Steps Nurses Can Take to Improve Health Equity in Cancer Clinical Trials

Faith Mutale, DNP, CRNP

A key component of health equity includes ensuring that clinical trials reflect subgroups of patients who are more reflective of real-world populations, according to Faith Mutale, DNP, CRNP. Mutale’s presentation “Minorities in Cancer Clinical Trials: 30 Years after the NIH Revitalization Act: Where Are We?” given at the 40th Annual CFS® highlighted the importance of representation in trials and building trust in the community.

Mutale said that clinical trials are not accurately representing the general population because inclusion of minorities is very low. She cited prostate cancer data demonstrating that between 2006 to 2020, demographics of patients in clinical trials were 2.9% African American, 7.9% Asian, and 76% Caucasian despite that fact that African Americans make up 13.4% of the population and have a higher ratio, 1:6, of developing prostate cancer. Additionally, in this time frame, 1 in 5 agents had differences in exposure/response based on race.

“The issues with under representation of minorities in cancer clinical trials are not insurmountable,” Mutale said. “But there has to be recognition of the fact that these issues cannot be solely dealt with by policymakers, legislators, or even other stakeholders such as advocacy groups. Advanced practice providers should step up and become part of stakeholders to increase the growth of minority participation in these trials.”

In an interview with Oncology Nursing News®, Mutale, a nurse practitioner in Head and Neck and Thoracic Oncology at the Abramson Cancer Center in Pennsylvania, explained steps that can be taken by the nurse to work towards achieving health equity.

What does health equity mean and what could it look like?

When I think about health equity, I think of that in terms of one size does not fit all, meaning different populations have different needs and resources must be allocated accordingly to meet the needs of different populations. I like the way that Wikipedia defines health equity: [It is] the absence of disparity in health and health care among populations. That sums it up.

It’s not going to be the same for all populations and in terms of what this would look like for our minority patients, they may require more resources to be allocated to them. For example, to be able to access sites that are offering trials, resources such as transportation [are needed]. Also, in order to pay for some of the out-of-pocket costs that are not completely covered by insurance companies [they need assistance].

What is the role of the oncology nurse in helping to achieve health care equity and combat these institutional problems?

One of the big things that nurses can do is to be able to identify systems issues that perpetuate disparities among minority patients in clinical trials. We’re providing care on a daily basis, we are talking to patients, and we spend much more time [with them] on average than probably any other health care provider.

[We need to be] able to identify those issues and then educate patients [about them]. I think that there is a need for clinical trials knowledge to be disseminated to all populations [it is important] that they understand. Some patients, when they come into clinic, may not have been provided with clinical trial information so they don’t know [what to expect]. It's our responsibility as patient advocates to help in this regard by increasing awareness of clinical trials as a viable treatment option.

A good proportion of our minority patients have misgivings about clinical trials, so educating our patients but also coming up with culturally relevant strategies to improve on is necessary.

One of the things that I wanted to convey is that there's a lack of knowledge among NPs in general—how much do we know about the disparities in cancer care? Do we look at who the patients who are coming in or the patients who are involved in clinical trials? What are we doing about that? There’s a need for improvement or increase in knowledge among nurses in terms of disparities in cancer care.

[We need] to take a step towards improving that because again we’re advocates; we need to be intentional about some of the issues that we have in cancer care so that health equity is really that for all populations, and not for just some patients.

Reference

Mutale F. Minorities in cancer clinical trials: 30 years after the NIH Revitalization Act: where are we? Presented at: 40th Annual CFS® conference; November 9-11, 2022; New York, NY.