Examining racial bias in cancer research trials

The study uncovered bias and stereotyping when recruiting patients for clinical trials.

Doctor and woman reading digital tabletA new study published in CANCER — a peer-reviewed journal of the American Cancer Society — by researchers at the University of Alabama at Birmingham is raising questions about racial bias in cancer research trials.

In a set of 91 interviews with research and health care professionals at five different academic centers about the recruitment of participants to cancer research studies, some respondents expressed sentiments reflecting bias against African Americans and Latinos. Most of the bias expressed by interviewees was based on stereotypes of minority groups’ being less suitable for participation in cancer research studies.

“Our findings are novel because less work has been done in the area of bias and how it might influence recruitment to cancer research studies,” said first author Soumya J. Niranjan, Ph.D., assistant professor of Health Services Administration at UAB. “The roles of bias and racial discrimination in clinical care have been more well-studied, but this is a relatively novel area of focus in the study of minority recruitment for cancer research studies.”

Examples of the stereotypes included perceptions that African Americans were less knowledgeable about cancer research studies, less likely to participate out of  altruism or simply less likely to complete all facets of the research study. In addition, respondents reported that the language barriers reduced the likelihood of physicians’ inviting cancer patients with low English proficiency to join cancer research studies. 

Five prominent themes emerged from the interviews:

  • Respondents noted language barriers and other factors that made communication with minority potential clinical trial participants difficult. 
  • Several respondents stated that they did not perceive minority patients to be ideal study candidates after they were screened for cancer clinical trials.
  • Some respondents described clinicians’ time constraints and negative perceptions of minority study participants as challenges.
  • When respondents discussed clinical trials with minority patients, they often addressed common perceptions to build trust.
  • For some respondents, race was perceived as irrelevant when screening and recruiting potential minority participants for clinical trials.

Raegan Durant, M.D., senior author and associate professor in the UAB Division of Preventive Medicine, says these stereotypes and other examples of bias based on stereotypes of minority potential participants raise concerns that non-whites may be offered fewer opportunities to participate in cancer research studies.

“In addition to the examples of stereotypes, many interviewees also reported taking a race-neutral approach to recruitment for research studies,” Durant said. “Even when research and health care professionals use race-neutral stances during study recruitment, this approach may overlook some of the well-established methods of engaging and recruiting potential minority participants in a culturally tailored manner.”  

Niranjan and Durant agreed that much work has been done to identify distrust of research among minority groups as a potential barrier to their participation in cancer research studies. Yet, far less in known about how professionals’ bias may limit minorities’ opportunities for study participation.  

They also noted that this study does not indicate that all research and health care professionals are biased or that all minorities are being deprived of opportunities to participate in cancer research studies. However, the long-term significance of their findings rests in the notion that biases potentially exist in virtually all forms of human interaction, and recruitment for cancer research studies is no exception.

“Once we acknowledge the potential presence of this bias in this context, we can better identify it, measure it and begin to think about how best to address it,” Durant said. “As with most phenomena in science, we have to come to terms with its existence so that it can be studied in an empiric fashion.”