Abstract
PURPOSE
The under-representation of African countries in cancer clinical trials continues to widen the cancer health disparity. In this study, we assessed health care workers' perspectives on recruitment and retention in cancer clinical trials in Nigeria.
METHODS
This study was a convergent parallel mixed-methods design, using a survey for quantitative analysis and focus group discussions (FGDs) for further qualitative investigation. The health care providers that participated in the study were drawn from the ICON-3 Practice-based Research Network across the six geopolitical zones in Nigeria.
RESULTS
Of the 42 providers, 35 completed the survey and 25 participated in the FGDs. The most cited (agreed or strongly agreed) patient-related barriers were lack of understanding of cancer clinical trials (83%), cultural barriers (77%), and lack of financial compensation for study visits (77%). The most cited provider-related barriers were negative attitude of the clinical team (89%), lack of training in good clinical practice (89%), and an overwhelming clinical workload (86%). On trial-related barriers, about 71% agreed or strongly agreed that lack of trial publicity was a barrier. Over 90% of the respondents agreed or strongly agreed that several factors, including the friendliness of the study team (97%) and clarity in the presentation of trial information (97%), are important facilitators. The FGDs unveiled additional themes, including systems-related barriers such as lack of infrastructure, limited research collaboration, and prolonged ethical approval process, and capacity building and community engagement as potential facilitators.
CONCLUSION
Our study provides providers' perspectives on the barriers and facilitators to the recruitment and retention of participants in cancer clinical trials in a low-resource setting and highlights the need for culturally appropriate recruitment strategies.
INTRODUCTION
The burden of cancer is disproportionately growing in Africa compared with other continents.1,2 Yet there is an under-representation of African countries in cancer clinical trials—the foundation of clinical oncology research and the basis for the discovery of new treatments and improving cancer outcomes.4-6 Of the 100,301 global cancer clinical trials listed on Clinical Trials.gov, as of October 2023, only 1.7% (1,680) were conducted in Africa, and although Nigeria is the most populous Black nation in the world, only 33 (<0.1%) cancer clinical trials were in Nigeria.7
CONTEXT
Key Objective
To identify factors that hinder or facilitate recruitment and retention in cancer clinical trials in Nigeria.
Knowledge Generated
The study highlighted multilevel barriers, including patient-, provider-, trial-, and systems-related barriers, that limit recruitment and retention in cancer clinical trials in Nigeria. The results also provided insights into the factors that may positively affect participants' willingness to enroll and remain in cancer clinical trials in Nigeria.
Relevance
These data may be useful in designing strategies to optimize participation and infrastructure for cancer clinical trials in Nigeria and similar low-resource settings.
There are major disparities in the recruitment of global minority populations in clinical trials in both high-income and low- and middle-income countries.8-13 According to the US Food and Drug Administration, only 5% of patients enrolled in clinical trials that led to the approval of new cancer drugs in 2020 were of African descent.14 The under-representation of racial minority populations in cancer clinical trials widens the cancer health disparity and results in a paucity of population-specific evidence on effective cancer treatments for these populations,13 including certain cancers essentially restricted to them.
Several studies have identified patient-, trial-, and systems-related barriers to participation of racial minorities in cancer clinical trials.17-21 However, despite the extensive body of literature, a paucity of studies focus on the barriers and facilitators to recruitment and retention in cancer clinical trials in Africa. Given the contextual differences, African participants are likely to face unique barriers to participating in cancer trials compared with other regions. Understanding these multilevel barriers can facilitate the inclusion of underserved global populations and diverse participation in cancer clinical trials. Thus, this study aimed to assess health care providers' perspectives on recruitment and retention in cancer clinical trials in Nigeria.
METHODS
Study Design and Population
This study was a convergent parallel mixed-methods design, with a quantitative cross-sectional survey and qualitative focus group discussions (FDGs).
Participants were health care providers from 12 Nigeria Implementation Science Alliance Model Innovation and Research Centers and six Regional Oncology Centers of Excellence across six geopolitical zones and part of the ICON-3 Practice-based Research Network.
Recruitment
For the quantitative survey, health care providers were invited via WhatsApp. For the qualitative FDG, a site doctor, gynea-oncologist, radio-oncologist, and palliative care expert were invited to Enugu State to participate in person. In total, 30 invitation e-mails were sent, and 28 participated.
Data Collection
The quantitative data collection used a pretested structured online questionnaire adapted from previous studies.25,26 A Web link was shared via WhatsApp. The questionnaire included three modules: (1) background information including demographic characteristics and professional experience; (2) perceived patient-, provider-, and trial-related barriers; and (3) perceived facilitators. Modules two and three were designed using a five-point Likert scale. For the qualitative inquiry, we conducted two FGDs. The providers were divided into two heterogeneous groups. A pretested FGD guide solicited views on the barriers, facilitators, and strategies for recruitment and retention for cancer clinical trials. The FGDs were audio-recorded, and field notes were taken.
Data Analysis
Survey data responses were summarized using descriptive statistics. Likert scale data were reported as proportions. The qualitative analysis used an inductive approach.27 Audio recordings and field notes were transcribed into analyzable text and cleaned for analysis. Members of the data analysis team read the data transcriptions in their entirety. Codes were assigned on the basis of the research objectives. Further coding into additional nodes (themes and subthemes) was performed until both theoretical and thematic saturation were observed. Additionally, two authors analyzed the initial sample of data to assess inter-rater reliability and rigor. Discussions were held to identify and resolve disagreements. The qualitative analysis used QSR NVivo Version 14.
Ethical Approval
Ethical approval for this research was obtained from the Nigerian National Health Research Committee (NHREC/01/01/2007-14/03/2023) and the John Hopkins Institutional Review Board. Informed consent was obtained from the participants before the commencement of both the quantitative and qualitative data collection.
RESULTS
Characteristics of the Study Population
Thirty-five (83%) of 42 health care providers completed the survey, and 25 (89%) of 28 providers participated in FGDs (Table 1).
TABLE 1.
Characteristics of the Study Participants
| Survey | N = 35, No. (%) |
|---|---|
| Sex | |
| Male | 16 (45.7) |
| Female | 19 (54.3) |
| Education | |
| Tertiary | 35 (100.0) |
| Specialty | |
| Oncologist | 6 (17.1) |
| Obstetrician/gynecologist | 6 (17.1) |
| Family physician | 3 (8.6) |
| General surgeon | 1 (2.9) |
| General practitioner | 4 (11.4) |
| Pain physician | 3 (8.6) |
| Nurse/midwife | 10 (28.6) |
| Anesthetist/palliative care physician | 2 (5.7) |
| Professional experience | |
| <5 years | 4 (11.4) |
| 5-10 years | 8 (22.9) |
| >10 years | 23 (65.7) |
| Previously participated in a clinical trial | |
| Yes | 12 (34.3) |
| No | 23 (65.7) |
| Previously participated in a clinical trial related to cancer (n = 12) | |
| Yes | 9 (25.7) |
| No | 3 (8.6) |
| Number of clinical trials participated in (n = 9) | |
| 1 | 2 (22.2) |
| 2 | 6 (66.7) |
| 4 | 1 (11.1) |
| Role in previous clinical trial (n = 9) | |
| Principal investigator | 1 (12.5) |
| Coinvestigator | 4 (50.0) |
| Other | 3 (37.5) |
| Missing | 1 |
Barriers to Retention and Recruitment in Cancer Clinical Trials
Patient-Related Barriers
Fear of side effects, cultural barriers, lack of financial compensation, and limited understanding were identified as major barriers (Table 2).
TABLE 2.
Patient-Related Barriers to Recruitment and Retention in Cancer Clinical Trials
| Patient-Related Barriers | Strongly Disagree, No. (%) | Disagree, No. (%) | Neutral, No. (%) | Agree, No. (%) | Strongly Agree, No. (%) |
|---|---|---|---|---|---|
| A fear of negative side effects of the trial drug, screening, or diagnosis method | 3 (8.6) | 3 (8.6) | 2 (5.7) | 18 (51.4) | 9 (25.7) |
| Lack of knowledge or understanding of clinical trials | 2 (5.7) | 3 (8.6) | 1 (2.9) | 21 (60.0) | 8 (22.9) |
| Lack of financial compensation for additional travel and study visits | 4 (11.4) | 2 (5.7) | 2 (5.7) | 19 (54.3) | 8 (22.9) |
| Cultural barrier | 2 (5.7) | 4 (11.4) | 2 (5.7) | 21 (60.0) | 6 (17.1) |
| Concerns about privacy and confidentiality issues | 3 (8.6) | 5 (14.3) | 5 (14.3) | 17 (48.6) | 5 (14.3) |
| Lack of partner/family support | 3 (8.6) | 6 (17.1) | 5 (14.3) | 19(54.3) | 2 (5.7) |
Fear of side effects.
In the survey, 77% of respondents identified fear of negative side effects as a major barrier, a concern echoed in the FGD.
“…side effect has a role to play; they can affect the retention of the patient especially how they are managed when presented with it. At times when a patient comes with a side effect to the hospital they have some notion in mind to that particular thing, they try to attach that side effect to what he or she is into, even when the side effects are not related to the medication. If the side effects are not handled and properly educated, we can lose the patient.” (Participant H1, Group A).
Cultural barriers.
About 77% of respondents agreed that cultural nuances can limit recruitment and retention. The FGD emphasized the need to understand cultural barriers like limited decision autonomy.
Poor understanding of patients' cultural and religious beliefs.
Research assistants and health care providers must understand patients' religious and cultural beliefs, as lack of cultural awareness can be a barrier.
“In Nigeria, there are many things you can’t do because of culture. You have to understand the culture of the place you want to use for the clinical trial. We are trying to do a demonstration trial and for the last one year we got barriers all the way.” (Participant H5, Group A).
Lack of autonomy in decision making.
Health care providers noted that many women in Nigeria lack autonomy in clinical trial decisions, which are often made by their husbands or family members.
“A general problem with clinical trial [is] because women don’t make decisions. If you seek consent from the woman, she will tell you to ask her husband … so ethically you seek the consent of the woman, but culturally you seek the consent of her husband. Even when the women consent, if the husband does not consent it is useless, she will not be part of the trial. So, I think that is a cultural barrier.” (Participant H6, Group A).
Lack of knowledge or understanding.
Approximately 83% of respondents agreed that patients' lack of understanding of clinical trials hinders recruitment and retention. FGDs linked this to low health literacy and language barriers. Moreover, some respondents noted that language barriers may affect effective communication and patient understanding.
“Many times, they don’t really understand what you are talking about. They don’t understand the process. They don’t understand the procedure, and if you don’t understand it, it is difficult to commit to it, so you will find that a number of times patient will fall out, they don’t stick to appointment.” (Participant H10, Group B).
Lack of financial compensation.
Over 77% of respondents agreed that lack of compensation and additional travel costs are a barrier FGDs emphasized the need for incentives due to the high cost of patient travel.
“…another thing is the geographic distance which comes with the logistics of going extra miles, coming with the financial implications. I think many things contribute to retention but I completely agree that distance is one of the main barriers and having to even enroll and committed.” (Participant H3, Group B).
Provider-Related Barriers
More than 75% of the respondents agreed or strongly agreed that all clinical team–related items were barriers (Table 3).
TABLE 3.
Provider-Related Barriers to Recruitment and Retention in Cancer Clinical Trials
| Provider-Related Barriers | Strongly Disagree, No. (%) | Disagree, No. (%) | Neutral, No. (%) | Agree, No. (%) | Strongly Agree, No. (%) |
|---|---|---|---|---|---|
| Overwhelming clinical workload and limited time for cancer clinical trials | 1 (2.9) | 2 (5.7) | 2 (5.7) | 13 (37.1) | 17 (48.6) |
| Lack of training in good clinical practice | 0 | 3 (8.6) | 1 (2.9) | 17 (48.6) | 14 (40.0) |
| Lack of motivation or incentives for the clinical team | 0 | 3 (8.6) | 2 (5.7) | 17 (48.6) | 13 (37.1) |
| Inexperience of clinical research team | 0 | 6 (17.6) | 2 (5.9) | 16 (47.1) | 10 (29.4) |
| Negative attitude of the clinical team to patients involved in clinical trials | 0 | 3 (8.6) | 1 (2.9) | 22 (62.9) | 9 (25.7) |
Inexperience of clinical research team.
Seventy-seven percent of survey respondents agreed that health care providers' lack of clinical research experience hinders recruitment and retention. FGDs also emphasized the need for provider training.
“One very important barrier is the skills. Not all of us know what clinical trial is and have the skills. We have not conducted one we have not seen one conducted. If we need to start then we to be trained.” (Participant H6, Group A).
Lack of training in good clinical practice.
Eighty-nine percent of respondents identified lack of training in good clinical practice as a barrier, with FGDs emphasizing that nondisclosure to patients critically impedes participation.
“You have to be open to the patient. Let them know the standard of care, this is what we are trying, based on available information. Let them know the pros and cons of what they are doing and then you lead them to taking the decision.” (Participant H7, Group A).
Negative attitude of the clinical team.
Almost 89% of respondents indicated health care providers' negative attitudes as a barrier, a sentiment echoed in group discussions.
“…some of our health workers are careless and inhuman, some will come with a problem instead of tendering and caring and encouraging the patient… I have worked in many centers and I experienced our behavior is not patient and encouraging. Health workers' behavior is one of the things that discourage patient willingness in recruitment in a clinical trial.” (Participant H5, Group B).
Overwhelming clinical workload and limited time.
Approximately 86% of respondents noted that limited time due to overwhelming workloads could hinder participation, a concern also raised in FGD.
“We are only two consultants in the hospital and actually the work is overwhelming. Most time you have only one consultant at a time so it is very difficult. Much work is a hindering factor, I want to do research but [the]workload is too much.” (Participant H4, Group A).
Lack of motivation or incentives.
Eighty-six percent of respondents identified a lack of motivation or incentives for the clinical team as a significant barrier, a sentiment echoed in FGDs regarding the need for better remuneration and institutional support.
“You are overworked, not well paid, and for you to do research which you may not gain much, you still have to pay to publish your results or findings. Recently we published a paper, like two hundred to three hundred thousand [US] dollars. You have to pay for what you have taken your time to research and the institution has no financial support.” (Participant H7, Group B).
Trial-Related Barriers
Approximately 71% of respondents identified lack of trial publicity as a barrier, whereas 66% cited prolonged participation time, and 63% noted that trial type, such as drug trials or those involving biospecimen collection, can limit participation. Delays in ethical approvals, lack of infrastructure, and limited collaboration were systemic barriers affecting trials (Table 4).
TABLE 4.
Trial-Related Barriers to Recruitment and Retention in Cancer Clinical Trials
| Trial-Related Barriers | Strongly Disagree, No. (%) | Disagree, No. (%) | Neutral, No. (%) | Agree, No. (%) | Strongly Agree, No. (%) |
|---|---|---|---|---|---|
| Prolonged total time for trial participation | 0 | 8 (22.9) | 4 (11.4) | 20 (57.1) | 3 (8.6) |
| The type of trial being a drug or treatment trial v nondrug trial | 0 | 3 (8.6) | 10 (28.9) | 20 (57.1) | 2 (5.7) |
| Trial involves the collection of biospecimens (eg, blood, urine) | 0 | 7 (20.0) | 6 (17.1) | 20 (57.1) | 2 (5.7) |
| Narrowly defined criteria for inclusion and exclusion | 2 (5.7) | 6 (17.1) | 9 (25.7) | 17 (48.6) | 1 (2.9) |
| Lack of trial publicity (eg, word of mouth, posters) | 2 (5.7) | 6 (17.1) | 2 (5.7) | 19 (54.3) | 6 (17.1) |
| Trial information provided too complex | 1 (2.9) | 5 (14.3) | 8 (22.9) | 11 (31.4) | 10 (28.6) |
| Weak and unclear information about who sponsors the trial | 1 (2.9) | 8 (22.9) | 9 (25.7) | 11 (31.4) | 6 (17.1) |
Lack of infrastructure.
Health care providers from both groups noted that many institutions in Nigeria lack essential infrastructure for conducting cancer clinical trials, including electricity and adequate facilities. They acknowledged, however, that the availability of such infrastructure varies by health facility type and the nature of the trial.
“…do we have the necessary infrastructure to conduct the trial, because when it comes to trial, it is a very strict thing. You know what has happened here about the light issue right. I am going to take samples that I am going to freeze, how do I maintain my temperature?”
Limited intrainstitutional and interinstitutional research collaboration.
Successful conduct of cancer clinical trials in Nigeria hinges on collaboration among global and local institutions, as well as clinical staff, with discussions highlighting its importance for recruitment and trial execution.
“I have the medical approval and the form, but I still do not have the 100% assurance to recruit a patient. So, if at any point we have to recruit even with medical approval, you face challenges recruiting participants for clinical trials. Usually, the challenge is getting the consent of the owners of [healthcare providers managing] the patient to allow you to recruit.” (Participant H6, Group A).
“For me, I think a major one is getting partnerships because obviously, we have not been able to do any work by ourselves. But if we have those who have developed it up to the stage of using drugs, for instance passing the phase of testing on animals, and now using it on humans.” (Participant H3, Group B).
Prolonged ethical approval process.
Health care providers noted delays in obtaining ethical approvals from various review boards as a barrier, affecting patient numbers and study duration.
“Looking at this from the system factor, delays in getting approvals, regulating bodies is a big problem. You want to get approval for your ethical work and all that. For regulating body to give you go ahead, there are many delays and bureaucratic principles, this can actually affect the process of clinical trial.” (Participant H6, Group B).
Facilitators to Retention and Recruitment in Cancer Clinical Trials
Incentives, community engagement, friendly study teams, and training for health care providers were noted as key facilitators (Table 5).
TABLE 5.
Facilitators of Recruitment and Retention for Clinical Trials
| Facilitators | Strongly Disagree, No. (%) | Disagree, No. (%) | Neutral, No. (%) | Agree, No. (%) | Strongly Agree, No. (%) |
|---|---|---|---|---|---|
| The friendliness of the clinical and study team | 0 | 1 (2.9) | 0 | 13 (37.1) | 21 (60.0) |
| Availability of incentives for participants | 0 | 1 (2.9) | 1 (2.9) | 16 (47.1) | 16 (47.1) |
| Patient fully informed of the risks and benefits of participation | 1 (2.9) | 0 | 1 (2.9) | 19 (55.9) | 13 (38.2) |
| Clarity in presentation of trial information | 0 | 1 (2.9) | 1 (2.9) | 22 (62.9) | 11 (34.1) |
| Simple consent procedure | 0 | 2 (5.7) | 2 (5.7) | 16 (45.7) | 15 (42.9) |
| Less frequent clinical follow-up visits | 1 (2.9) | 4 (11.4) | 3 (8.6) | 15 (42.9) | 12 (34.3) |
| Provision of regular information about what is happening in the trial | 0 | 1 (2.9) | 1 (2.9) | 17 (48.6) | 16 (45.7) |
| Important and relevant research focus that is likely to benefit the community | 0 | 0 | 3 (8.6) | 19 (54.3) | 13 (37.1) |
| Physicians’ recommendation for trial participation | 0 | 0 | 7 (20.6) | 20 (58.8) | 7 (20.6) |
Availability of Incentives
Health care providers suggested that offering incentives, such as waivers of ethical clearance fees and monetary rewards for clinicians, could encourage participation.
“…instead of insisting you pay for ethical clearance because you are staff of the institution and you want to do research in the institution; something that will benefit the institution: they can give a waiver for it.” (Participant H5, Group B).
Some health care providers emphasized the importance of incentives, such as free medical services and transportation funds, to encourage patient participation.
“Patients need incentives when they fall sick from side effects of the trials. They will need money to get treated or the treatment should be offered to them for free.” (Participant H4, Group B).
Friendliness of the Clinical and Study Team
During the FGDs, health care providers emphasized that a friendly attitude from clinical and study teams is a crucial facilitator:
“We need to have the ability to treat the patients well. When you do that, they will comply.” (Participant H10, Group B).
Capacity Building
Health care providers highlighted the importance of training to foster teamwork and collaborations.
“Some of the solutions, we need to train ourselves, training and retraining. Colleagues can stand as stumbling blocks, we need to gain their support.” (Participant H2, Group A).
Community Engagement
FGDs emphasized that community engagement and patient education, along with involving local stakeholders, are essential for maintaining patient interest and ensuring success:
“We should involve community and religious leaders by educating them about the trial, so when they go back home they will be the ones to create awareness for the people and they will participate. So, getting the approval and making them stakeholders is very important.” (Participant H7, Group A).
DISCUSSION
This mixed-methods study assessed health care providers' perspectives on the barriers and facilitators to the recruitment and retention of participants in cancer clinical trials. Some patient-related barriers identified in this study have been reported in previous studies and add to evidence suggesting that some barriers are common across various settings. Fear and skepticism related to clinical trials have limited participation of minorities.17,28,29 Uncertainty about clinical trial effects, especially the use of “experimental,” has been reported to influence negative perceptions in trial participants.30,31 We corroborate findings that financial burden due to frequent clinic visits and additional laboratory investigations limit participation in clinical trials. Unfamiliarity with patient's religious beliefs and lack of autonomy in decision making are two unique cultural subthemes identified in our study that can be ameliorated with tailored culturally appropriate strategies.
We found skill-related gaps, poor attitude of clinical staff, lack of incentives, and high clinical workload as provider-related barriers, consistent with previous studies.30,31,34 Most health care providers reported lacking expertise and need for further training in conducting clinical trials. Similarly, they identified training gaps in research personnel, particularly inadequate disclosure of clinical trial information to patients, as critical to recruitment. Poor health worker attitudes toward patients could negatively affect participation because a good provider-patient rapport is necessary to establish trust and encourage participation.
Although the health care providers identified trial-related barriers that have been identified in previous studies, we also found lack of publicity of cancer clinical trials as an important barrier. Context-specific strategies to publicize clinical trials could increase its awareness and participation. Such strategies could include community outreach programs,35 use of champions, and physician endorsement.36 Strict eligibility criteria such as the exclusion of patients due to comorbidities also limit clinical trial participation. Pragmatic trials have the potential to increase participation due to more lenient eligibility criteria.37
Specific systemic barriers were also identified in this study. The lack of infrastructure for clinical trials is a huge impediment in most African settings. Critical to clinical trial participation is the collaboration between researchers in the global north and global south whereby the capacity and skills of global south researchers are developed while they contribute context-specific expertise and cultural awareness to study design and implementation.
The respondents identified friendliness of staff, clear and consistent information updates, incentives, and full disclosure of trial information as important facilitators. Thus, regular training of clinical and research staff on good interpersonal relationships and empathy could improve their attitudes toward patients and increase participation. Likewise, provision of incentives to participants and clinical staff could facilitate participation. Participants could be provided with transportation reimbursement and compensation for their time in research activities, whereas clinical staff could be provided with professional development credits.34 Finally, providers also identified community engagement as an important facilitator. Involving appropriate community leaders or gatekeepers can facilitate education and mobilization of the target population.
The small sample size of the survey limits our study's generalizability; however, it supplements the in-depth FDG qualitative analysis. Thus, quantitative percentages should be interpreted carefully and in the context of the FDG analysis. Additionally, some of the health care providers included in the study had not participated in cancer clinical trials, so they may not have provided firsthand views. The FGDs examined the perspectives of physicians and did not include other health care providers who care for patients with cancer. Nevertheless, our findings provide useful insights into the barriers and facilitators to the recruitment and retention of participants in cancer clinical trials in Nigeria, which may contribute to the development of strategies for patient accrual. Although this manuscript focuses on the perspective of health care providers alone, we will complement these results with a subsequent publication on the perspective of patients.
In conclusion, our study highlights the need for culturally appropriate recruitment strategies, training of clinical and research staff on clinical trials, simplifying clinical trial procedures, and strengthening collaboration between researchers in the global north and global south to increase participation in cancer clinical trials in low-resource settings.
ACKNOWLEDGMENT
We acknowledge members of the ICON-3 Practice-based Research Network (PBRN) for participating in the study and staff of the IVAN Research Institute who coordinated the study implementation.
DISCLAIMER
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
SUPPORT
Supported by the National Cancer Institute of the National Institutes of Health under award number P50CA098252. The National Institute of Health also supported E.E.E., B.O.O., N.I.-A., T.C.O., and I.U.I. time on this grant under award number 1UO1CA275118.
AUTHOR CONTRIBUTIONS
Conception and design: Babayemi O. Olakunde, Ngozi Idemili-Aronu, Tara M. Friebel-Klingner, Anne F. Rositch, Richard B.S. Roden, Echezona E. Ezeanolue
Financial support: Richard Roden
Provision of study materials or patients: Adaeze Chike-Okoli
Collection and assembly of data: Ngozi Idemili-Aronu, Tara M. Friebel-Klingner, Ijeoma U. Itanyi, Kimberly Levinson, Echezona E. Ezeanolue
Data analysis and interpretation: Ngozi Idemili-Aronu, Adaeze Chike-Okoli, Ijeoma U. Itanyi, Tonia C. Onyeka, Kimberly Levinson, Anne F. Rositch, Tzyy-Choou Wu, Echezona E. Ezeanolue
Manuscript writing: All authors
Final approval of manuscript: All authors
Accountable for all aspects of the work: All authors
AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/go/authors/author-center.
Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).
Anne F. Rositch
Employment: Hologic
Stock and Other Ownership Interests: Hologic
Richard B.S. Roden
Employment: Quince Therapeutics (I)
Stock and Other Ownership Interests: Papivax LLC, Papivax Biotech Inc, Up Therapeutics LLC, Pathovax LLC
Consulting or Advisory Role: Quince Therapeutics
Patents, Royalties, Other Intellectual Property: Bravovax (royalties) Pathovax (royalties)
Echezona E. Ezeanolue
Stock and Other Ownership Interests: Lion Health
Consulting or Advisory Role: Novo Nordisk (Inst)
Speakers' Bureau: Seqirus Usa Inc
Open Payments Link: https://openpaymentsdata.cms.gov/physician/1091751
No other potential conflicts of interest were reported.
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