This past June, when the NCI Clinical Trials Working Group focused on the ongoing need to increase recruitment of minority populations to cancer clinical trials, a key element of their proposed solution was to fund more Minority-Based Community Clinical Oncology Programs (MB-CCOPs), and for good reason. Over the last decade, more than 5,500 minorities have enrolled in both treatment and prevention clinical trials sponsored by NCI through the MB-CCOP network.
The MB-CCOPs were launched in 1990 as part of the efforts of the CCOPs to deliver the best cancer care to patients, wherever they live. At least 40 percent of the local populations served by MB-CCOPs are minorities and the programs have had a disproportionately positive effect: In 2003, for instance, the MB-CCOPs accounted for less than 20 percent of the CCOP network but enrolled half of the minority patients in the studies. (August 2 NCI Cancer Bulletin and August 2 Journal of Clinical Oncology.)
"Despite the recruitment challenges remaining, and any new barriers that may arise, the MB-CCOPs have shown that they can use their infrastructure to engage community health care providers and successfully recruit minorities into prevention trials," says Dr. Worta McCaskill-Stevens, the MB-CCOP program director in NCI's DCP.
Minority communities experience an unequal burden of cancer, and the professionals who work with them face challenges in recruiting for trials. In some African American communities, for example, earning the trust of patients and their families is essential.
"We address the issue of trust immediately, and we focus on educating people about the clinical trials that are available," says Dr. Lucile Adams-Campbell of the Howard University Cancer Center in Washington, D.C., who directs the District's MB-CCOP.
MB-CCOPs also benefit the communities they serve. In Puerto Rico, for example, the program targets cancer patients who cannot afford the drugs and treatments being evaluated. This was the case in trials that recently led to the new standard of care for HER-2 positive breast cancer. "This program offers patients hope and state-of-the-art therapies in their own communities from people who know their language and their culture," says the director, Dr. Luis Baez of the University of San Juan.
Dr. McCaskill-Stevens feels that MB-CCOPs also are in a unique position to address issues critical to minority populations and cancer, including mentoring investigators, sharing recruitment strategies with other institutions, identifying trends in cancer incidence in their local communities, and contributing to trial designs that account for competing minority health issues.
Dr. McCaskill-Stevens is optimistic about the increasing access that minorities will have to cancer trials, whether for prevention or treatment. "The future of minority participation in cancer trials rests with the burgeoning potential of this network," she says. "Their early successes will continue to bring quality health care delivery to diverse groups for years to come."
By Edward R. Winstead