Skip to main content

Bias in cancer trials

For many years I served on NHS research ethics committees.  One aspect of clinical trials that always concerned us was how representative any trial was of the population.  This matters a great deal, as biased samples may give erroneous results or miss results that are of crucial importance  

Now, new research has revealed bias and stereotyping among clinical and research professionals who recruit patients to enrol in cancer clinical trials. The findings are published online in CANCER, a peer-reviewed journal of the American Cancer Society (ACS).



It is important to include diverse patients in clinical trials to ensure that the results will apply to patients in the general population.

One form of bias is in the selection of those on the trail.  The proportion of racial and ethnic minorities participating in cancer clinical trials is persistently lower than the proportion of minorities in the U.S. population at large.  This has the potential for giving a false perspective.

So, does bias by healthcare and research professionals help explain why racial and ethnic minorities are not adequately represented in clinical trials? 

A team led by Dr Raegan W. Durant, of the University of Alabama at Birmingham, conducted interviews of cancer centre leaders, principal investigators of clinical trials, referring clinicians, and research staff at five U.S. cancer centres. A total of 91 individuals were interviewed.

Five prominent themes emerged from the interviews:

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

Dr Soumya Niranjan, the first author of the report states that,

“Examples of the stereotypes we observed included perceptions that African Americans were less knowledgeable about cancer research studies, less likely to participate due to altruism, or simply less likely to complete all facets of the research study,”  

These and other examples of bias based on stereotypes of potential minority participants raise concerns that non-whites may be offered fewer opportunities to participate in cancer research studies.

Dr Niranjan also noted that even when research and healthcare professionals use race-neutral stances during clinical trial recruitment, this approach may overlook some of the well-established methods of engaging and recruiting potential minority participants in a culturally tailored manner. 

The authors make clear that not all healthcare professionals and research is biased. Still, the findings do indicate that more care needs to be taken in ensuring clinical trials are sufficiently representative of the population, or whether a particular section of the community needs to be targeted. 

Only by acknowledging the bias can it bet better identified in trials. 

 

Comments

Popular posts from this blog

Prioritising people in nursing care.

There has been in recent years concern that care in the NHS has not been sufficiently 'patient centred', or responsive to the needs of the patient on a case basis. It has been felt in care that it as been the patient who has had to adapt to the regime of care, rather than the other way around. Putting patients at the centre of care means being responsive to their needs and supporting them through the process of health care delivery.  Patients should not become identikit sausages in a production line. The nurses body, the Nursing and Midwifery Council has responded to this challenge with a revised code of practice reflection get changes in health and social care since the previous code was published in 2008. The Code describes the professional standards of practice and behaviour for nurses and midwives. Four themes describe what nurses and midwives are expected to do: prioritise people practise effectively preserve safety, and promote professionalism and trust. The

Half measures on heat pumps

Through the "Heat and Buildings Strategy", the UK government has set out its plan to incentivise people to install low-carbon heating systems in what it calls a simple, fair, and cheap way as they come to replace their old boilers over the coming decade.  New grants of £5,000 will be available from April next year to encourage homeowners to install more efficient, low carbon heating systems – like heat pumps that do not emit carbon when used – through a new £450 million 3-year Boiler Upgrade Scheme. However, it has been widely criticised as inadequate and a strategy without a strategy.  Essentially, it will benefit those who can afford more readily to replace their boiler.   Undoubtedly, the grants will be welcome to those who plan to replace their boilers in the next three years, and it might encourage others to do so, but for too many households, it leaves them between a rock and a hard place.  There are no plans to phase out gas boilers in existing homes.  Yet, that is wha

No real commitment on climate

Actions, they say, speak louder than words.  So, when we look at the UK government's actions, we can only conclude they don't mean what they say about the environment and climate change.  Despite their claims to be leading the charge on reducing emissions, the UK government is still looking to approve new oil fields.  The Prime Minister, Boris Johnson,  has announced his support for developing the Cambo oil field and 16 other climate-destroying oil projects. Cambo is an oil field in the North Sea, west of Shetland. A company called Siccar Point has applied for a permit to drill at least 170 million barrels of oil there. If it's allowed to go ahead, it will result in the emissions equivalent of 18 coal plants running for a year.  What? Yes, 18 coal plants a year!  Today, as I write, Greenpeace is demonstrating in Downing Street against this project.  I suppose it will get the usual government dismissal and complaints about inconveniencing others.  Well, we know it won't