Disparities in gastrointestinal cancer trials recruitment: analyzing demographic gaps compared to the real-world
Original Article

Disparities in gastrointestinal cancer trials recruitment: analyzing demographic gaps compared to the real-world

Wissam Ghusn1,2 ORCID logo, Elisia Maalouf3, Noura Jawhar4, Yara Salameh2, Marita Salame4, Andrew Takchi5, Lynn Kobeissi6, Tamara Kadi7, Rudy Mrad2, Sara F. Haddad8, Aline Charabaty6, Sandra Quezada9

1Department of Internal Medicine, Boston University, Boston, MA, USA; 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; 3Division of Infectious Disease, Boston Children’s Hospital, Boston, MA, USA; 4Division of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA; 5Montefiore Einstein Comprehensive Cancer Center, New York, NY, USA; 6Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA; 7Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 8Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; 9University of Maryland School of Medicine, Baltimore, MD, USA

Contributions: (I) Conception and design: W Ghusn; (II) Administrative support: A Charabaty, S Quezada; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: W Ghusn, E Maalouf, N Jawhar, Y Salameh, M Salame, A Takchi, L Kobeissi, T Kadi, R Mrad, SF Haddad; (V) Data analysis and interpretation: W Ghusn; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Wissam Ghusn, MD. Department of Internal Medicine, Boston University, 715 Albany St., Boston, MA 02118, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Email: wissamghusn7@gmail.com.

Background: Gastrointestinal (GI) cancers are a leading cause of morbidity and mortality worldwide, accounting for a substantial portion of cancer incidence and cancer-related deaths. Randomized clinical trials (RCTs) are fundamental to the development of new therapies, as they generate evidence on efficacy and safety. However, concerns persist regarding whether trial populations accurately reflect the demographics of real-world patient populations, including variations by age, sex, race, and ethnicity. Underrepresentation of specific subgroups, such as older adults, racial/ethnic minorities, or those with distinct biological risk factors, can limit the external validity of trial findings and impede equitable treatment outcomes. As global populations become increasingly diverse and the burden of GI cancers continues to rise, identifying and addressing disparities in trial enrollment is essential for advancing precision medicine and ensuring that evidence-based treatments benefit all patients equally. This study aimed to compare the demographic profiles of participants in GI cancer RCTs with real-world data, and identify specific disparities in age, sex, race, and ethnicity that could undermine the generalizability of trial results.

Methods: We performed a retrospective analysis of GI cancer RCTs registered in ClinicalTrials.gov between 2000 and 2024. Trials reporting demographic data on age, sex, race, and ethnicity were included. We categorized these trials based on cancer subtype [colorectal, pancreatic, gastric, hepatic, esophageal, and cholangiocarcinoma (CCA)]. The distribution of demographic variables was compared against real-world incidence data from the Surveillance, Epidemiology, and End Results (SEER) program. Discrepancies were quantified as the difference between trial participant proportions and SEER population estimates to identify under- or over-represented groups.

Results: We observed consistent underrepresentation of older adults (>65 years) across multiple GI cancer subtypes, particularly those with higher prevalence in older populations. Male participants were disproportionately low in esophageal and hepatic trials. Racial and ethnic imbalances were most evident in pancreatic, hepatic, and CCA studies, with White participants overrepresented and Black, Asian, and Hispanic populations underrepresented.

Conclusions: Significant demographic disparities persist in GI cancer RCTs, notably for older adults, men in certain subtypes, and racial/ethnic minority groups. These discrepancies threaten the generalizability of clinical trial evidence, potentially perpetuating gaps in care. More inclusive recruitment strategies and trial designs are essential to ensure equitable treatment outcomes for diverse patient populations.

Keywords: Gastrointestinal cancer (GI cancer); disparities; randomized clinical trials (RCTs); older adults; racial and ethnic minorities

Submitted Apr 07, 2025. Accepted for publication Aug 12, 2025. Published online Oct 28, 2025.

doi: 10.21037/jgo-2025-276

Highlight box

Key findings

• Randomized controlled trials (RCTs) in gastrointestinal (GI) oncology underrepresent key demographic groups, including older adults, racial and ethnic minorities, and, in certain cancers, male patients.

• This mismatch between trial populations and the real-world cancer burden limits the external validity of findings and risks perpetuating inequities in care.

What is known and what is new?

• While it is known that cancer trials often lack demographic diversity, few studies have comprehensively evaluated representation across multiple GI cancer types.

• Our study systematically compares the demographic composition of GI cancer RCTs with real-world data from Surveillance, Epidemiology, and End Results, revealing consistent and significant disparities in enrollment by age, sex, and race/ethnicity. Notably, Black and Hispanic patients were underrepresented in most trials, and older adults were frequently excluded despite bearing a disproportionate burden of disease.

What is the implication, and what should change now?

• These findings call for structural changes in trial design and recruitment, including broader eligibility criteria, enhanced community engagement, and routine monitoring of enrollment demographics.

• Institutions and regulatory bodies must prioritize equity in clinical research to ensure trial findings are applicable to the populations most affected by GI malignancies.

• Without intentional reform, RCTs risk reinforcing disparities in cancer care and limiting access to emerging therapies for underrepresented groups.

Introduction

Gastrointestinal (GI) cancers, which include cancers of the esophagus, stomach, colorectum, liver, and pancreas, collectively represent a significant public health burden, accounting for over one-quarter of all new cancer cases and one-third of cancer-related deaths (1). In the United States, GI cancer mortality trends have shown a complex pattern, with overall declines in mortality rates for certain cancers, such as colorectal and stomach cancer, attributed to improvements in screening and early detection (2). However, for other GI cancers, including pancreatic and liver cancers, mortality rates have risen, largely due to increasing rates of obesity, diabetes, and other metabolic conditions (2). Despite advancements in diagnostic technologies, surgical techniques, and systemic therapies, survival rates for many GI cancers remain low, particularly when diagnosed at later stages (3,4).

Randomized clinical trials (RCTs) are central to evidence-based medicine, providing critical insights that guide treatment approaches and improve patient outcomes in GI cancers (5). To ensure the broad applicability of these findings, it is essential that RCTs include participants reflective of the diverse demographics affected by GI cancers, including differences in race, ethnicity, age, and sex. For example, African American and Hispanic patients have higher incidence rates and face poorer survival outcomes in certain GI cancers, such as colorectal and pancreatic cancers, compared to other groups (6). This pattern is influenced by complex factors including socioeconomic status, access to specialized care, and genetic variation (6). By capturing a wide demographic spectrum, clinical trials can yield findings that are relevant and beneficial to all populations affected by GI cancers.

Considering demographic factors is crucial in clinical trials for GI cancers to ensure that treatments are effective across varied patient backgrounds. Differences in pharmacogenomics, where genetic and biological factors affect how individuals metabolize medications, highlight the importance of a representative trial population (7). Treatments tested on demographically diverse participants are more likely to produce outcomes that can be generalized to the broader patient population, promoting effective, personalized care and minimizing the risk of adverse effects that might disproportionately affect certain groups (8). Additionally, broader representation in clinical trials can foster trust in medical research, helping to engage communities historically marginalized in healthcare (9).

This study seeks to rigorously analyze disparities in RCT recruitment for GI malignancies by comparing the demographic characteristics of RCT participants to real-world cancer epidemiology. By quantifying these disparities, we aim to highlight the gaps in current research practices and advocate for more inclusive recruitment strategies that enhance the external validity of GI cancer trials. Through this work, we underscore the need for policy and institutional changes that prioritize diversity in clinical research.

Methods

This study is a retrospective analysis using data from RCTs that focus on various GI malignancies. Data were extracted from a publicly accessible database, ClinicalTrials.gov, encompassing trials conducted within the United States from 2000 to 2024. We applied specific filters to include all trials that were categorized as completed and interventional, spanning phases 2, 3, and 4. We also applied a filter to include trials that only include the United States. GI malignancies examined included colorectal, pancreatic, gastric, hepatic, esophageal, and cholangiocarcinoma (CCA) cancers, ensuring a comprehensive view across a spectrum of GI cancers.

Study design

RCTs that reported demographic data, such as age, sex, race, and ethnicity, were included to allow an in-depth analysis of participant characteristics. This study design facilitated an evaluation of demographic representation trends across different types of GI cancers and provided insights into recruitment patterns. Because this analysis used publicly available and anonymized data, institutional review board approval was not required.

Data sources and variables

The key variables extracted from each trial included age, sex, race, and ethnicity. Age was categorized into groups: 0–65 years and over 65 years, to capture age-related patterns in trial recruitment. Sex was categorized as male and female. Race and ethnicity were recorded based on standard classifications used in clinical settings: White, Black or African American, Asian, Native Hawaiian or Pacific Islander, American Indian or Alaska Native, and other races, with ethnicity classified as Hispanic or Latino, non-Hispanic or Latino, and unknown. Each trial was also identified by the specific GI cancer type studied and the total number of participants recruited to assess whether certain cancer types were associated with greater demographic diversity.

Real-world data comparisons

To assess the representativeness of RCT populations for GI cancers, we compared trial participant demographics with real-world epidemiological data sourced from national health surveys and cancer registries. For population demographics in the US, we have used the census data (10). For all GI malignancies, including colorectal, pancreatic, esophageal, CCA, and gastric cancers, we obtained real-world data from the Surveillance, Epidemiology, and End Results (SEER) program (11-18). This approach enabled a comprehensive comparison between RCT populations, and the broader U.S. patient population affected by GI malignancies, highlighting any potential demographic discrepancies. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments.

Statistical analysis

Descriptive statistical analyses were used to summarize the demographic distribution of trial participants across different cancer types. Age was reported as mean and standard deviation (SD), while categorical variables, including sex, race, and ethnicity, were summarized as percentages. These analyses were performed using JMP version 17 (SAS Institute Inc., Cary, NC, USA), providing a comprehensive view of demographic representation in GI cancer RCTs. We did not perform statistical hypothesis testing between trial and SEER proportions, as the datasets represent separate, non-random populations. Applying inferential statistics (e.g., Chi-squared tests) may be inappropriate in this context and risk overstating precision. Instead, we focused on clinically meaningful differences that are policy-relevant, even if they are not statistically significant.

Results

Esophageal cancer

In total, 151 esophageal cancer trials were included, enrolling 23,690 participants with a mean age of 61.1 years (SD 10.7 years). Participants over the age of 65 years were slightly underrepresented (61% in RCTs vs. 63% in real-world). Males, who have a higher incidence of esophageal cancer in the general population, were also underrepresented (64% in RCTs vs. 82% in real-world). Racially, Asian participants were notably overrepresented (12% in RCTs vs. 5% real-world), while Hispanic (7% vs. 8%) and American Indian/Alaska Native (0.2% vs. 1%) groups were modestly underrepresented (Figure 1).

Figure 1 Demographic distribution of esophageal in RCTs and real-world data. RCT, randomized clinical trial.

Gastric cancer

In this study, 112 gastric cancer trials enrolled 13,963 participants with a mean age of 58.6 years (SD 11.3 years). Adults >65 years percentage was similar (61% in RCTs vs. 60% real-world). Male and female proportions were relatively balanced with population data. Asian participants were overrepresented (12% vs. 10%), while Hispanic (10% vs. 15%) and American Indian/Alaska Native (1% vs. 3%) groups were underrepresented (Figure 2).

Figure 2 Demographic distribution of gastric cancer in RCTs and real-world data. RCT, randomized clinical trial.

Colorectal cancer (CRC)

A total of 345 CRC trials were included, enrolling 181,579 participants with a mean age of 55.9 years (SD 9.8 years). Participants over 65 were also markedly underrepresented (32% in RCTs vs. 56% real-world). Sex representation was close to population estimates. Native American (0.2% vs. 2%) and Hispanic (16% vs. 17%) participants were slightly underrepresented, while Black participants were overrepresented (20% vs. 15%) (Figure 3).

Figure 3 Demographic distribution of CRC in RCTs and real-world data. CRC, colorectal cancer; RCT, randomized clinical trial.

Pancreatic cancer

In total, 256 pancreatic cancer trials including 16,132 participants with a mean age of 62.5 years (SD 11.6 years) were analyzed. Patients over 65 years were strongly underrepresented (43% in RCTs vs. 69% real-world). RCTs also underrepresented Black (8% vs. 15%), Asian 3% vs. 5%), and Hispanic (10% vs. 21%) populations (Figure 4).

Figure 4 Demographic distribution of pancreatic cancer in RCTs and real-world data. RCT, randomized clinical trial.

CCA

A total of 44 CCA trials were included, enrolling 2,196 participants with a mean age of 62.7 years (SD 10.1 years). Adults over 65 years made up only 45% of RCT participants vs. 64% in real-world. Hispanic (9% vs. 13%), Asian (8% vs. 12%), and especially Black (8% vs. 21%) participants were markedly underrepresented (Figure 5).

Figure 5 Demographic distribution of cholangiocarcinoma in RCTs and real-world data. RCT, randomized clinical trial.

Hepatic cancer

In total, 125 hepatic cancer trials included 6,033.5 participants with a mean age of 58.8 years (SD 9.6 years). Patients over 65 years were notably underrepresented (31% RCT vs. 60% real-world). Males, who are more likely to develop liver cancer, were underrepresented (64% vs. 73%). Black (12% vs. 21%), Asian (7% vs. 12%), Native American (0.4% vs. 6%), and Hispanic (10% vs. 26%) groups were consistently underrepresented (Figure 6).

Figure 6 Demographic distribution of hepatic cancer in RCTs and real-world data. RCT, randomized clinical trial.

Discussion

This study highlights significant disparities in the representation of various demographic groups in RCTs for GI cancers compared to real-world data. Although RCTs are essential for establishing evidence-based standards in cancer treatment, our findings reveal that certain groups, such as older adults, racial minorities, and Hispanic individuals, are underrepresented, potentially impacting the generalizability and effectiveness of trial outcomes across the broader cancer population.

Age-related disparities were consistent across most GI cancer trials, with younger populations (0–65 years) overrepresented relative to real-world incidence. This skew in age distribution may limit the applicability of trial results to older adults, who bear a substantial portion of the disease burden in real-world settings (19). For cancers like CRC, CCA and hepatic cancer, where older adults are disproportionately affected, this age gap raises concerns about the relevance of trial outcomes to the majority of the affected population (20). Given the unique physiological responses and comorbidities present in older populations (21), ensuring age diversity in RCTs is essential for tailoring effective treatments that can be safely and effectively administered to older adults.

Sex-based disparities were less pronounced but still present in certain cancers. For instance, male participants were underrepresented in esophageal, CCA and hepatic cancer trials. These imbalances may affect the generalizability of trial findings, as varying physiological responses between sexes can influence outcomes (22). Ensuring adequate representation of both sexes in clinical trials is essential to capture a complete range of responses and provide robust data that can guide treatment decisions for all patients (23).

The underrepresentation of Black, Asian, and Hispanic subgroups across many trials (e.g., pancreatic, hepatic, and CCA) further underscores the need for inclusive recruitment practices. In trials for pancreatic and hepatic cancers, Hispanic participants were significantly underrepresented in trials relative to their real-world GI cancer incidence, which could hinder the applicability of RCT findings to this population. Similarly, Black and Asian populations, who are disproportionately affected by certain GI cancers (24), were not adequately represented in pancreatic, CCA and hepatic cancer trials. Addressing these gaps is crucial, as genetic, lifestyle, and environmental factors associated with race and ethnicity may influence cancer biology and treatment outcomes, underscoring the need for ethnically diverse trial cohorts (25,26).

Our findings highlight a critical need for policy-level interventions and industry and institutional efforts to enhance diversity in cancer clinical trials (27,28). Initiatives to broaden eligibility criteria, expand trial locations to underrepresented communities, and implement targeted recruitment strategies for racial and ethnic minorities, older adults, and other marginalized groups could help bridge these disparities (29). Achieving a demographically representative sample in clinical trials would not only improve the generalizability of findings but also strengthen public trust in research, fostering broader participation in future trials (30). Addressing these disparities aligns with the broader goals of precision medicine, aiming to provide evidence-based, personalized care for all patients with GI cancers (31).

The underlying causes of these observed disparities revolve around both structural and logistical factors. For instance, racial and ethnic minorities may have limited access to specialized cancer centers, experience mistrust stemming from historical injustices, and face outreach efforts that fail to consider language or cultural nuances. Older adults, meanwhile, may be excluded by rigid eligibility criteria or discouraged by concerns about treatment toxicity and comorbidities. Offering flexible study visit schedules, partnering with local health advocates, and revising inclusion criteria can help increase participation. Collaborating with community organizations to build trust and integrating transparent reporting of demographic data are also key steps toward more equitable recruitment practices. Such strategies not only enhance the external validity of trial outcomes but also contribute to reducing disparities in GI cancer care overall.

Limitations

This study is limited by its exclusive focus on US-based RCTs, which may reduce the generalizability of our findings to international populations with different demographic profiles and healthcare practices. Additionally, the reliance on publicly available data introduces potential biases due to incomplete reporting of demographic details and variations in data collection methods between trials and real-world sources (e.g., SEER). Furthermore, key factors such as socioeconomic status, health literacy, and comorbidities were not captured in our analysis, potentially influencing recruitment patterns. Another limitation is that a pre-defined threshold for clinically meaningful differences between RCT data and real-world demographics was not established, which may affect the precision of interpreting the observed disparities.

Conclusions

This study underscores significant demographic discrepancies between RCT populations and real-world patients with GI malignancies. Our analysis revealed underrepresentation of certain groups, particularly older adults, racial minorities, and Hispanic populations, across trials for colorectal, pancreatic, esophageal, CCA, gastric, and hepatic cancers. These disparities may limit the generalizability of trial results and hinder the applicability of evidence-based treatments across diverse patient populations. Addressing these gaps through more inclusive recruitment strategies and broadened eligibility criteria is essential to ensure that clinical trials reflect the true demographics of affected populations, ultimately advancing equitable and effective cancer care for all individuals.

Acknowledgments

None.

Footnote

Peer Review File: Available at https://jgo.amegroups.com/article/view/10.21037/jgo-2025-276/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-2025-276/coif). A.C. has consulting roles with AbbVie, Eli Lilly, Janssen, Pfizer, and Takeda. S.Q. reports grants from NIH and AGA, consulting fees from Pfizer, honoraria and travel support from AGA, service on a Data Safety Monitoring Board, and a leadership role with the CCF National Board of Trustees; no other conflicts were disclosed. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Arnold M, Abnet CC, Neale RE, et al. Global Burden of 5 Major Types of Gastrointestinal Cancer. Gastroenterology 2020;159:335-349.e15. [Crossref] [PubMed]
  2. Ali H, Ishtiaq R, Tedder B, et al. Trends in mortality from gastrointestinal, hepatic, and pancreatic cancers in the United States: A comprehensive analysis (1999-2020). JGH Open 2024;8:e13064. [Crossref] [PubMed]
  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:7-30. [Crossref] [PubMed]
  4. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. [Crossref] [PubMed]
  5. Hariton E, Locascio JJ. Randomised controlled trials - the gold standard for effectiveness research: Study design: randomised controlled trials. BJOG 2018;125:1716. [Crossref] [PubMed]
  6. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017;67:7-30. [Crossref] [PubMed]
  7. Sharma S, Mariño-Ramírez L, Jordan IK. Race, Ethnicity, and Pharmacogenomic Variation in the United States and the United Kingdom. Pharmaceutics 2023;15:1923. [Crossref] [PubMed]
  8. Adan C. The importance of diversity in clinical research. Br J Nurs 2023;32:898-901. [Crossref] [PubMed]
  9. Armstrong K, Ritchie C. Research Participation in Marginalized Communities - Overcoming Barriers. N Engl J Med 2022;386:203-5. [Crossref] [PubMed]
  10. Census.gov. 2023 Population Projections for the Nation by Age, Sex, Race, Hispanic Origin and Nativity. Census.gov; 2023. Available online: https://www.census.gov/data/tables/2023/demo/popproj/2023-summary-tables.html
  11. Siegel RL, Wagle NS, Cercek A, et al. Colorectal cancer statistics, 2023. CA Cancer J Clin 2023;73:233-54. [Crossref] [PubMed]
  12. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024;74:12-49. [Crossref] [PubMed]
  13. Moshayedi N, Escobedo AL, Thomassian S, et al. Race, sex, age, and geographic disparities in pancreatic cancer incidence. J Clin Oncol 2022;40:520.
  14. National Cancer Institute. Cancer Stat Facts: Esophageal Cancer. 2024. Available online: https://seer.cancer.gov/statfacts/html/esoph.html
  15. Kulshrestha A, Flores R, Gulati S, et al. 1429P Differences in esophageal cancer incidence and survival by race/ethnicity: A SEER analysis. Ann Oncol 2024;35:S890-S891.
  16. Javle M, Lee S, Azad NS, et al. Temporal Changes in Cholangiocarcinoma Incidence and Mortality in the United States from 2001 to 2017. Oncologist 2022;27:874-83. [Crossref] [PubMed]
  17. Antwi SO, Mousa OY, Patel T. Racial, Ethnic, and Age Disparities in Incidence and Survival of Intrahepatic Cholangiocarcinoma in the United States; 1995-2014. Ann Hepatol 2018;17:604-14. [Crossref] [PubMed]
  18. National Cancer Institute. Cancer Stat Facts: Pancreatic Cancer. 2017–2021. Available online: https://seer.cancer.gov/statfacts/html/pancreas.html
  19. Prathap R, Kirubha S, Rajan AT, et al. The increasing prevalence of cancer in the elderly: An investigation of epidemiological trends. Aging Med (Milton) 2024;7:516-27. [Crossref] [PubMed]
  20. Vitale A, Spolverato G, Bagante F, et al. A multi-institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma. J Surg Oncol 2016;113:420-6. [Crossref] [PubMed]
  21. Cesari M, Onder G, Russo A, et al. Comorbidity and physical function: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study). Gerontology 2006;52:24-32. [Crossref] [PubMed]
  22. Kim HI, Lim H, Moon A. Sex Differences in Cancer: Epidemiology, Genetics and Therapy. Biomol Ther (Seoul) 2018;26:335-42. [Crossref] [PubMed]
  23. Vera R, Juan-Vidal O, Safont-Aguilera MJ, et al. Sex differences in the diagnosis, treatment and prognosis of cancer: the rationale for an individualised approach. Clin Transl Oncol 2023;25:2069-76. [Crossref] [PubMed]
  24. Huang J, Lucero-Prisno DE 3rd, Zhang L, et al. Updated epidemiology of gastrointestinal cancers in East Asia. Nat Rev Gastroenterol Hepatol 2023;20:271-87. [Crossref] [PubMed]
  25. Puka K, Kilian C, Zhu Y, et al. Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults? BMC Public Health 2023;23:1591. [Crossref] [PubMed]
  26. Zavala VA, Bracci PM, Carethers JM, et al. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 2021;124:315-32. [Crossref] [PubMed]
  27. Ghusn W, Mosleh KA, Hage K, et al. A comprehensive analysis of health care Inequities in randomized clinical trials following bariatric surgeries. Am J Surg 2024;237:115796. [Crossref] [PubMed]
  28. Gala K, Ghusn W, Tariq R, et al. Demographic Disparities in Recruitment for Clinical Trials Focused on Endoscopic Bariatric Therapies. Obes Surg 2023;33:3699-702. [Crossref] [PubMed]
  29. Kelsey MD, Patrick-Lake B, Abdulai R, et al. Inclusion and diversity in clinical trials: Actionable steps to drive lasting change. Contemp Clin Trials 2022;116:106740. [Crossref] [PubMed]
  30. Antoine-LaVigne D, Hayes T, Fortenberry M, et al. Trust and Biomedical Research Engagement of Minority and Under-Represented Communities in Mississippi, USA. Int J Environ Res Public Health 2023;20:1592. [Crossref] [PubMed]
  31. Edwards TL, Breeyear J, Piekos JA, et al. Equity in Health: Consideration of Race and Ethnicity in Precision Medicine. Trends Genet 2020;36:807-9. [Crossref] [PubMed]
Cite this article as: Ghusn W, Maalouf E, Jawhar N, Salameh Y, Salame M, Takchi A, Kobeissi L, Kadi T, Mrad R, Haddad SF, Charabaty A, Quezada S. Disparities in gastrointestinal cancer trials recruitment: analyzing demographic gaps compared to the real-world. J Gastrointest Oncol 2025;16(5):1962-1970. doi: 10.21037/jgo-2025-276

Article Options

Download Citation

Share