patients in the U.S. participate in a clinical trial, and among those who do participate, certain groups are severely underrepresented. For example, although Hispanics and Latinos represent 13% of the nation’s cancer population, their enrollment rates are disproportionately low at about 1%. This is important because the participation of those from diverse socioeconomic backgrounds is imperative to our understanding of the differences in cancer biology related to ancestry, which can impact the effectiveness and safety of new treatments.

Ines Sanchez-Rivera, M.D., hematologist and medical oncologist at Texas Oncology–El Paso Gateway and El Paso Grandview, is area medical director of Texas Oncology in El Paso and leads clinical research in the region. This Hispanic Heritage Month, we spoke with Dr. Sanchez-Rivera about the importance of clinical research in advancing cancer care, what types of barriers underrepresented groups face in accessing clinical trials, and how her team works to overcome these barriers to connect patients with leading-edge treatments.

1) How do clinical trials advance cancer treatment and research?

goal of a clinical trial is to determine whether a new medication is better than treatments currently available, also known as the “standard of care.” This is the model we’ve adopted to make treatment safer and more effective, which has led to fewer side effects and increased survival rates for many cancer types.

At Texas Oncology, we collaborate with Sarah Cannon Research Institute to connect patients with clinical trials. We also have access to innovative research in partnership with Mary Crowley Cancer Research and NEXT Oncology. Through these partnerships, our patients have access to clinical trials with newer therapies and better ways to treat cancer.

2) What are the primary benefits for patients who choose to participate in clinical trials?

Participants receive leading-edge treatment, which means they get access to newer therapies that might be more effective than standard care. Clinical trial participants also have more touch points with their care team, including Texas Oncology clinicians who are investigating the clinical trial, followed by the research team for years to evaluate the treatment’s long-term efficacy.

3) Why is it important to include a diverse patient population in clinical trials? How does this impact the development and effectiveness of new cancer treatments?

It's super important because a person’s genetic make-up, their ethnic background, gender, and other characteristics can actually impact how aggressive their cancer is, how they respond to treatment, and how some drugs are processed within the body.

People from specific ethnic or racial groups, such as Hispanics in Texas with Mexican ancestry, have similar genetic traits that can influence the effectiveness of cancer medications. Culturally, our diet, customs, and behaviors can also impact our cancer journey, so it’s important to include a wide variety of people in clinical research.

Many clinical trials collect samples for circulating tumor DNA or tissues that can be analyzed later to help develop new drugs or pathways for treatment. We need diverse participation to provide treatments that are more effective for everyone.

4) Certain groups, like Hispanics and Latinos, are historically underrepresented in clinical trials. What types of barriers do these populations typically face in accessing clinical trials?

In my experience, what often stops people from participating is mistrust. They say they don’t want to be a guinea pig, because they assume participants are either receiving untested therapies or a placebo instead of treatment — which usually isn’t the case. These treatments are evaluated extensively before they reach human trials, and there are teams of experts monitoring active trials to ensure patients are doing well.

For some randomized trials, patients may receive the standard available treatment rather than the new therapy. This means everyone participating in a trial receives active treatment for their cancer while simultaneously helping to advance research and build a better future for patients.

5) How do you and the team at Texas Oncology work to overcome these barriers and improve accessibility to clinical trials for Hispanics and Latinos?

A big part of clinical trial accessibility is providing all the information in the patient’s preferred language. I won’t open a clinical trial unless all patient materials are available in Spanish. Then, I make sure patients take these materials home to discuss with their families. Mostly, it’s about educating them on their options, making sure they have time to think about whether they want to participate, and ensuring they can ask questions so we can do our best to give them answers.

6) Where should patients start if they want to participate in a clinical trial?

It starts with a conversation. There have been instances where patients call because they learn of a clinical trial happening at a Texas Oncology site close to home. They usually find these online through Cancer.gov or ClinicalTrials.gov, which list all active clinical trials.

However, most patients are identified by their doctor, who shares information about the trial and connects them with a research team if the patient is interested in learning more. For example, I have a patient who is now finishing treatment through a clinical trial. When they first came to me, their prognosis and cancer type was high risk. I knew of a new trial that could help, so I told the patient about it. Then, I connected them with the research team to help them get more information to see if they were interested. After a thorough screening process to determine if they were a viable candidate, the patient joined the trial, and now, after undergoing this new treatment for about a year or so, their tumor has completely disappeared. There’s no other drug in the world that would have been able to do that.

To learn more about participating in a clinical trial and the innovative cancer research taking place at Texas Oncology locations across the state, visit TexasOncology.com/clinical-trials.