Access to Cancer Treatment Clinical Trials for Racialized Adults and Older Adults: An Equity-Focused Rapid Scoping Review

Le résumé fourni par la source

PURPOSE The intersection of race and older age exacerbates health disparities within marginalized communities. However, mitigating these disparities starts from ensuring enrollment of these racialized older adults into clinical trials. Therefore, this scoping review identified barriers, facilitators, and solutions to enhancing access to clinical trials among racialized adults with cancer. METHODS This scoping review was conducted based on the Arksey and O'Malley framework and the work of Levac et al. The databases searched included Medline ALL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, CINAHL, Scopus, and Global Index Medicus. Articles from inception to December 12, 2023, were collected. Abstract and full-text screening was conducted by pairs of reviewers. Data abstraction was performed by one reviewer, with verification by a second reviewer. Included articles involved adults 18 years and older who identified as racialized persons with cancer or clinicians caring for racialized adults with cancer. RESULTS Ultimately, 80 papers reporting on 76 studies were included. The most common barrier reported by patients was limited awareness of trials, whereas clinicians reported insufficient awareness of available clinical trials as the most common barrier. Establishing trusting relationships with clinicians was the most common patient-described facilitator. Similarly, clinicians reported pre-existing trusting relationships with patients as the most common facilitator. Intervention studies used educational materials offered in non-English languages and trial materials featuring racialized patients. While these interventions improved patients' willingness to participate, most did not report statistical inference results. CONCLUSION Although many barriers exist to racialized older adults' access to cancer clinical trials, future intervention studies should prioritize assessing their enrollment rates to improve the health equity of racialized older adults through a more representative evidence base.

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