Helena Wilcox
Senior Researcher, Health Policy Partnership
Eleanor Wheeler
Associate Director of Research and Policy, Health Policy Partnership
Clinical trials are fundamental for the development of new treatments, but major disparities in access exist. This limits our understanding of how treatments will work in different people and perpetuates health inequalities.
It is well-documented that people from disadvantaged and marginalised backgrounds often have worse health outcomes than the general population. So, it is of significant concern that progress to address health inequalities is extremely limited.
Why clinical trial access is important
Clinical trials play an essential role in developing new therapies; they help us understand how different treatments work and how effective they are. For illnesses where no cure is currently available, such as some advanced cancers, clinical trials are also an important route for people to access potential new treatments.
However, we know that not everyone is offered the opportunity to participate in a clinical trial, even when they are medically eligible. For example, in the US, the key clinical trials that led to an FDA-approved metastatic breast cancer treatment had less than 3% of Black women participants, even though Black women experience both higher rates of metastatic breast cancer and worse outcomes.
People from disadvantaged and marginalised backgrounds often have worse health outcomes than the general population.
Ways to encourage diverse participation
Many factors contribute to this, and it is important that they are addressed as part of trial development. For example, where a clinical trial takes place has a significant influence on whether people can take part, often based on time, cost and transport options. Providing information in more accessible formats — such as translations into other languages or visual aids — can help make the trials accessible to more people and enable them to participate.
Limiting treatment knowledge
The impact of limited diversity in clinical trials is stark. When clinical trials are not adequately representative of everyone with the condition, this reduces our understanding of how treatments will work in different people. Sometimes, this can even contribute to higher rates of serious side effects; this can mean some people have more limited treatment options due to this risk or are, understandably, less willing to continue with some types of treatment.
Addressing these challenges is undoubtedly complex, but progress is accelerating, and there are many examples of best practices. By acting across the sector and collaborating with communities who have historically been overlooked in clinical trials, we can improve treatments and outcomes for everyone.