Abstract A089: Addressing both community and institutional barriers increases accrual of minority patients in breast cancer clinical trials
Authors: Trant Amelia A. , Walz Lucas , Allen Whitney , Verma Hannah , Le Mindy , DeJesus Jose , Hatzis Christos , Silber Andrea 
Published: August 2020

Abstract
Background: Clinical trials (CT) allow new treatments to become standard practice. Diversity in CT benefits both participating and future patients, but traditionally underserved ethnic/racial minorities participate in CT at lower rates than Whites. Previous studies have claimed that personal and community barriers prevent participation, but the intersection of community and institutional factors has been understudied. For the past two years, the Oncology Welcomes New Haven into Trials (OWN IT) initiative at the Yale Cancer Center has taken a multitiered approach to breast cancer minority CT accrual.
Methods: Focus groups at community centers were held to better understand community perspectives on CT. Ongoing outreach was performed by physicians and community health workers at local events. Institutional barriers were addressed through executive council representation, grand rounds presentations, and didactic lectures with health care providers at multiple federally qualified health centers. Studies with eligibility criteria favorable to minority patients were opened. An anonymous, 5-minute survey was conducted at regular visits with Smilow Breast Center patients to gauge awareness of and access to CT. The survey was performed on iPads with the Qualtrics application in English or Spanish. Survey data were compared to the Yale Cancer Center Clinical Trials Office, Connecticut Tumor Registry, and U.S. Census records. Two-tailed Fisher's exact tests were used for all analysis.
Results: In Sept. 2015, only 11% of 98 CT participants were minorities even though minorities accounted for 17% of breast cancer incidence in New Haven County and 16% in Connecticut. By Sept. 2017, 22% of 89 were minorities, p=0.049. Survey results confirmed a reduction in the disparity: 162 patients were asked to take the survey—12 declined, and 150 completed it. The ethnic/racial breakdown of the participants was as follows: 69% White, 10% Black, 9% Hispanic/ Latino, 3% Asian, and 9% unknown; this is in line with both the Connecticut Tumor Registry data and expected incidence based on the 2010 U.S. census. The percentage of patients invited to participate in CT and the percentage of offers declined were as follows: invited 41%, declined 19% (White); 60%, 33% (Black); 29%, 0% (Hispanic/ Latino); 25%, 0% (Asian); and 36%, 0% (unknown). There were no significant differences in invitation or decline rates between White and minority patients or between individual racial/ethnic groups. Black and Hispanic/Latino patients were significantly less likely than White patients to be aware of CT prior to the survey with only 58% confirming prior knowledge compared to 95% of white patients, p &lt;.01.
Conclusions: Efforts to increase minority participation in CT through institutional and community engagement were successful. Patient education regarding CT should be increased for minority patients. This approach will be used with other disease types at the Yale Cancer Center.
Citation Format: Amelia A. Trant, Lucas Walz, Whitney Allen, Hannah Verma, Mindy Le, Jose DeJesus, Christos Hatzis, Andrea Silber. Addressing both community and institutional barriers increases accrual of minority patients in breast cancer clinical trials [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A089.