Background:
African-american patients have been under-represented in oncology clinical trials. better understanding barriers to african-american participation may help increase the accrual of african-american patients onto clinical trials.
Methods:
Two hundred eighteen patients with malignant disease (72 african-american patients and 146 white patients) were recruited from the duke cancer clinic and from duke oncology outreach clinics (doors). patients were interviewed using a standardized survey. questions included patients' knowledge of cancer, religious/spiritual beliefs, satisfaction with medical care, knowledge of clinical trials, reasons for participating or refusing to participate in a clinical trial, financial/transportation issues, and demographic factors, such as age and education. data on attitudes and belief were analyzed for group differences between african-american patients and white patients as well as between patients who were treated at the duke cancer clinic and patients who were treated at doors clinics.
Results:
Willingness to participate in a clinical trial depended on both race and clinic site. forty-five percent of white patients, compared with 31% of african-american patients, were willing to participate in a clinical trial (p = 0.05). white and african-american patients who were treated at the duke cancer clinic were more willing to participate in a trial compared with their counterparts who were treated at doors clinics (47% vs. 37%, respectively; p = 0.09). the greatest differences between groups (african-american patients vs. white patients and duke cancer clinic patients vs. doors patients) were education and income: much greater percentages of african-american patients and doors patients did not complete high school and had annual incomes < $15,000. in addition, more african-american patients than white patients believed that god would determine whether they would be cured or would die from their disease. in a multivariate analysis, education, income, and belief that god would determine the patient's outcome also were correlated with a decreased willingness to participate in clinical trials.
Conclusions:
Factors associated with religion, education, and income, rather than race, may be major barriers to clinical trial participation. interventions that target education and income may increase the recruitment of african-american oncology patients onto clinical trials.