ideasIdea
Fund investigators from under-represented communities and community sites to lead trials
Patients are more likely to join a trial when the doctor offering it looks like them or works in their community. Funding more such doctors to become trial leaders would change who is enrolled.
Career development awards, protected time and mentorship for oncologists from under-represented groups and those practising in community, rural and safety-net settings, tied to becoming principal investigators. Cooperative groups set targets for the share of PIs from these backgrounds. Evidence that racial concordance and community-based investigators raise minority enrolment is observational but consistent.
Hypothesis
Sites led by investigators from under-represented groups or based in community settings will enrol a higher share of minority and low-income participants, and increasing their number will shift network-level representativeness.
Rationale
Investigator distribution mirrors academic centre demographics; recruitment relationships run through clinicians. Workforce interventions have long lags but compound.
What would test it
Fund 50 awards over five years and compare enrolment demographics at awardees' sites with matched non-awardee sites.
Maturity
early clinical
Who has to act
philanthropy
Cost to try
Medium ($1M to $50M)
Years to first evidence
5
Bottlenecks it attacks
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.
- Not enough oncologists, nurses, pathologists, physicists · The number of people with cancer is rising faster than the workforce trained to treat them.