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Improving Access to Clinical Trials for Rural Populations

March 8, 2021
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Montana is one of the most rural states in the U.S. Nearly half of its population (43.6 percent) live in rural regions, totaling slightly less than half a million people (442,718). Accordingly, accessing healthcare services can be difficult for Montana’s citizens, and gaining access to clinical trials is particularly challenging.

The clinicians at Bozeman Health Cancer Center in Bozeman, Montana, say that distance is less of an obstacle to accessing clinical trials than having an adequate number of trials in the state that match the needs of the local patient population. “We serve communities as far as 110 miles away, and those patients probably have equal opportunity to participate in trials as do the patients who live in Bozeman,” says Dr. Hensold. “I think patients in Montana have come to accept the fact that they need to travel to get their healthcare. They accept having to go to our center to participate in a clinical trial, just as they do to receive standard therapy. I think that, though daunting, the nature of the geography here is just an accepted part of life. When clinicians are able to enroll a patient in a clinical trial, they are generally interested.”

The bigger challenge to enrolling patients in clinical trials, says Dr. Hensold, is the limited number of trials being conducted in the region compared to larger cities that have a much broader range of trials available. Despite Bozeman Health Cancer Center’s participation in the National Cancer Institute’s Community Oncology Research Program (NCORP) and its affiliation with an academic medical center, Dr. Hensold says there are still not enough clinical trials available to his patients that match their needs. “I think the trials that are offered through NCORP are well-designed trials that ask good questions about how to manage patients clinically,” says Dr. Hensold. “The difficulty, frankly, is that we just don’t have enough trials that are applicable to the general patient population.”

Dr. Hensold says he especially sees this gap emerging in his treatment of patients with breast cancer: “We see approximately 140 new patients with breast cancer a year, and we frequently have no trials available that any of those patients are eligible for. I can’t remember the last time we had a patient with breast cancer go on a NCORP trial, simply because of the limited number of trials and the strict eligibility criteria.”

Unfortunately, Dr. Hensold says he does not see this issue resolving any time soon. “There’s a movement toward more and more consolidation of cancer care into large, urban cancer centers,” he explains. This can lead to access barriers to cancer care in general—not just to clinical trials in particular.  As for programs that offer a large range of clinical trials, says Dr. Hensold, they also are being consolidated into the largest cancer centers: “This only amplifies the access problem. If you want to enroll patients into clinical trials, you need to have a large number of trials to choose from to ensure they can meet the needs of your patient population.”

One potential solution, says Dr. Hensold, is to bring together other local oncology groups in the state that want to offer industry trials. “Why couldn’t we do this as a separate consortium?” he asks. “I think that could be part of the answer.” Through such a collaboration, a cancer program that is able to offer an industry trial could serve as a single study site, but it could also tap into a larger pool of patients through the consortium. “It would increase access to clinical trials for all of us,” says Dr. Hensold. Such a consortium could also promote clinical education, he adds, bringing together providers from different sites to discuss research and available trials on a regular basis.

“Bozeman is not a big center,” says Dr. Hensold. “We have five oncologists right now. To get to the point that we could support the infrastructure for clinical trials took us a while.” Joining forces with other local cancer centers in Montana, he says, may make it easier for similar programs to open trials to their patients.

Over the course of his career in medicine, oncologist Jack Hensold, MD, has had many roles. Before joining Case Western Reserve University in Cleveland, he was an instructor of medicine at Harvard Medical School and a visiting scientist at Massachusetts Institute of Technology. At Case Western, he served as an associate professor of medicine and ran a research lab funded by grants from the National Institutes of Health, the American Cancer Society, and the Veterans Administration. At Case Western, Dr. Hensold became the director of the university’s hematology and medical oncology fellowship program, and he chaired the Scientific Review Board for the American Cancer Society in Ohio.

Having studied, lived, and worked in large urban academic medical centers in Illinois, Wisconsin, Massachusetts, and Ohio, in 2004, Dr. Hensold decided to relocate to southwest Montana. Since then, he has been caring for patients at the Bozeman Health Cancer Center in Bozeman, Montana.

This blog post is adapted from an article that previously appeared in ACCC’s Research Review newsletter. Read back issues of the newsletter and learn more about the role of clinical trials in cancer programs and practices.

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