The Problem of Underrepresentation: Black Participants in Lifestyle Trials Among Patients with Prostate Cancer
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The Problem of Underrepresentation: Black Participants in Lifestyle Trials Among Patients with Prostate Cancer Kyle B. Zuniga 1,2 & Hala Borno 3 & June M. Chan 4,5 & Erin L. Van Blarigan 4,5 & Terence W. Friedlander 3 & Sunny Wang 6 & Li Zhang 3,5 & Stacey A. Kenfield 4 Received: 9 November 2019 / Revised: 5 February 2020 / Accepted: 6 February 2020 # W. Montague Cobb-NMA Health Institute 2020
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. Keywords African Americans . Prostatic neoplasms . Exercise . Diet . Randomized controlled trial Hala Borno and Stacey A. Kenfield contributed equally as principal investigators.
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40615-020-00724-8) contains supplementary material, which is available to authorized users.
As with many cancers, the burden of prostate cancer is greater among Black patients compared to White patients [1]. Black patients are diagnosed with prostate cancer at a younger age, tend to have more aggressive disease, and have poorer survival outcomes [2–4]. Multiple biological and socioecological reasons for this disparity have been proposed. Some studies have suggested that genetic susceptibility and differences in androgen biology predispose Black patients to worse outcomes independent of socioeconomic variables [5, 6]. Still, psychosocial determinants of health such as socioeconomic status, education level, perceptions o
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