The Problem of Underrepresentation: Black Participants in Lifestyle Trials Among Patients with Prostate Cancer

J Racial Ethn Health Disparities. 2020 Oct;7(5):996-1002. doi: 10.1007/s40615-020-00724-8. Epub 2020 Feb 20.

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; Diet; Exercise; Prostatic neoplasms; Randomized controlled trial.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Black or African American / statistics & numerical data*
  • Humans
  • Life Style / ethnology*
  • Male
  • Middle Aged
  • Prostatic Neoplasms / ethnology*
  • Randomized Controlled Trials as Topic / statistics & numerical data*
  • SEER Program
  • United States / epidemiology