Racial Disparities in Head and Neck Cancer Chemotherapy Trials Participation and Treatment

Introduction: The purpose of this study was to identify the representation of race in clinical trials directing the Nation Comprehensive Cancer Network (NCCN) guidelines for chemotherapy for head and neck squamous cell carcinoma.

Methods: Head and neck squamous cell carcinoma (HNSCC) chemotherapy clinical trials cited by the 2018 NCCN guidelines “Principles of Systemic Therapy” were reviewed. Trials that included participants' race were identified. Race-based proportions were compared with the corresponding portions in the general US population of patients with the HNSCC between 1985 and 2015 derived from the SEER program. Clinical, socioeconomic, and institutional characteristics were compared between races.

Results: Of the 38 chemotherapy trials cited by the 2018 NCCN guidelines “Principles of Systemic Therapy,” only 29% of trials reported race. Of those trials that reported race, only 72% of trials reported Black or African American race. The other 28% grouped different races as “other” or “non-white”. Within the 72% of studies that reported on Black or African American race, only 14% of participants identified as Black or African American.

Conclusions: Cancer treatment guidelines are based on clinical trials that are not adequately representative of the patients we apply them to. These differences can be a source of heterogeneity of treatment effect and can result in worse outcomes in our patients than would have been expected based on the clinical trials and guidelines.