The Problem of Underrepresentation: Black Participants in Lifestyle Trials Among Patients with Prostate Cancer.

Kyle B Zuniga, Hala Borno, June M Chan, Erin L Van Blarigan, Terence W Friedlander, Sunny Wang, Li Zhang, Stacey A Kenfield

Journal: Journal of racial and ethnic health disparities 2021;7(5):996-1002

PMID: 32078741

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Abstract

INTRODUCTION

Healthy lifestyle behaviors are an essential component of prostate cancer survivorship; however, it is unknown whether Black participants are adequately represented in randomized controlled trials (RCTs) on lifestyle interventions. The goal of this study was to identify types of lifestyle RCTs that may require improved recruitment resources to enhance generalizability of lifestyle recommendations to Black patients.

MATERIALS AND METHODS

ClinicalTrials.gov was used to identify lifestyle RCTs among patients with prostate cancer. Using racial distribution data from the Surveillance, Epidemiology, and End Results (SEER) program as a reference, one-sample proportion tests were performed to assess adequate recruitment of Black participants.

RESULTS

Of 31 lifestyle trials, one trial reported race-specific results. Proportion of Black participants was acquired from 26 trials. Compared to the US population, Black participants were overrepresented in the overall study population (17% versus 15%, p = 0.019). Black participants were underrepresented in trials exploring exercise interventions (9% versus 15%, p = 0.041), trials among patients with advanced disease (9% versus 16%, p < 0.001), and in university-funded trials (12% versus 15%, p = 0.026).

CONCLUSIONS

The reporting of race data, and race-specific results when feasible, is essential for clinicians to accurately generalize findings from lifestyle trials. Additional resources may be necessary to aid in strategic recruitment of Black participants for trials on exercise interventions, trials among patients with advanced disease, and in university-funded trials.

Address: UCSF Osher Center for Integrative Medicine, University of California, San Francisco, UCSF Box 1726, 1545 Divisadero Street, Suite 301, San Francisco, CA, 94143, USA. [email protected].; College of Physicians and Surgeons, Columbia University Medical Center, 630 W 168th Street, New York, NY, 10032, USA. [email protected].; Division of Hematology and Medical Oncology, University of California, San Francisco, San Francisco, CA, USA.; Department of Urology, University of California, San Francisco, San Francisco, CA, USA.; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.; Division of Hematology-Oncology, San Francisco VA Health Care System, San Francisco, CA, USA.; Division of Hematology and Medical Oncology, University of California, San Francisco, San Francisco, CA, USA.; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.; Department of Urology, University of California, San Francisco, San Francisco, CA, USA.

DOI: 10.1007/s40615-020-00724-8

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https://medlineplus.gov/prostatecancer.html

MeSH Terms: Black or African American, Humans, Life Style, Male, Middle Aged, Prostatic Neoplasms, Randomized Controlled Trials as Topic, SEER Program, United States