Researchers call for inclusive cancer trials and treatments to address overlooked source of structural racism

Researchers from Harvard University and Queen Mary University of London have proposed policy changes in cancer care to take account of a common genetic variation.

Research published in September in JAMA Network Open, led by Dr. Stephen Hibbs from the Wolfson Institute of Population Health in collaboration with Harvard University, highlights a source of discrimination in clinical trials and cancer treatment guidelines.

The study found that people with the Duffy null phenotype—a trait predominantly found in people of African or Middle Eastern descent—risk exclusion from clinical trials due to eligibility criteria based on absolute neutrophil counts (ANC).

Additionally, in the second part of the research paper, analysis of the prescribing guidelines for first-line cancer treatments revealed that Duffy null individuals face increased risks of treatment delays, dose reductions or therapy discontinuations. A lack of acknowledgment of natural variations in ANC levels across populations within treatment guidelines exemplifies structural racism in health care.

In a new article published Nov. 23 in the New England Journal of Medicine, Dr. Hibbs and his co-authors propose strategies for addressing the discriminatory practices that can impact cancer patients with the Duffy null phenotype. Their suggestions include:

• Eliminating the use of ANC-based criteria when clinically unnecessary
• Routine testing for the Duffy null phenotype during cancer trial screening
• Including dose modifications for people with Duffy null in new clinical trials

They also recommend expanding collaborations with clinicians and researchers in regions where the Duffy null phenotype is most prevalent—such as sub-Saharan Africa and the Arabian Peninsula—to gain insights on the safety and logistics of implementing specific dose modifications for these patients.