According to Faith Mutale, DNP, CRNP, a key component of health equity involves ensuring that clinical trials reflect subgroups of patients that are more reflective of the real-world population. Mutale’s presentation “Minorities in Cancer Clinical Trials: 30 Years After the NIH Revitalization Act: Where Are We?” given on 40th Annual CFS® highlights the importance of representation in trials and building trust in the community.
Mutale said clinical trials are not an accurate representation of the general population because minorities are too few to be included. They cited prostate cancer statistics, saying that the demographics of patients in clinical trials between 2006 and 2020 were 2.9% African American, 7.9% Asian, and 76% Caucasian, despite the fact that African Americans make up 13.4% of the population. % share and their proportion is high. , 1:6, to the development of prostate cancer. Additionally, in this time frame, 1 in 5 agents had differences in risk/response based on race.
“The issue of under-representation of minorities in cancer clinical trials is not insurmountable,” Mutale said. “But the fact has to be acknowledged that these issues cannot be solely tackled by policy makers, legislators, or even other stakeholders such as advocacy groups. For this advanced practice providers should step up and become part of the stakeholders.
in an interview with Oncology Nursing News®, a nurse practitioner in Head and Neck and Thoracic Oncology at Abramson Cancer Center in Mutale, Pennsylvania, outlines the steps nurses can take to work toward achieving health equity.
What does health equity mean and what might it look like?
When I think about health equity, I think that one size does not fit all, meaning that different populations have different needs and there are different strategies to meet the needs of different populations. resources should be allocated accordingly. I like how Wikipedia defines health equality as: [It is] Absence of inequality in health and health care among the population. He summarizes it.
It’s not going to be the same for all populations and what this will look like for our minority of patients may require more resources to be allocated to them. For example, to be able to access sites that are offering tests, resources such as transportation [are needed], Also, to pay for some out-of-pocket costs that are not fully covered by insurance companies [they need assistance],
What is the role of the oncology nurse in achieving health care equity and helping to address these institutional problems?
One of the biggest things nurses can do is be able to identify system issues that perpetuate disparities among minority patients in clinical trials. We’re providing care on a daily basis, we’re talking to patients, and we spend a lot of time [with them] Probably on average more than any other health care provider.
[We need to be] able to identify those issues and then educate patients [about them], I feel there is a need to spread the knowledge of clinical trials to all populations [it is important] that they understand. Some patients, when they come to the clinic, may not have been informed of the clinical trial, so they may not know [what to expect], It is our responsibility as patient advocates to help in this regard by raising awareness of clinical trials as a viable treatment option.
A good proportion of our minority patients have misconceptions about clinical trials, so educating our patients but coming up with culturally relevant strategies for improvement is essential.
One of the things I wanted to point out is that there is a lack of knowledge among NPs in general – how much do we know about disparities in cancer care? Do we see who are the patients who are coming in or the patients who are in clinical trials? What are we doing about that? There is a need to improve or increase knowledge among nurses in the context of disparities in cancer care.
[We need] To take a step towards rectifying this because again we are advocates; We need to be intentional about some of the issues in cancer care so that health equity really does happen for all populations, not just some patients.
Mutale F. Minorities in Cancer Clinical Trials: 30 Years After the NIH Revitalization Act: Where Are We? Presented here: 40th Annual CFS® Conference; November 9-11, 2022; New York, NY.