When it comes to prostate cancer, Black men are more likely to get the disease, and they’re more likely to have it come back or spread to other parts of the body. They’re two to three times more likely than White men to die of prostate cancer.
Despite these statistics, the number of Black men enrolled in clinical trials for prostate cancer is far below what’s reflected in the actual U.S. population.
Black men represent 13.4% of the population but only 6.7% of participants in prostate cancer clinical trials. What’s more, the larger a clinical trial, the lower the percentage of Black men represented. This lower percentage has been a trend for the last two-plus decades, declining 5% per year.
Without adequate numbers of Black men in clinical trials, research won’t reflect accurate information on how new therapies work for the Black community, and outcomes for the Black community will continue to be worse than those of the White community.
Reasons for Disparities
For every 100,000 Black men in the U.S., 173 have prostate cancer and 38 die from it. For every 100,000 white men, 97 have prostate cancer and 18 die from it.
Researchers don’t know the exact reasons for this greater burden on Black men, but it may be multiple factors including:
- The Black community experiences health conditions such as heart disease, obesity, diabetes, and infections in greater numbers than White populations. These conditions impact how well prostate cancer treatments work or whether they’re options at all.
- Historically, discrimination and racism in the U.S. prevented people in the Black community from being able to achieve the same access to quality health care, jobs, education, and money, all of which impact overall health.
- Structural racism can impact the quality of care Black people receive, regardless of socioeconomic status.
- A history of harm by the health care system led to medical mistrust in the Black community. This impacts how often some Black people see doctors and how willing some are to follow treatment plans.
Some of these same reasons impact the Black community’s participation in clinical trials:
- Clinical trials often happen at major academic centers, so access to them is often limited to the people who either live close by or have the means to travel.
- Costs of clinical trials are typically covered by the sponsor of the study and health insurance. Lack of health insurance can prevent participation.
- Sponsors of the trial may not reach out to as many Black communities when recruiting for enrollees.
- Medical mistrust in the Black community keeps some Black men with prostate cancer from seeking out, or being willing to participate in, clinical trials.
Looking Forward
Researchers in the health care community are trying to find solutions to help correct the imbalance and disparity in clinical trial representation – not only for prostate cancer, but for other cancers and conditions as well.
Some of the avenues they’re exploring include:
- Increase diversity among doctors and nurses. When your doctor comes from a cultural background similar to yours, it can help you feel more at ease. This can build trust and create an avenue for better communication between you and your doctor.
- Provide better clinical trial education to Black communities. It helps to strengthen communication between primary care doctors and community health centers. This way, they can work together to get information about care options – including clinical trials – to the populations they serve.
- Lower cost barriers. Find solutions, such as providing transportation, free childcare, lost salary compensation, and a clear understanding of what costs are included. This may help increase clinical trial participation of those in lower socioeconomic populations.
- Educate doctors about health disparities. When cancer doctors are aware of representation issues in clinical trials, they can be part of the solution by talking with their Black patients about clinical trial options.
- Improve cancer care in underserved populations. With better cancer care come better health outcomes. Organizations like the American Society of Clinical Oncologists are working to increase the number of doctors in underserved areas.
Clinical Trials for Black Men With Advanced Prostate Cancer
Recently, researchers have been studying the effectiveness of a specific drug combination in men with advanced prostate cancer. Results show that the therapy, which includes the drugs apalutamide and abiraterone plus prednisone, works better in Black men than White men.
Two years after the start of the study, only 14% of Black study participants had died, compared to 33% of the White participants. Without enough Black participants, this important finding may not have happened. By increasing diversity in enrollment, it’s possible that future clinical trials could uncover important and even life-saving treatment breakthroughs for the Black community.
Show Sources
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SOURCES:
UroToday: “The Underrepresentation of Black and Hispanic Men in Clinical Trials Compared With Their Share of Prostate Cancer Incidence.”
JCO Clinical Oncology: “Tackling Diversity in Prostate Cancer Clinical Trials: A Report From the Diversity Working Group of the IRONMAN Registry.”
JAMA Oncology: “Declining Representation and Reporting of Racial and Ethnic Minority Patients in Prostate Cancer Clinical Trials Despite Persistent Health Disparities—Where Progress Confronts Limitations.”
Cancer.net: “Cancer Does Not Affect All People Equally: An Expert Q&A on Cancer Disparities and Health Equity.”
ASCO Daily News: “Disparities Persist in Black and Hispanic Enrollment in Industry-Funded Prostate Cancer Clinical Trials.”
Oncologist: “Perceptions of Cancer Care and Clinical Trials in the Black Community: Implications for Care Coordination Between Oncology and Primary Care Teams.”
Journal of Clinical Oncology: “Addressing Financial Barriers to Patient Participation in Clinical Trials: ASCO Policy Statement.”
Duke Health: “Black Men with Metastatic Prostate Cancer May Benefit From Drug Combination.”
