Study finds women disproportionally absent from clinical trials leadership

Even as women have gained ground in oncology, they remain under-represented as leaders of phase III clinical trials, MD Anderson researchers have found.

A team led by author Emma Holliday, M.D., assistant professor of Radiation Oncology, published its research this month in JAMA Oncology, reporting that of 598 Phase III cancer studies published between 2003 and 2018, only 107, or 17.9 percent, had female corresponding authors.

The study showed 14.4 percent of industry-funded trials and 25.9 percent of National Cancer Institute cooperative group trials had female researchers in leadership roles.

Holliday says this study is a follow up on prior work that has shown women are not proportionately represented in the upper echelons of oncology academia.

“We wanted to examine whether this was also true with regard to clinical trial leadership,” Holliday says. “We also wanted to see if we could identify factors or areas of research with better representation of women among trial leaders.” 

“Dr. Holliday has done quite extensive work already regarding improvements in gender balance among academic oncologists,” says first author Ethan Ludmir, M.D., a resident in Radiation Oncology. “We wanted to examine if there were gender disparities among those who lead our most impactful trials which often enroll hundreds of patients and have the capacity to change the standard of care in cancer.”

The numbers proved somewhat surprising for the research team. Ludmir says he did not anticipate such a marked difference between the women-led industry-funded studies versus non-industry-sponsored trials.

Holliday said they did not determine whether the low numbers are the result of fewer women submitting grants for industry funding or whether grants submitted by women were funded at a disproportionately lower rate.

Recognizing the disparity, removing barriers

So, how do the numbers increase? “The first step is recognizing the disparity and starting the conversation,” Holliday says. “As an oncology community, I think we’re making great strides. There is an increasing body of research within oncology focused on this work that is getting increasing attention.”       

Holliday said that last year, for the first time, the American Society for Radiation Oncology (ASTRO) annual meeting hosted a dedicated educational session on gender equity. “So, in this regard, we’re getting somewhere” she says.

She adds that a workforce analysis a few years ago showed women make up almost 50 percent of the workforce among hematology/oncology fellows. That number is also growing for radiation oncology residency spots, “albeit a little more slowly.”

“Women are entering the field of academic oncology, but finding it difficult to stay or advance; finding it difficult to find mentorship or sponsorship; facing policies that force them to choose between family and career opportunities, and facing implicit or even explicit bias in the workplace,”  Holliday says.

Ludmir says there are many gender-related barriers to success in academic oncology.  “In academic medicine, the tenure clock and the parenthood clock overlap a great deal, and, therefore, advancement in the academic world can be impacted by having children.”

Holliday says institutional policies and culture need to be closely examined “to help reduce biases and barriers to success. We also need to be honest with ourselves regarding what success looks like. We don’t necessarily need 50 percent of all trials to be run by women. However, we need to make sure every woman who is interested in participating in academic medicine has equal access to a seat at the table.”

Ludmir and Holliday have data showing that female oncologists disproportionately treat breast cancer compared to other disease sites.  They are currently working on this as an upcoming manuscript.

Mentorship challenges and clinical cancer research

“More broadly, I think you could make the case that perhaps female representation and mentorship within breast cancer has been stronger than other fields within oncology,” Ludmir says. 

“I would add that women oftentimes find it harder to find a mentor/sponsor,” Holliday says. “It is easier and more comfortable to mentor someone who is similar to you and who has had similar life experiences as you. This is not to say men cannot mentor women and vice versa.

“However, I do think it is helpful for a young woman entering the field of academic oncology to see a woman in leadership in her chosen field. There have been similar discussions for improving inclusion of underrepresented minorities within academic medicine as well.”  

National Institutes of Health Director Francis Collins, Ph.D., recently wrote an opinion piece for the NIH about gender bias and harassment of women in the field of medicine. The article "identified the critical role that scientific leaders must play to combat cultural forces that tolerate gender harassment and limit the advancement of women." He also said he will turn down invitations to speak at meetings where invited speakers do not reflect a commitment to diversity.

Ludmir says Collins should be commended for both this piece as well as other recent steps taken to improve gender equity in the medical field. Holliday co-authored a paper about this problem last fall.