The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review
Extant literature reveals how patients of marginalized social identities, socioeconomic status (SES), and medical experiences – especially patients of color and older adults – are underrepresented in cancer clinical trials (CCTs). Emerging evidence increasingly indicates CCT underrepresentation amon...
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Cambridge University Press
2025-01-01
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| Series: | Journal of Clinical and Translational Science |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2059866124006770/type/journal_article |
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| author | Grace Ann Hanvey Hannah Johnson Gabriel Cartagena Duane E. Dede Janice L. Krieger Kathryn M. Ross Deidre B. Pereira |
| author_facet | Grace Ann Hanvey Hannah Johnson Gabriel Cartagena Duane E. Dede Janice L. Krieger Kathryn M. Ross Deidre B. Pereira |
| author_sort | Grace Ann Hanvey |
| collection | DOAJ |
| description | Extant literature reveals how patients of marginalized social identities, socioeconomic status (SES), and medical experiences – especially patients of color and older adults – are underrepresented in cancer clinical trials (CCTs). Emerging evidence increasingly indicates CCT underrepresentation among patients of lower SES or rural origin, sexual and gender minorities, and patients with comorbid disability. This review applies an intersectional perspective to characterizing CCT representativeness across race and ethnicity, age, sexual and gender identity, SES, and disability. Four databases were systematically queried for articles addressing CCT participation inequities across these marginalizing indicators, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. One hundred one articles were included in a qualitative evaluation of CCT representativeness within each target population in the context of their intersectional impacts on participation. Findings corroborate strong evidence of CCT underrepresentation among patients of color, older age, lower SES, rural origin, and comorbid disabling conditions while highlighting systemic limitations in data available to characterize representativeness. Results emphasize how observed inequities interactively manifest through the compounding effects of minoritized social identity, inequitable economic conditions, and marginalizing medical experiences. Recommendations are discussed to more accurately quantify CCT participation inequities across underserved cancer populations and understand their underpinning mechanisms. |
| format | Article |
| id | doaj-art-953252870e814ff7b7ca7e920faa53ac |
| institution | Kabale University |
| issn | 2059-8661 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Journal of Clinical and Translational Science |
| spelling | doaj-art-953252870e814ff7b7ca7e920faa53ac2025-02-03T08:19:47ZengCambridge University PressJournal of Clinical and Translational Science2059-86612025-01-01910.1017/cts.2024.677The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic reviewGrace Ann Hanvey0https://orcid.org/0009-0008-1304-5626Hannah Johnson1Gabriel Cartagena2Duane E. Dede3Janice L. Krieger4https://orcid.org/0000-0001-9950-9170Kathryn M. Ross5Deidre B. Pereira6University of Florida, Department of Clinical and Health Psychology, Gainesville, FL, USAUniversity of Florida, Department of Clinical and Health Psychology, Gainesville, FL, USAYale University, Department of Psychiatry, New Haven, CT, USAUniversity of Florida, Department of Clinical and Health Psychology, Gainesville, FL, USAMayo Clinic Comprehensive Cancer Center, Jacksonville, FL, USAUniversity of Florida, Department of Clinical and Health Psychology, Gainesville, FL, USAUniversity of Florida, Department of Clinical and Health Psychology, Gainesville, FL, USAExtant literature reveals how patients of marginalized social identities, socioeconomic status (SES), and medical experiences – especially patients of color and older adults – are underrepresented in cancer clinical trials (CCTs). Emerging evidence increasingly indicates CCT underrepresentation among patients of lower SES or rural origin, sexual and gender minorities, and patients with comorbid disability. This review applies an intersectional perspective to characterizing CCT representativeness across race and ethnicity, age, sexual and gender identity, SES, and disability. Four databases were systematically queried for articles addressing CCT participation inequities across these marginalizing indicators, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. One hundred one articles were included in a qualitative evaluation of CCT representativeness within each target population in the context of their intersectional impacts on participation. Findings corroborate strong evidence of CCT underrepresentation among patients of color, older age, lower SES, rural origin, and comorbid disabling conditions while highlighting systemic limitations in data available to characterize representativeness. Results emphasize how observed inequities interactively manifest through the compounding effects of minoritized social identity, inequitable economic conditions, and marginalizing medical experiences. Recommendations are discussed to more accurately quantify CCT participation inequities across underserved cancer populations and understand their underpinning mechanisms.https://www.cambridge.org/core/product/identifier/S2059866124006770/type/journal_articleCancerclinical trialshealth inequitiesrepresentationunderserved populations |
| spellingShingle | Grace Ann Hanvey Hannah Johnson Gabriel Cartagena Duane E. Dede Janice L. Krieger Kathryn M. Ross Deidre B. Pereira The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review Journal of Clinical and Translational Science Cancer clinical trials health inequities representation underserved populations |
| title | The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review |
| title_full | The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review |
| title_fullStr | The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review |
| title_full_unstemmed | The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review |
| title_short | The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review |
| title_sort | role of social economic and medical marginalization in cancer clinical trial participation inequities a systematic review |
| topic | Cancer clinical trials health inequities representation underserved populations |
| url | https://www.cambridge.org/core/product/identifier/S2059866124006770/type/journal_article |
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