Fix the neutrophil count rule that excludes many people of African ancestry
Many healthy people of African descent have naturally lower white-cell counts because of a common genetic variant. Trials use a single cut-off that wrongly labels them unfit, so they are turned away. The rule should be adjusted for this variant.
The Duffy-null phenotype (ACKR1 rs2814778 CC), carried by a majority of people of West African ancestry, is associated with lower baseline neutrophil counts without increased infection risk. Protocols would use Duffy-status-specific absolute neutrophil count thresholds (or exclude on infection history rather than ANC alone), and dose-modification rules for neutropenia would be reinterpreted accordingly. Duffy status is a cheap blood test.
- 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.
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.
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not linked directly; found by shared links- IdeaPay trial participants for their time, not only their expenses
Shares Trials do not represent the people who get cancer, Trials enrol too few, too slowly.
- IdeaTravel, lodging and meals reimbursed as a standard line in every trial budget
Shares Trials do not represent the people who get cancer, Trials enrol too few, too slowly.
- IdeaStop over-excluding people who could become pregnant; study pregnancy exposure
Shares Trials do not represent the people who get cancer, Trials enrol too few, too slowly, Triple-negative breast cancer (TNBC).
- IdeaCommunity health workers and trusted local organisations paid to recruit for trials
Shares Trials do not represent the people who get cancer, Trials enrol too few, too slowly.
- IdeaAt least a third of pivotal-trial sites in community and rural settings
Shares Trials do not represent the people who get cancer, Trials enrol too few, too slowly.
- IdeaRemove blanket exclusions for mental illness and dementia; support consent instead
Shares Trials do not represent the people who get cancer, Trials enrol too few, too slowly.
- IdeaMobile research units bring trial visits to rural towns
Shares Trials do not represent the people who get cancer, Trials enrol too few, too slowly.
- IdeaDrop the 'must speak English' rule: translated consent and questionnaires as standard
Shares Trials do not represent the people who get cancer, Trials enrol too few, too slowly.