On August 25, 2022, Blood Advances published a new study, authored by Ruemu Birhiray, MD and his daughter, Maya Birhiray, BS, that outlined practical strategies to promote diversity, equity, and inclusion in clinical cancer research. Dr. Birhiray, a clinical oncologist at the Hematology Oncology of Indiana Division of the American Oncology Network, and Ms. Birhiray, were frustrated at the lack of inclusion of minorities in cancer research and use the study to promote a five-step approach to increase inclusion in clinical trials through their non-profit organization, Indy Hematology Education, Inc.
In the study, Dr. and Ms. Birhiray state that “disparities in cancer treatment, a major contributor to decreasing outcomes in cancer mortality, can be related to the underrepresentation of Blacks and other racial minorities in clinical trials.” They point to statistics that state that between 2008 and 2018, only 7.8% of 230 trials documented the four major races in the United States and 25.2% reported racial subgroup analyses. Of the clinical trials that provided representation information, 76.3% of participants were White, 18.3% were Asian; 3.1% were Black, and 6.1% were Hispanic.
The five-step approach established by Indy Hematology Education, Inc., a 501(c) non-profit organization incorporated to promote education and advocacy, can be remembered by the acronym DRIVE:
- D: Diversity officer for clinical research studies
- R: Ranking of clinical studies for diversity
- I: Individual diversity, equity, inclusion, and access plan
- V: Verification of study diversity
- E: Elevate and enhance training of minority investigators and research team members
The study article by the Birhirays outlines specific responsibilities and strategies for each of the five steps, from qualifications and trainings of the diversity officers to tactics that can be used to enhance the training of minority investigators and research team members.
The DRIVE strategies themselves are not novel ideas, as each element was informed by previous research and the DRIVE strategies were derived from existing guidelines, including the American Association for Cancer Research recommendations for myeloma clinical research, and real-world examples from other fields. However, it’s the way they are presented and focused that aims to change the way clinical trials are conducted.
“There are things we can do today that can change the trajectory of minority patient inclusion in clinical trials that do not require legislation. They are actions that are within our immediate reach,” said Dr. Birhiray.
Specifically, Dr. Birhiray emphasized the “R,” ranking of clinical studies for diversity, meaning clinical trials should be reviewed and ranked based on the diversity of the patient population. He believes this should be emphasized because “we live in a country where everybody wants to win, and keeping score motivates people. No one wants their study to have a low ranking.” He continued on, noting that “if you have a limited number of podium presentations, and we require you to prioritize the presentation of studies that represent everyone, I think it will force our research community to innovate.”
Ms. Birhiray emphasized that “tangible things are being done to make medicine more applicable to everyone” and “we want people to know that medicine is a field open to everyone and that our community values them.”
While DRIVE is currently only a vision, the Birhirays believe that with publicity and outreach, it will have a real-world impact on the medical field. In the coming weeks and months, the Birhirays intend to focus on advocacy – through hosting a summit surrounding the Indy Hematology Education, Inc., 19th Annual Meeting and writing a “Black Paper,” a white paper focused on creating representation of marginalized identities in cancer research.
Ms. Birhiray concluded by reminding us that “diversity is everyone’s responsibility” and does not include “just racial and ethnic diversity” but also “factors like socio-economic groups, sex, gender, age, and career stage.”