Recruitment and Retention Strategies for Historically Marginalized Populations in Colorectal Cancer Trials: A Cross-Sectional Analysis Using Systematic Review Methods

Colorectal cancer (CRC), a leading cause of cancer mortality, disproportionately impacts historically marginalized populations due to persistent health inequities. Effective recruitment and retention strategies are crucial to improving the representation of these populations in clinical trials. This study aims to evaluate the use of recruitment and retention strategies in CRC clinical trials, their impact on participant diversity, and the presence of diversity recruitment goals and ethical considerations.

We conducted a cross-sectional analysis of CRC treatment trials following PRISMA guidelines. Eligible studies were assessed for recruitment and retention strategies, diversity recruitment goals, and ethical considerations. Data were extracted in duplicate, ensuring masked and independent evaluations.

Of the 2563 records identified, 55 studies met the inclusion criteria. Most trials (83.6%) focused on therapeutic interventions, and government funding was the most common (38.2%). Only three studies (5.5%) reported strategies to recruit historically marginalized populations, and 54 studies (98.2%) lacked diversity recruitment goals. None of the trials discussed ethical considerations related to diverse recruitment.

This study highlights significant gaps in recruitment and retention strategies for historically marginalized populations in CRC clinical trials. Few studies implement strategies to address these disparities which affect the diversity of the trial population, underscoring the need for targeted efforts to improve trial inclusivity. Addressing these gaps is critical to ensuring more equitable and representative outcomes in CRC research.