Epistemic Equity in Oncology Trials—Lessons From Nasopharyngeal Cancer

This invited commentary, published in JAMA Network Open, uses nasopharyngeal cancer as a case study to examine the concept of epistemic equity in oncology trials, defined as the fair representation of diverse patient populations in the clinical evidence base that guides treatment decisions. The commentary responds to research showing that nasopharyngeal cancer exhibits distinct histologic subtypes that vary significantly across racial and ethnic groups in the United States, a finding with direct implications for trial eligibility and the generalizability of treatment evidence. Because the vast majority of clinical trial data in this disease originates from populations in East and Southeast Asia, where nonkeratinizing disease predominates, American patients of other racial and ethnic backgrounds may be guided by evidence that does not adequately reflect their disease biology.

The commentary argues that equity in oncology research must extend beyond representation in enrollment numbers to encompass whether the knowledge produced by trials is actually applicable to the full diversity of patients who will ultimately receive those treatments. Nasopharyngeal cancer illustrates a broader challenge across oncology: when trial populations are systematically misaligned with real-world patient populations in disease characteristics as well as demographics, the resulting evidence base may perpetuate rather than reduce health disparities.