Workforce, economic, and infrastructural barriers to global oncology clinical trial participation: Focus on sub-Saharan Africa.

Abstract

11091 Background: Despite Sub-Saharan Africa's (SSA) growing cancer burden, the region remains grossly underrepresented in global oncology clinical trials. With only 109 open trials identified continent-wide in 2019 compared to 7,557 in the United States, this disparity highlights systemic barriers. As well, the unique genetic variations in the African pan-genome makes a strong case for urgent population-specific research. Methods: Using the Pan African Clinical Trial Registry, we identified 151 oncology trials across 255 continent-wide recruitment sites. A review of published literature was carried out to assess oncologist distribution and SDI index within highlighted countries hosting clinical trials in SSA. Results: Of the 1,759 clinical oncologists identified in SSA, Egypt accounts for 85.2% (n=1,500) and hosts 46.36% of all oncology trials (n=70). Kenya, with only 0.34% oncologists (n=6), contributes 17.88% of clinical trials (n=27). Nigeria, with 3.63% oncologists (n=64), hosts 11.26% of trials (n=17). Ethiopia and Tanzania each house 0.34% oncologists (n=6), yet Ethiopia conducts 7.95% (n=12) and Tanzania 3.97% (n=6) of trials. South Africa, with 2.27% oncologists (n=40), hosts 3.97% of trials (n=6). Other countries, including Ghana and Morocco, collectively contribute to 8.61% of trials (n=13) with varying oncologist representation. The few available trials are mostly concentrated in Egypt, Kenya, and Nigeria. In addition, most trials disproportionately focus on breast and cervical cancer, with the added challenge of limited oncologist distribution. Infrastructure deficits, financial constraints, and cultural barriers further impede trial initiation and participation. Conclusions: Access to clinical trials remains a pillar of high-quality cancer care. Oncology research in SSA is hindered by multifaceted barriers, limiting the development of effective, region-specific therapies. Strategies to address these barriers include investing in the training of healthcare professionals, providing adequate infrastructure, increasing funding through public-private partnerships, and enhancing community engagement to build trust and improve trial participation. Distribution of clinical oncologists, oncology trials, and SDI index across selected African countries. African Countries with Oncology Clinical Trials Number of Clinical Oncologists in AfricaN=1759 % of Clinical Oncologists in Africa by Country Number of Clinical Trials in Africa by Country % of Clinical Trials in Africa by Country SDI Index Egypt 1500 85.2% 70 46.36% Middle Kenya 6 0.34% 27 17.88% Low-Middle Nigeria 64 3.63% 17 11.26% Low-Middle Ethiopia 6 0.34% 12 7.95% Low South Africa 40 2.27% 6 3.97% Middle Tanzania 6 0.34% 6 3.97% Low-Middle Ghana 10 0.57% 5 3.31% Low-Middle Morocco 28 1.59% 1 0.66% Low-Middle Others 99 5.63% 7 4.64% Total 1759 100% 151 100%