Building Trust and Removing Barriers in Clinical Trial Diversity

Despite clinical trials being the engine of oncologic progress, representation remains a significant hurdle in achieving equitable outcomes. For Kathie-Ann Joseph, MD, MPH, FACS, bridging this gap requires more than just opening new study sites; it demands a fundamental shift in how the oncology community approaches patient trust and trial logistics.

Joseph spoke with CancerNetwork® about the imperative of "cultural concordance" in the clinical workforce and the need to reframe trials as a pillar of standard care rather than an experimental burden. She also challenged trial designers to mitigate the geographic and socioeconomic barriers that frequently lead to patient attrition among underrepresented groups.

Jospeh is chief of Breast Surgery and co-director of the Breast Oncology Program, Rutgers Cancer Institute and Jack & Sheryl Morris Cancer Center; associate chief surgical officer for System Integration and Quality, RWJBarnabas Health; director of Breast Surgical Services, RWJBarnabas Health Southern Region; and professor of surgery, Rutgers Robert Wood Johnson Medical School.

Transcript:

We have clinical trial enrollment in general. I would love to see it improve overall. Nationwide, we need to see if every patient with breast cancer, if applicable, should be enrolled in a clinical trial. First, you need to develop trust with your patients. The trials should be available so that it’s not too much of a burden on the patient. [Patients] need to see people like me, doctors that look like me, and more staff that looks like them, that they can trust. For any doctor, any oncologist, it’s about building that trust so they understand that clinical trials should be part of the standard care. It’s not something that is an experiment, but it’s something that we’re doing to advance the treatment of cancer care, and if that can be explained in a way that the patients understand, but we need to address the barriers that patients experience when they enroll in a trial. If it involves a lot of testing, blood draws and so forth, and patients live far away, we have to start to think about ways that we can address it, so these trials don’t become a burden to the patient. If that means if patients can do things locally in their community, so if they live far away, we need to think about that too, so that patients don’t drop out of trials and so forth. We just have to be thoughtful about the way that we design trials and make it easier for them to not just sign up for a trial and want to sign up for a trial, but also to continue and complete a trial.