Clinical trials play a critical role in quality cancer care, but international research shows that few cancer patients, particularly culturally and linguistically diverse (CALD) patients, participate in trials. This limits generalisability of trial results and increases health disparities. This study aimed to establish rates and correlates of trial participation among CALD patients in South Western Sydney Local Health District (SWSLHD), a highly culturally diverse area.
Data from all cancer patients diagnosed and/or treated in SWSLHD from January 2006 to July 2016 were analyzed retrospectively. The primary outcome was trial enrolment among patients born in non-English speaking countries (CALD) versus English speaking countries (non-CALD). Subgroup analyses also evaluated differences in trial enrolment between CALD patients whose preferred language was or was not English. Multivariable logistic regression evaluated CALD status as a predictor of trial participation, while controlling for moderators including age and socio-economic status.
Trial participation was significantly lower in CALD patients than non-CALD patients (5.7% versus 8.4%, OR=0.80, 95% CI: 0.69-0.91, p=0.001). In particular, CALD patients whose preferred language was not English were significantly less likely to participate in trials than non-CALD patients (3.9% versus 8.4%, OR=0.46, 95% CI: 0.37-0.56, p<0.0001). There was no significant difference in trial participation rates for CALD patients whose preferred language was English and non-CALD patients (7.7% versus 8.4%, OR=0.87, 95% CI: 0.74-1.03, p=0.11).
Limited English proficiency seems particularly unfavourable to trial participation. Development and evaluation of strategies to overcome language barriers (e.g. simplified and translated multimedia participant information materials) is needed.