Randall A. Oyer, MD, was named the Association of Community Cancer Centers (ACCC) President for 2020-2021 at the ACCC 46th Annual Meeting & Cancer Center Business Summit held March 4-6 in Washington, D.C.
ACCC invites each president to select a theme for their year in office that addresses a timely issue in cancer care through the creation of programs and resources. Dr. Oyer announced that the theme of his presidency will be “Community Oncology Can Close the Gap in Cancer Research.”
“Over the past year ACCC has heard from our members that there are gaps in community research,” said Dr. Oyer. Respondents to ACCC’s “2019 Trending Now in Cancer Care Survey” identified their top three challenges to offering patients with cancer clinical trials as staff resources and training (53%), program infrastructure (50%), and lack of patient understanding of the clinical trials process (46%). Citing these survey findings, Dr. Oyer remarked: “We have a serious imbalance in our clinical trials work. Our patients are in the community, yet the trials are at academic medical centers. And I believe that ACCC is uniquely situated to close this gap.”
Among the plans to achieve this goal outlined by Dr. Oyer were the following:
“We would like to improve our care and access for traditionally underserved communities. We would like to increase sensitivity, awareness, and understanding of the needs specific to geriatric oncology. And we would like to bring precision medicine into the community by understanding how to use the new precision diagnostics and radiology techniques to make sure that our patients have access to these services.”
The resources and tools that will be developed in conjunction with Dr. Oyer’s President’s Theme will be posted to this webpage as they are available.
Community Oncology Can Close the Gap in Cancer Research
By Amanda Patton
Although multidisciplinary cancer care is synonymous with access to cutting-edge treatment options, including clinical trials, improving nationwide patient participation remains a challenge. Learn how this large independent oncology practice in northwest Arkansas grew its research program to offer patients access to phase I, II, and III trials in the communities where they live and work.
Improving patient access to clinical trials has long been a vexing issue for clinicians and patient advocates. Although trials are the backbone of cancer research, participation rates have remained unchanged in recent decades. As a result, more attention is being paid to the lack of diversity in clinical trial populations.
The National Coalition for Cancer Survivorship (NCCS) held its 2019 Cancer Policy Roundtable in Washington, D.C. late last year. It featured a cross-disciplinary panel comprised of patient advocates, a cancer survivor, researchers in health services and disparities, and a physician, all of whom addressed disparities in access to clinical trials and strategies for improvement.
Joseph Unger, PhD, MS, a biostatistician and health services researcher at Fred Hutchinson Cancer Research Center, introduced the current clinical trial landscape. Dr. Unger said that healthcare professionals typically hold the general belief that 2 to 3 percent of patients with cancer participate in clinical trials. But his research indicates that, in fact, 8.1 percent of patients with cancer take part in trials.
Dr. Unger’s study aimed to define and quantify the factors that create barriers to clinical trial participation. He said these barriers can include transportation difficulties, comorbid conditions, fear, and distrust of the medical establishment. He suggested that researchers, clinicians, and advocates start by addressing these barriers if they want to substantially increase trial participation rates among minority groups.
Patients at the roundtable shared their own challenges when looking for, applying to, or participating in clinical trials. Sharon Rivera-Sanchez—a clinical trial participant and founder of Saving Pennies 4 a Cure—shared her story about participating in clinical trials after she was diagnosed with triple-negative breast cancer. “I participated in two clinical trials; both I found on my own,” said Rivera-Sanchez. When asked how she found her first clinical trial, she responded, “Good Morning America,” eliciting surprise from the group. Rivera-Sanchez explained that the television show’s anchor just happened to be interviewing a physician who was promoting a new trial for triple-negative breast cancer patients.
Rivera-Sanchez left her first clinical trial because traveling to Los Angeles from her home in Richmond, Virginia, was too much of a burden. Afterward, she found a trial in Pennsylvania that, although closer to her, still required an eight-hour round-trip drive. Rivera-Sanchez’s description of her experience with clinical trials and the passion for patient advocacy they engendered in her set the mood for the remainder of the roundtable discussion.
Rather than focusing on smaller, provider-based improvements (e.g., having one-on-one discussions with patients about clinical trials), the roundtable panelists discussed how larger institutions can address trial participation disparities.
Drawing on her own experience, Rivera-Sanchez said that many patients who are interested in clinical trials search online before speaking to their doctors. After her own diagnosis, Rivera-Sanchez said she turned to social media and the internet for information, even before her first consultation with her oncologist. She suggested that reaching patients via these channels can be more effective than traditional phone calls and mailings.
Panelists agreed that the circumstances of lower-income patients and language barriers can create significant obstacles to trial participation. The legacy of historical abuses in the medical research community—of which the Tuskegee syphilis experiment is the most-cited example—contribute to general distrust of the medical establishment by racial minorities. Glenn Ellis Sr., medical ethicist and president of Strategies for Well-Being, added that the way research is most often conducted can also be problematic. “There’s something structurally wrong with how we are doing research,” said Ellis, explaining that the structure and preconditions of trials often limit or eliminate participation by minority groups.
The panelists agreed that “regulation from the top down” can be unhelpful when trying to broaden clinical trial access. Tighter regulations on clinical trial design can add additional barriers to patient recruitment, such as longer washout periods or treatment delays. Dana L. Dornsife, a panelist and chairman of Lazarex Cancer Foundation, suggested leveraging industry competition by motivating companies to promote diverse enrollment and creating stronger requirements for diversity reporting.
The roundtable closed with panelists warning against the assumption that those underrepresented in clinical trials experience disparities mainly due to poverty and/or a lack of education. This creates a false narrative, they agreed. Designers of clinical trials must be careful to take into account the many ways in which some groups are excluded from trials if they truly want to diversify the populations in those trials.
Clinical trials are crucial to cancer research and are often the standard of care for patients with cancer, but for patients in rural areas, accessing clinical trials can pose significant geographic and financial barriers. On a recent episode of CANCER BUZZ, we talk to one health system that has harnessed its passion and creativity to work around obstacles and ensure its rural patients have access to cutting-edge cancer treatments.
Development of an actionable framework to address cancer care disparities in medically underserved populations in the United States: expert roundtable recommendations
Jan 19, 2021
Published in the Journal of Oncology Practice
Presented at the 2020 JADPRO Live Virtual Meeting
Presented at the 2020 ASCO Quality Care Symposium
In the current oncology clinical trials landscape, many barriers
remain to clinical trial enrollment that affect both the oncologist
and the patient. Among these are trial locations, strict eligibility
requirements, insufficient resources to support appropriate clinical
trial education and screening, as well as patient and provider
attitudes about trials.
Research nurse Joannne Riemer, RN, BSN, started her position at Johns Hopkins Medical Institution in 2010. Within six months, she was working with checkpoint inhibitors. From her vantage point in clinical trials research, she discusses the many changes in IO clinical trials patient selection over the last eight years.
combatCOVID.hhs.gov provides important information and links to access the most current treatment guidelines and inpatient and outpatient clinical trials.
An expert panel reviews currently available data on cancer care disparities, discusses the needs of disadvantaged populations, and shares practical solutions and methods for implementing bias training.
An expert panel of past ACCC Presidents will share their perspectives on changes to clinical research during the pandemic.
Optimal care delivery changes from place to place—what works best for one location and patient population may not be ideal for another. The same applies to cancer research. Understanding the needs of your patient population is critical to trial design and implementation. How can you proactively involve your community in cancer research activities? (January 27, 2021)
Key issues in high integrity tissue acquisition facing community cancer programs. (December 17, 2020)
Learn how to identify key disparities in clinical trial access for patients with multiple myeloma and explore strategies that can help improve access for underserved communities. (October 21, 2020)
Key results from a recent nationwide survey on the role of APs in cancer clinical research. (November 2, 2020)
Learn more about resources which already exist, successful models for pharmacist integration into oncology research teams, and the unique skills which pharmacists offer the interdisciplinary team. (October 30, 2020)
Join Nadine J. Barrett as she details strategies to improve clinical trial accrual for racial and ethnic minorities, as well as other at-risk groups. (July 24, 2020)
A Conversation With ASCO’s Dr. Richard Schilsky
January 28, 2021
Oyer Underscores Importance of Innovation and Collaboration in Cancer Care
Ongoing Minority Underrepresentation in Clinical Research Leads to Efforts to Bridge the Divide
Sep 22, 2020
ASCO-ACCC collaboration aims to make clinical trial diversity ‘part of our DNA'
July 31, 2020
Oncologists Scramble to Shift Resources, Develop New Protocols in Response to Novel Coronavirus
Apr 17, 2020
ACCC President Talks Community Oncology and Bridging the Research Gap
March 26, 2020
Challenges for Clinical Trials and Treating Patients With Cancer in Light of the Coronavirus
March 20, 2020
Randall A. Oyer, MD, Becomes President of the Association of Community Cancer Centers
March 11, 2020
Randall Oyer, MD, shares goals as the incoming President of ACCC
March 10, 2020
We sat down with journalist Mary Elizabeth Williams, one of the first patients treated with combination immunotherapy, to discuss her experience as an IO patient and how to bridge communication gaps among patients, doctors, and researchers.