DISCUSSION
lung cancer, cancer
LUNG CANCER, CANCER
Our study is the first one to look at the reporting trends in race and sex in phase III lung cancer trials over the last 35 years. The results of our analysis further substantiate the evidence that continues to highlight the disparities surrounding race in clinical trials.Examining the trends in reporting sex, we find more positive changes over time. In the studies we reviewed, 98.8% reported participant sex. Analyzing these trends, we noted the progressive increase in women's representation since 1985. While the trends over time are promising, females are still underrepresented with a mean participation rate of 34.97% from 2015 to 2019. This is despite females accounting for 48.9% of lung cancer in the United States.We were surprised to find the limited number of studies that reported race before 2000. In reviewing the literature for evidence, we encountered significant variability in race reporting across different studies. As an example, Brahan and Bauchner found significant increases in race reporting from 29.6% to 63.5% in pediatric studies conducted in 1991–1993 and 2000–2002.Our findings of minority underrepresentation in lung cancer phase III clinical trials have also been observed in other studies as well. A 2004 study looking at race‐based disparities in cancer clinical trials also found White participants to represent 85.6% of all participants, and another study found White participants to represent 76.3% of all participants in cancer drug clinical trials.There can be several explanations for this decline in African American participation. One reason can be attributed to historical influences relating to novel research.The principles of justice, beneficence, and medicine's professional code of conduct require diversity and inclusion as a mission critical to its social contract with society. These higher moral values call out for all efforts to ensure adequate access of all segments of society to the benefits of biomedical research. While it may be debatable that non‐reporting is not synonymous with not‐being included, it is a strong enough evidence to support the conclusion of non‐inclusion. Although positive changes have been made in the reporting of sex, there is room for improvement when it comes to the reporting of race. The responsibility to move the needle forward falls on the shoulders of all stakeholders. The clinicians and patient care teams should review and discuss the importance of race and sex reporting with the patients in the broader context of its value to society and in addressing the disparities. The clinical trials’ sponsors should work with the study teams to ensure the recording of sex and race among other demographic information in case report forms. Medical publishers should mandate the reporting of race and sex as a criterion for acceptance of publication.Our study does have limitations. Given that this study was a retrospective analysis, it carries the same weaknesses associated with such studies. As noted in Section 