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      Do Tobacco Treatment Trials Address Disparities in Smoking Outcomes Among Black and Hispanic Cancer Patients? A Systematic Review of Smoking Cessation Interventions for Black and Hispanic Patients Diagnosed with Cancer

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          Abstract

          Objective

          To characterize the representation of Black and Hispanic cancer patients in tobacco treatment trials, and to offer recommendations for future research.

          Methods

          We conducted two systematic searches of the literature (2018, 2021) using 5 databases (MEDLINE via EBSCO, Pubmed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE)) to examine the prevalence of tobacco trials that included Black or Hispanic cancer patients. Two coders independently screened all articles at title, abstract, and full-text to identify eligible trials. Information about the proportion of Black and Hispanic patients included, trial design features, and whether the authors analyzed outcomes for Black and Hispanic patients were documented.

          Results

          Of 4682 identified studies, only 10 published trials included and reported on the rates of Black or Hispanic cancer patients enrolled in their tobacco trial. The proportion of enrolled Black cancer patients ranged from 2 to 55.6%. Only our studies documented enrollment rates for Hispanics, and rates were less than 6%. None of the studies offered strategies to promote or the accrual of Black or Hispanic patients.

          Discussion

          There remains a large gap in the literature regarding the reach and efficacy of tobacco treatment for Black and Hispanic cancer patients. Black and Hispanic cancer patients remain largely under-represented in tobacco cessation trials, limiting the applicability of existing, evidence-based treatments. To optimize intervention generalizability, future studies should emphasize the targeted recruitment and engagement of these patients in tobacco trials.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40615-023-01705-3.

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          Most cited references35

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          Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States

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            Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer.

            Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care.
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              Twenty years post-NIH Revitalization Act: enhancing minority participation in clinical trials (EMPaCT): laying the groundwork for improving minority clinical trial accrual: renewing the case for enhancing minority participation in cancer clinical trials.

              The National Institutes of Health (NIH) Revitalization Act of 1993 mandated the appropriate inclusion of minorities in all NIH-funded research. Twenty years after this act, the proportion of minority patients enrolled in cancer clinical trials remains persistently low. Clinical trials are vehicles for the development and evaluation of therapeutic and preventive agents under scientifically rigorous conditions. Without representation in trials, it is projected that disparities in the cancer burden for minorities will increase. For this review article, the authors counted the frequency with which minorities were the primary focus of National Cancer Institute-sponsored clinical trials, examined citations from the PubMed database focusing on the search terms "NIH Revitalization Act of 1993" and "enhancing minority accrual to cancer clinical trials," and supplemented the review with their expertise in NIH-funded research related to minority accrual in cancer clinical trials. The reporting and analyses of data based on minorities in clinical trials remain inadequate. Less than 2% of the National Cancer Institute's clinical trials focus on any racial/minority population as their primary emphasis. The current review of the literature indicated that the percentage of authors who reported their study sample by race/ethnicity ranged from 1.5% to 58%, and only 20% of the randomized controlled studies published in a high-impact oncology journal reported analyzing results by race/ethnicity. Proportionately greater population increases in minorities, accompanied by their persistent and disproportionate cancer burden, reinforce the need for their greater representation in clinical trials. Renewing the emphasis for minority participation in clinical trials is warranted. Policy changes are recommended. © 2014 American Cancer Society.
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                Author and article information

                Contributors
                gperez@mgh.harvard.edu
                Journal
                J Racial Ethn Health Disparities
                J Racial Ethn Health Disparities
                Journal of Racial and Ethnic Health Disparities
                Springer International Publishing (Cham )
                2197-3792
                2196-8837
                19 July 2023
                19 July 2023
                2024
                : 11
                : 4
                : 2390-2406
                Affiliations
                [1 ]Harvard Medical School/Massachusetts General Hospital, ( https://ror.org/002pd6e78) Boston, MA USA
                [2 ]Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA 02114 USA
                [3 ]Department of Psychology, University of Cincinnati, ( https://ror.org/01e3m7079) Cincinnati, OH USA
                [4 ]Tufts University, ( https://ror.org/05wvpxv85) Medford, MA USA
                [5 ]Bamboo Health, Boston, MA USA
                [6 ]Memorial Sloan Kettering Cancer Center, ( https://ror.org/02yrq0923) New York, NY USA
                Author information
                http://orcid.org/0000-0002-7524-4961
                Article
                1705
                10.1007/s40615-023-01705-3
                11236890
                37468742
                3460ca41-2014-40d3-a3b9-63d709f538e9
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 4 October 2022
                : 30 May 2023
                : 27 June 2023
                Funding
                Funded by: National Cancer Institute
                Award ID: 3R01CA166147 – 02S1
                Award Recipient :
                Funded by: National Institute of Cancer
                Award ID: K07 CA211955
                Award ID: GKP
                Award Recipient :
                Categories
                Article
                Custom metadata
                © W. Montague Cobb-NMA Health Institute 2024

                tobacco treatment,tobacco and health,cancer disparities,clinical trial participation

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