Scholarship program aims to encourage more diversity in clinical trials

A metro Detroit cancer specialist is applauding a foundation’s efforts to address the long-standing need for increasing the number of people of color who participate in clinical trials.

The Bristol Myers Squibb Foundation has offered a new round of scholarships and internships for medical students to help recruit people from underrepresented or disadvantaged communities to join the trials.

Wayne State University Professor of Oncology Hayley Thompson directs outreach and engagement for the Karmanos Cancer Institute.

She says patients sometimes respond much more positively when they talk with a doctor who shares their same background.

Listen: WSU oncology professor on importance of including people of color in clinical trials

The following interview has been edited for clarity and length.

Hayley Thompson: When we decrease that social distance between a health care provider and a patient, we know that communication is stronger. There’s more relationship building. Patients ask more questions. We see that definitely in data. So it would stand to reason that when a Black physician might approach a Black patient around participating in a clinical trial, which is basically research, they might be more open and willing to participate in that work because they’re being asked by someone who is similar to them in terms of group membership and culture and experiences. It may also be the case that those physicians may be communicating more effectively with those patients as well. However, I think that’s only one piece of the puzzle.

Quinn Klinefelter, WDET News: What would you say are some of the other parts? Does it seem that people of color are often more reluctant than others to join in these clinical trials?

HT: I think there are multiple reasons. You have to look at the patient level. And a lot of times it’s just a lack of knowledge about what a clinical trial is. I was recently talking with some of my community partners and colleagues about the fact that it has the word “trial” in it, right? Trials don’t necessarily have great connotations for many groups and for many people. And there’s not necessarily a lot of public awareness about the role that clinical trials and research play in disease prevention and innovative treatment or quality of life when you’re coping with disease or illness. I work in a cancer center, so cancer clinical trials are a huge part of what we do. But you have to be treated on site. So we have to really think about whether people of color have equal access to the settings where clinical trials are being offered. Any barriers to access to health care are similar to the barriers to accessing clinical trials. Think about transportation, child care, food insecurity, all the things that are going to come into play and potentially be barriers to participating in a clinical trial as well.

There’s a lot of research that shows oftentimes African Americans and other people of color are not even asked to join clinical trials. And that has to do, to some degree, with biases within our health care systems. Providers may be making assumptions that some people may not be interested in trials. Or it may be too difficult to explain what a trial is or persuade them to participate in it. So that’s a piece of it too. Because when people understand what clinical trials are about, when it’s explained well and they are asked in an appropriate way, people are interested. I think it’s a little bit of a myth to say that people just don’t trust trials. There are a lot of factors that influence people’s interest. Another factor that is also really key here, that is not talked about as often, are the eligibility criteria depending on who is sponsoring the trials. And sometimes people are not eligible because of co-morbidities or other chronic conditions or diseases they may have that might disqualify them. And sometimes those disqualifying conditions really would not necessarily affect the outcomes of the trial.

QK: I’ve talked with some people who will still bring up those infamous Tuskegee experiments, where they had 400 Black men with syphilis who were never treated or even told what the experiment was about. That still seems to resonate with some people. They really either have a fear or a suspicion about any kind of clinical trials. Have you found that is a factor as well?

HT: I think that certainly is something that is part of a collective memory and influences the decision of some around trials. And it’s important that we remember that. But I think people also look to current day racism in health care and their own experiences or those of their friends and family members. Negative experiences in health care settings or negative experiences with research today have just as much of an influence as Tuskegee. And that’s something we can do something about right now in 2024. How do we make clinical trials more easily understood by the general population? How do we make it easier for them to participate? And how do we help people understand the protections that are in place? Those are things that we can tackle today that don’t have anything to do with Tuskegee.

QK: On the other side of it, when you look at what is currently happening with clinical trials, it sounds like most of the participants are white. How much does that throw off the results or affect whatever comes from these trials and what they could do for the total population?

HT: It’s a huge issue. If we don’t have diversity in our clinical trials then we don’t have a complete picture about the impact of the interventions that we’re testing. Trials are supportive care. And whether it be due to ancestry or genetic factors or because of cultural reasons, different groups of people are different. And we need to have that representation in our trials to really understand how certain strategies work across different groups of people. There really is a significant limitation when we don’t have that diversity in our samples for our trials.

There’s ongoing work here in Detroit at Karmanos and across the country addressing this issue. I oversee the Karmanos Office of Cancer Health Equity and Community Engagement. With our community partners and just regular people who want to participate in our work around cancer prevention and control, we’ve created a video about clinical trials. It has diverse physicians and scientists talking about the trials. It has cancer survivors who talk about their experiences on cancer clinical trials. And we’ve seen increases in people’s knowledge about trials and a shift in their attitudes where people are much more interested in participating in clinical trials. We see increases also in their belief that people of color should be a part of clinical trials. And that’s just from our community information video. That’s a strategy that we want to disseminate throughout our hospital and even to other parts of the country. I have a colleague at Wake Forest University where they have a whole program targeting health care providers. It’s called “Just Ask.” It tries to break down the barriers for health care providers, making sure that they consistently offer clinical trials to all their patients, regardless of race, ethnicity or other demographics.