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Diverse populations and enrollment in pediatric cancer clinical trials: Challenges and opportunities

Survival rates for pediatric cancer have improved significantly over the past five decades,1 mainly due to clinical trial (CT) participation.2 Hispanic children have a significantly higher incidence of leukemia and lymphoma; however, Hispanics and African Americans have poorer 5-year overall survival rates than their non-Hispanic White (NHW) counterparts.3-5 Lower survival rates are at least partially attributable to lower enrollment in CTs.6 The National Institutes of Health Revitalization Act of 1993 mandated the inclusion of women and minorities in CTs.7 However, to date, only 2% of approximately 10 000National Cancer Institute (NCI) CTs have sufficient minority participants.8 Despite the NCI’s efforts to include minorities in research, Hispanics and African Americans are severely underrepresented compared to NHWs (1-7% and 15% vs 67%, respectively).8 Enrollment rates in cancer CTs are even lower at 0.4-2.2% for Hispanics and 5.4% for African Americans, even at NCI-designated cancer centers.8 Ourwork demonstrated thatHispanics are underrepresented in pediatric cancer research.9 Consequently, cancer outcomes data are primarily based on data from NHWs, providing inadequate information toadequately assess treatmentbenefits for minorities. According to U.S. Census Bureau projections, more than half of the U.S. population is expected to be other than NHW by 2045.10 Without proactive CT planning and effective interventions, the disparity