Background:
Culturally and linguistically diverse (CALD) populations are under-represented in cancer clinical trials worldwide. Barriers exist at both patient and systems levels, resulting in inequitable access to innovative treatments and potential disparities in outcomes. Understanding these challenges is essential to improving inclusivity in trial recruitment.
Methods:
We reviewed published literature, local health service data, and stakeholder perspectives to identify barriers and facilitators for CALD patient participation in cancer clinical trials. Considerations were categorised into patient-level and system-level domains, highlighting actionable strategies for trial design, conduct, and policy.
Results:
Patient-level factors included language barriers, low health literacy, differing cultural perceptions of cancer and research, mistrust of healthcare systems, and competing socio-economic priorities. These can reduce awareness of trials, limit informed consent processes, and affect willingness to participate. Facilitators include the use of professional interpreters, culturally adapted patient information, involvement of family/community decision-makers, and engagement with community leaders to build trust.
System-level factors encompassed trial eligibility criteria inadvertently excluding CALD patients, limited availability of translated study materials, insufficient funding for interpreter use, rigid consent and visit schedules, and lack of diversity awareness among trial staff. Successful strategies include embedding cultural competence training, integrating interpreter services into research budgets, building flexible trial visit structures, and partnering with multicultural health units to support recruitment and retention.
Conclusion:
Recruiting CALD patients into cancer clinical trials requires a multifaceted approach that addresses both patient-level needs and systemic barriers. Tailoring communication, building trust, and ensuring culturally safe trial environments, alongside policy and funding reforms, are critical to achieving equitable representation. These considerations not only enhance inclusivity but also improve the generalisability of trial results and the reach of advances in cancer care.