Cancer trials in the community

Thursday, August 1, 2019

Edward S. Kim, MD, of Levine Cancer Institute at Atrium Health in Charlotte, N.C., chats with David H. Henry, MD, host of Blood & Cancer, about how to perform clinical trials in the community oncology setting.

Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, discusses a byproduct of our fragmented health care system – patients having to hear the same bad news repeated over and over.

Show notes

  • Only 3%-4% of adult oncology patients are enrolled in clinical trials.
  • Most patients diagnosed with cancer are seen in community settings (as opposed to academic centers).
  • Oncologists in the community setting face significant obstacles to enrolling their patients in clinical trials:
    • Communication between academic and community centers often is lacking, especially in more rural areas of the country.
    • Community-based oncologists usually are not compensated for time spent on research or academic work.
    • Treatment pathways used by many oncologists may not offer any information regarding clinical trials.
    • The traditional infrastructure of a community practice may not have the necessary experts to facilitate clinical trial participation.
    • Community oncologists may not feel comfortable talking to their patients about a novel drug of which they have little knowledge.
  • How can community oncologists facilitate participation in clinical trials?
    • There must be a cultural change, starting with the organization’s leadership.
    • A study coordinator is crucial.
    • Data, finance, and regulatory individuals are likely required.
    • Coordination with pharmacy and pathology usually is necessary.
    • Electronically Accessible Pathways (EAPathways) is a tool developed by Dr. Kim’s team. It is available and allows any oncologist to input a patient’s information to determine if there is an appropriate clinical trial available.

Show notes by Sugandha Landy, MD, a resident in the department of internal medicine, University of Pennsylvania, Philadelphia

Dr. Kim can be reached at [email protected]

Additional reading

Patronik KE and ES Kim. A novel clinical pathways approach to delivering regional-based clinical trials and patient care in a hybrid academic- community-based system. J Clin Pathways. 2018 May;4(4):52-5.

Ersek JL et al. Implementing precision medicine programs and clinical trials in the community-based oncology practice: Barriers and best practices. Am Soc Clin Oncol Educ Book. 2018 May 23:38:188-96.

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Podcast Participants

David Henry, MD
David Henry, MD, FACP, is a clinical professor of medicine at the University of Pennsylvania and vice chairman of the department of medicine at Pennsylvania Hospital in Philadelphia. He received his bachelor’s degree from Princeton University and his MD from the University of Pennsylvania, then completed his internship, residency, and fellowship at the Hospital of the University of Pennsylvania. After 2 years as an attending in the U.S. Air Force, he was drawn to practicing as a hem-onc because of the close patient contact and interaction, and his belief that, win or lose with each patient, one can always make a difference in their care and lives. Follow Dr. Henry on Twitter: @davidhenrymd. Dr. Henry reported being on the advisory board for Amgen, AMAG Pharmaceuticals, and Pharmacosmos. He reported institutional funding from the National Institutes of Health and FibroGen.
Ilana Yurkiewicz, MD
Ilana Yurkiewicz, MD, is a fellow in hematology and oncology at Stanford University, where she also completed her internal medicine residency. Dr. Yurkiewicz holds an MD from Harvard Medical School and a BS from Yale University. She went into hematology and oncology because of the high-stakes decision-making, meaningful relationships with patients, and opportunity to help people through some of the toughest challenges of their lives. Dr. Yurkiewicz is also a medical journalist. She is a former AAAS Mass Media Fellow and Scientific American blog columnist, and her writing has appeared in numerous media outlets including Hematology News, where she writes the monthly column Hard Questions. Dr. Yurkiewicz is on Twitter: @ilanayurkiewicz. Dr. Yurkiewicz has no relevant conflicts of interest.