University of Pennsylvania
Ruth C. & Raymond G. Perelman Professor of Medicine
Perelman School of Medicine
Inaugural Director, Office of Diversity
Abramson Cancer Center
Determining ways to mitigate unconscious bias in breast cancer clinical trials.
Black women with breast cancer have the highest death rate and shortest survival times out of all racial and ethnic groups with a mortality rate 41 percent higher compared to white women. The overall 5-year relative survival rate is 82 percent for Black women and 92 percent for white women. One way to close this gap would be to increase the number of Black patients in clinical trials. But only three to five percent of Black patients with cancer enroll in clinical trials which severely limits the progress against this disease. Research has identified patient, provider, and system level barriers to enrollment of Black patients in breast cancer clinical trials. One of the important and less studied barriers to clinical trial participation is that Black patients are not informed or offered the opportunity to participate. In fact, among Black patients with metastatic breast cancer, 40 percent reported that no one on their care team had discussed clinical trials. Yet, studies show that when clinical trials are offered, over half of all patients (55 percent) agree to participate. Dr. Guerra and her colleagues are examining the impact of systemic negative perceptions and attitudes, assumptions, stereotypes, and bias on enrolling Black patients with breast cancer in clinical trials.
Prior work led to the development and testing of unconscious bias training specifically designed for cancer researchers (the ASCO-ACCC’s “Just ASK™” trial). Dr. Guerra will build on this work and conduct a randomized controlled study to determine if the completion of this training by breast cancer clinical trial researchers increases the rate of offering breast cancer treatment trials to Black patients with breast cancer. She hypothesizes that “Just ASK™” unconscious bias training is associated with higher rates of offering cancer clinical trials to Black patients with breast cancer. If this training is shown to be effective, it can be disseminated widely across providers and researchers caring for diverse populations of women with breast cancer so that they may have the opportunity to access cutting edge cancer therapies that may prolong their survival.
Carmen Guerra, MD, MSCE, FACP is the Ruth C. and Raymond G. Perelman Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania. Dr. Guerra is a general internist trained in epidemiology and cancer equity researcher. She also serves as the Vice Chair of Diversity and Inclusion for the Department of Medicine and the Associate Director of Diversity and Outreach for the Abramson Cancer Center.
Dr. Guerra’s research has focused on developing and evaluating interventions to increase the participation of underrepresented populations in cancer screenings and cancer clinical trials. Dr. Guerra developed a breast cancer screening patient navigation program in 2014 which has provided over 5000 free mammograms to un- and under-insured women in the Philadelphia region. The program has identified over 100 women with breast cancer and linked them to cancer treatment at the Abramson Cancer Center. In addition, Dr. Guerra has created multiple programs to increase participation of Black and Hispanic patients in cancer clinical trials including a Cancer Clinical Trials Ambassador Program and a financial reimbursement program for out-of-pocket costs accrued by patients during participating in cancer treatment trials.
Dr. Guerra co-chaired the American Society of Clinical Oncology-Association of Community Cancer Centers (ASCO-ACCC) national workgroup that developed the first unconscious bias training specifically for cancer research teams, “Just Ask”; an equity, diversity and inclusion site self-assessment for cancer research teams to identify best practices; and the ASCO-ACCC joint research statement “Increasing Racial and Ethnic Diversity in Cancer Clinical Trials.” She is member of the American Cancer Society (ACS) National Board of Directors, a member of the ACS Clinical Guidelines Development Group and an author of the ACS colorectal, cervical and HPV clinical practice guidelines which widely influence clinical practice.
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