Diversity in Clinical Trials | City of Hope

Why Diversity in Clinical Trials Is Essential to Science, Health Outcomes

"Despite remarkable advances in cancer treatments and cures, many patients lack access to specialty care, which is even more pronounced among vulnerable and disadvantaged communities,” said Angela L. Talton, senior vice president and chief diversity, equity and inclusion officer at City of Hope.
However, City of Hope scientists aim to change that. “Our clinical and research scientists are conducting research studies on health disparities within diverse communities and helping us find the best ways to address complex health issues, including diversity in clinical trials,” she continued.

Diversity Is Essential in Clinical Studies

People of different races, ethnicities, ages and sexual orientations have varying physical, genetic and environmental factors and vulnerabilities that come into play with diseases. A medication, for example, may affect patients of different races or even ages differently. If this is not researched and tested during clinical trials, crucial information may be missed.
Rick Kittles
Rick Kittles, Ph.D.
Scientists such as Edward S. Kim, M.D., M.B.A., Rick Kittles, Ph.D., Leanne Burnham, Ph.D., Mustafa Raoof, M.D., M.S., William Dale, M.D., Ph.D., Shiuan Chen, Ph.D., Susan Neuhausen, Ph.D., and Kimlin Tam Ashing, Ph.D., are leading groundbreaking research and clinical trials among diverse populations. Currently, only 3-5% of adults in the United States participate in clinical trials. Of that group, 75% are white and 56% are women.
““If you focus on just one population, you’re going to miss a lot of data,” said Kittles, professor and director of the Division of Health Equities in the Department of Population Sciences.
City of Hope Edward Kim
Edward S. Kim, M.D., M.B.A.
Kim, physician-in-chief of City of Hope Orange County and vice physician-in-chief of City of Hope National Medical Center, has advocated for years for expansion of clinical trial inclusivity. His work has reduced barriers to clinical trials. “For too long, cancer studies have followed rigid eligibility requirements that overlooked real-world cancer patients' diversity,” he said. “Now, by ensuring trial participants look more like those we treat, we can reverse this age-old and dangerous blind spot. Most importantly, our clinical findings will be more applicable to our patient populations, implemented sooner and reach more people.”
Ashing, professor in the Division of Health Equities, said she is optimistic that City of Hope is taking a significant lead in making clinical trials more inclusive.
“City of Hope has recruited scientists with a specific interest in clinical trial diversity in their own research and secured funding for health equity research, and we are better able to harness the wealth of expertise we have here,” she said. “We have a growing staff of scientists who are culturally sensitive and have cultural humility, and who are prioritizing reaching diverse and medically underserved communities.”
CV Bio Profile picture Ashing Giwa Kimlin
Kimlin Tam Ashing, Ph.D.
City of Hope’s health equities program directs funds provided by the Beckman Endowment for pilot projects that address health disparities research. These projects include investigations and interventions that address health conditions disproportionately affecting certain ethnic groups or medically underserved populations. The goal for these funded projects is to increase the number of clinical trials that target these diverse populations to address their disease and inform the science.

Multiracial Prostate Cancer Study

For example, Burnham, a postdoctoral fellow in the Division of Health Equities, has dedicated her career to addressing inequities in prostate cancer among Black men. African American men are the most likely to be
Leanne Burnham - Health Equities
 Leanne Burnham, Ph.D.
diagnosed with advanced and incurable prostate cancer, and they have a 111% higher risk of dying from it than other ethnic groups.
“We are strategically recruiting African American men to studies to advance precision medicine by exploring potential racial/ethnic differences in drug efficacy and outcomes due to genomic variation,” she said.

Colorectal Cancer Deadlier

Colorectal cancer is also more prevalent among Black people, a group that has the highest rate of morbidity,
Mustafa Raoof
 Mustafa Raoof, M.D., M.S.
but it is curable if caught early. Raoof, an assistant professor in the Division of Surgical Oncology of the Department of Surgery, is the senior author of a study published in JAMA Network Open about the increased incidence of colorectal cancer in the Black population.
Looking at the data of 16,382 adult patients in the California Cancer Registry, Raoof found that Black patients were the least likely to receive chemotherapy (59% compared to 65% among white people) and had a 17% higher chance of death compared to white patients, even when the scientists controlled for age, sex and comorbidities.
“These troubling statistics are the result of a disparity in access to health care,” Raoof said.

More Asian Participation

Chen, the Lester M. and Irene C. Finkelstein Chair in Biology, has a $3.3 million grant from the National Cancer Institute that supports a Phase 2 clinical trial studying the effects of white button mushrooms on prostate
Shiuan Chen, Ph.D.
cancer. In his research, he has found that mushroom chemicals reduce the activity of an enzyme called steroid 5-alpha reductase that produces dihydrotesterone, or DHT, which drives prostate cancer development.
Chen and his research team are actively recruiting in the Asian community for participation in the trial. Mayra Serrano, Dr.P.H., M.P.H., senior manager of the Center of Community Alliance for Research & Education, known as CCARE, is helping Chen in trial enrollment from the Hispanic community, with Kittles reaching out to the Black community for participation.

Breast Cancer in Latinas

Neuhausen, The Morris & Horowitz Families Professor in Cancer Etiology & Outcomes Research, is using her $3 million grant from the California Initiative to Advance Precision Medicine to continue funding her research involving the genomics of breast cancer in Latinas.
Susan Neuhausen
Susan Neuhausen, Ph.D.
“Using a combined germline/somatic genomics approach, our goal is to identify additional breast cancer predisposition genes — genes that show moderate to high increased risk of developing breast cancer”  in Latinas, Neuhausen explained.
Neuhausen said Latinas are a woefully underrepresented group in genomic studies and clinical trials related to breast cancer. “In public databases where researchers can study breast cancer, Latinas account for only 36 out of about 1,100 tumors cataloged,” she said. “That means only 3% are Latina. African Americans and Asians are also underrepresented, but we and other researchers are changing that by studying large numbers of breast cancers in these other populations.”

Addressing Inequities Among LGBTQIA+ 

Serrano also leading a cancer needs assessment among the LGBTQIA+ community, and has expanded outreach to sexual and gender minorities to be inclusive of all races and ethnicities, in the
April - Minority Month - Serrano
Mayra Serrano, Dr. Ph.H., M.P.H.
hopes she and her team can identify inequities in access to treatment and capture data that could increase clinical trial participation.
“City of Hope is leading the conversation about the needs of these diverse populations and reinforcing that — regardless of gender, sexual orientation, race or ethnicity — everyone should receive equal and appropriate health treatment, disease prevention education and the opportunity to participate in a clinical trial,” she said.

A Seat at the Table for Older Adults

City of Hope is a leader in offering older patients appropriate and personalized cancer care. A study led by Dale, the Arthur M. Coppola Family Chair in Supportive Care Medicine, and Mina Sedrak, M.D., M.S., revealed little effort has been made to improve older adult representation in clinical trials of new cancer drugs, even when the treatment is aimed at a disease that disproportionately affects this age group.
William Dale, M.D. Ph.D.
William Dale, M.D., Ph.D.
“Two in 5 Americans with cancer are age 70 or older, yet fewer than 25% of those patients are in cancer clinical trials,” said Sedrak, asistant profsesor and deputy director of clinical trials in the Center for Cancer and Aging and lead author of the study.  
“We don’t know enough about treating our largest group of cancer patients,” Dale said. “Actively including older adults in clinical trials is incredibly important.” 

A Call to Action

Kittles was on the steering committee for a groundbreaking report published by the American Association for Cancer Research that speaks to the gap in cancer treatment and outcomes based on race, age, ethnicity, socioeconomic status, sexual orientation and more. There has been some progress toward closing this health gap, he said, “but not enough yet.”
“It’s not easy to change the health outcomes of these communities,” Kittles said. “But I do know that as we attack those barriers and remove them, more and more individuals in those communities will see great improvement.”