Abstract A090: Overcoming racial and ethnic disparities in cancer clinical trial accrual during the COVID-19 pandemic: A partnership between a cancer center’s clinical trials office and community outreach and engagement
Authors: Nodora Jesse 
Published: January 2023

Abstract
Background: Despite passage of the NIH Revitalization Act in 1993, enrollment in clinical trials remains low for Black and Hispanic adults. The novel coronavirus 2019 (COVID-19) pandemic resulted in substantial disruptions to patient care, including challenges for clinical trial accrual. The extent to which the pandemic has disrupted clinical trial enrollment continues to be investigated; data on enrollment disruptions for different racial and ethnic groups are scarce. Objective: We compared racial and ethnic patient accrual to intervention cancer clinical trials before, and during the COVID-19 pandemic. Methods: We assessed monthly and annual enrollment to all intervention and treatment-intervention-only clinical trials coordinated by the Moores Cancer Center Clinical Trials Office (MCC CTO) from January 1, 2019 to December 31, 2021. We considered monthly enrollment from January 1, 2019 to March 31, 2020 to include the period before the onset of the COVID-19 pandemic and from April 1, 2020 to December 31, 2021 for the pandemic phase. We assessed the annual percentage of individuals enrolled in trials (i.e., 2019, 2020, and 2021) according to race (White, African American/Black, and Asian) and ethnicity (Hispanic, non-Hispanic). Results: Enrollment to all intervention clinical trials dropped from 512 patients in 2019 (pre-pandemic period) to 455 in 2020 and 447 in 2021, during the pandemic. Monthly accrual data show a drop in treatment intervention trials with the onset of the pandemic, from 36 in March 2020 to 25 in April 2020. This drop was followed by a quick rebound in May (n=42) and June (n=40), similar to the 2019 pre-pandemic figures (n=44 for May and 39 for June). Accrual dropped sharply with the second wave of the pandemic, from 34 in November 2020 to 17 in January 2021 but rebounded to 43 in May 2021. Annual enrollment by race shows that the percent of non-White cancer patients increased each year after the onset of the pandemic, from 23.5% in 2019 to 26.2% in 2020, and 31.3% in 2021 (p=0.06 comparing White to non-White patients for 2019 versus 2020 and 2021 combined). Similarly, the proportion of Hispanic patients on treatment trials increased from 21% in 2019, to 24% in 2020, and 27% in 2021 (p=0.34 comparing 2019 to 2020 and 2021 combined). Conclusion: Our results, from a single NCI designated comprehensive cancer center, show that although a drop-in accrual to interventional trials occurred from 2019 to 2020 and extended into 2021, accrual for non-White and Hispanic patients increased over this time period. We hypothesize that this was due to existing strategies that were in place as part of a MCC CTO-Community Outreach and Engagement partnership that provided institutional-, provider-, and patient-level support for accrual of under-represented patients. Furthermore, COVID-adaptive contingency measures to overcome challenges due to the pandemic were also implemented including pre-infusion COVID19 testing, remote interpreter services, and per protocol flexibility in minimizing in-person study visits.
Citation Format: Jesse Nodora. Overcoming racial and ethnic disparities in cancer clinical trial accrual during the COVID-19 pandemic: A partnership between a cancer center’s clinical trials office and community outreach and engagement [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A090.