Racial/ethnic disparities in pediatric oncology clinical trial enrollment at rady children's hospital San Diego (RCHSD)

Background: In the United States, more than 12,000 children ages 0-21 are diagnosed with cancer each year. Over the past few decades, survival rates in pediatric oncology have improved dramatically, as a result of the successful enrollment of approximately 70% of the cases in clinical trials. Purpose: To assess disparities in clinical trial participation for childhood cancer by age, sex, cancer type, and Hispanic ethnicity at RCHSD. Methods: Data including enrollment in any clinical trial at RCHSD for newly diagnosed patients in 2010 was collected. We sub-grouped and analyzed by race/ethnicity, age, sex, and cancer type (solid or liquid). Rates of enrollment among different sub-groups were obtained and compared. Results: There were 121 cases included in the analysis. When analyzing by race/ethnicity, only comparisons between Hispanics and Non-Hispanic whites (NHWs) were assessed. Our analysis revealed significant underrepresentation among Hispanics (59%) when compared to NHWs (93%) in treatment protocols (p=0.021) and among males (40%) when compared to females (58%) enrolled in any protocol (p=0.038). Additional underrepresentation occurred in enrollment in a biology protocol among Hispanics compared to NHWs (46.5% vs. 60.5%), although the results did not reach statistical significance. Conclusion: Participation in clinical trials at RCHSD is low overall. Significant underrepresentation in clinical trial participation was observed for Hispanics and males. Targeted interventions including the use of multidisciplinary healthcare teams, expanded services/resources, and an emphasis on cultural competency should be implemented to address these disparities and to ensure the ethical practice of pediatric oncology, including an equal clinical trial accrual.