For healthcare professionals striving to address health disparities affecting Black Americans, understanding the biological differences that impact disease manifestation and treatment response is essential. BlackDoctor.org’s Clinical Trials Day Summit facilitated discussions among medical experts on how clinical trials can serve as a crucial pathway to developing more effective treatments for Black patients—if designed and implemented with their unique biology in mind.
Biological Differences Demand Specialized Research
“We know now that on a cellular level, our breast cancer is different, and we now have data to prove it,” explains Ricki Fairley, breast cancer survivor and advocate. “Our immune system cells are different too. And so the research has to happen for us, and we must advance the science.”
This revelation isn’t limited to breast cancer. The experts highlight how Black patients’ biology, genetics, genomics, and environmental factors create distinct disease profiles requiring targeted research approaches.
“All of these factors play into why we need to be considered and our science need to be considered different,” Fairley emphasizes.
Clinical Evidence of Differential Treatment Response
Keith Crawford, MD, Director of Clinical Trials and Patient Education at PHEN (Prostate Health Education Network), provides compelling evidence of how treatments can yield dramatically different results in Black patients.
In one notable example from prostate cancer research, “When you combined the drugs together, it had no impact on white men. But when you combine it together for Black men, it doubled the life expectancy.”
This striking finding underscores the critical importance of including adequate representation of Black patients in clinical trials. As Dr. Crawford notes, prostate cancer trials typically have “between four to seven percent participation of black men in a clinical trial when there’s a need for 22 to 25 percent participation.”
The Stress Factor: A Crucial Variable
For healthcare providers seeking to improve Black health outcomes, understanding the impact of chronic stress is essential. Wendy Garvin Mayo, DNP, a board-certified nurse practitioner specializing in mental health support for cancer patients, explains: “Black individuals in America specifically have higher levels of stress… related to prejudice, discrimination, which leads to a lot of these chronic illnesses such as diabetes, high blood pressure, and cancers.”
This chronic stress affects not only disease development but also treatment efficacy. Dr. Crawford elaborates on the physiological mechanism: “Your stress increases cortisol levels. Your cortisol levels suppress your immune system.”
Provider Responsibility in Clinical Trial Enrollment
Healthcare providers play a pivotal role in addressing the underrepresentation of Black patients in clinical trials. Dr. Mayo points out: “Many people aren’t asked. They don’t know about it. So never mind being educated—they have no knowledge of it.”
This highlights the responsibility of providers to proactively discuss clinical trial options with Black patients. Dr. Mayo emphasizes that organizations must “take responsibility of who they’re hiring and how passionate they are about really inclusion, diversity… these things are important.”
Supporting Patients Through the Clinical Trial Process
When presenting clinical trials as an option, providers should recognize the challenges patients face in processing information. Dr. Crawford notes that “Once they say you have cancer, you don’t hear anything,” emphasizing that “that’s why it’s important to have somebody there who can listen for you and then help you manage the stress.”
Dr. Mayo adds that “when we are stressed… it’s hard for you to take in effectively take in information to understand and process. It’s also hard to advocate for yourself.”
The Promise of Personalized Medicine Through Clinical Trials
For healthcare providers, clinical trials represent a pathway to more personalized medicine for Black patients. As research continues to uncover biological differences, trials designed with these differences in mind can yield treatments that significantly improve outcomes.
“We’re moving towards making cancer a chronic disease,” Dr. Crawford states, pointing to the potential for extending life through targeted treatments. “The treatment options that are out there, we have men who were diagnosed with metastatic prostate cancer that I can put you on the line with that are eight years out.”
By prioritizing the inclusion of Black patients in clinical trials and recognizing the unique biological and social factors affecting their health, healthcare professionals can help build a more equitable future in medicine—one where treatments are designed for all bodies, not just some.