While the pandemic continues to disrupt the conduct of cancer research, clinical trials remain crucial to advancing clinical care and providing the latest treatment options to all patients, including those in medically underserved communities. Given its location in the American southwest, Yuma Regional Medical Center (YRMC) Cancer Center has a long history of providing culturally appropriate care for its largely Hispanic population. The cancer center’s strong research program enabled it to offer its patients early access to COVID-19 trials that were not available to patients in most of the country.

Located in the southwest corner of Arizona, where the border intersects with California and Mexico, YRMC Cancer Center is a not-for-profit, sole community provider that serves nearly 205,000 people, many of whom have low incomes. More than half of the patients the cancer center sees are covered by Medicare (49.9%) or Medicaid (26.4%).¹ Barriers to healthcare for much of this population have always been a concern, says Abhinav Chandra, MD, medical director of YRMC Cancer Center and Institutional Research.

“Providing screening and access to care have always been a challenge in this particular border town,” explains Dr. Chandra. “The ratio of doctors to patients is very low, so we are federally designated as a medically underserved area.” One of YRMC Cancer Center’s primary focuses is on improving access by enabling enrollment into clinical trials, which can provide treatment options otherwise unavailable to most patients.  

While disparities in cancer care and access to clinical trials are not new, the pandemic has underlined the need to address them. Healthcare organizations are increasing their collaborative efforts to find new ways to expand access to clinical trials among underrepresented groups. YRMC Cancer Center is forging a path from which others can learn.

Partnering for Access

As COVID-19 made its way to Yuma, the Institutional Research Department at YRMC Cancer Center was watching and waiting. “The pandemic in Yuma came a little late,” says Dr. Chandra. “We were seeing what was happening across the nation, especially in New York, and before that, in Italy and China. That gave us time to open some relevant clinical trials.”

Many patients with cancer are immunocompromised and at high risk for viral infections, so Dr. Chandra and his team at YRMC Cancer Center planned early for how they would manage treatment for their patients who contracted COVID-19. At the same time, the Mayo Clinic, through the Food and Drug Administration's (FDA’s) expanded access program, had begun the first clinical trials investigating the efficacy of convalescent plasma as a treatment modality for COVID-19.² YRMC partnered with Mayo to help conduct those trials.

“In Yuma, even our very first patients with COVID-19 who came to the hospital in April were able to get convalescent plasma through our partnership with Mayo,” says Dr. Chandra. “We were able to open the Expanded Access Program and give our patients very relevant treatment options right from the beginning.” Patients also were able to receive remdesivir through the FDA’s Emergency Use Authorization.

Building Trust

Dr. Chandra notes that trust is perhaps the most critical factor in ensuring the inclusion of patients from varying social, cultural, and racial backgrounds in clinical trials. YRMC Cancer Center works hard to build trust from within its community by cultivating a deep understanding of the patients it serves. Some successful strategies YRMC Cancer Center has used in recruiting for clinical trials include:

• Enabling shared decision-making between patients and their providers by employing certified, in-person translators and validated translation services. At YRMC Cancer Center, family members never serve as a patient’s sole translators.
• Integrating bilingual social workers and nurse navigators into patient care
• Enabling social workers and nurse navigators to continually conduct outreach activities to increase awareness about clinical trials and reduce the fears and stigmas associated with them
• Providing culturally and linguistically sound educational resources for both patients and caregivers to help increase their understanding of clinical trials
• Partnering with community organizations on patient outreach efforts, such as helping provide transportation
• Enabling seamless patient access to multilingual telehealth and virtual health services
• Ensuring consent forms are available in multiple languages and formats at the beginning of clinical trial enrollment periods

Building a Research Team

A commitment to continually analyze metrics and apply strategies to minimize errors and improve processes has directly improved patient experience, quality of care, financial stability, and overall growth at YRMC Cancer Center. In 2016, YRMC centralized all of its research activities under one umbrella by hiring a Director of Institutional Research. Since then, the cancer center’s research department has been able to grow its portfolio of clinical trials and grants. This has enabled YRMC Cancer Center to subsidize additional staff, including two clinical research associates, one clinical research assistant, and one research program financial analyst.

Physicians in underserved communities have a “moral responsibility to ensure equitable cancer care for every patient,” Dr. Chandra says. He affirms that the team at YRMC Cancer Center will continue to expand clinical trial access to its community and provide a roadmap for other communities to follow.

References

1. Yuma Regional Medical Center. Patients Come First: 2018 Report to the Community.
2. The Mayo Clinic. EAP for Convalescent Plasma no Longer Enrolling; The FDA Authorized Emergency Use. Oct. 5, 2020.
   

You also may be interested in

• Access an on-demand replay of a webinar exploring strategies for sustaining clinical trial programs during COVID-19 and increasing the relevance of research to vulnerable and underserved populations.
• In July 2020, the American Society of Clinical Oncology (ASCO) joined ACCC to announce a new collaboration to promote clinical trials in cancer programs with racially diverse communities. The joint initiative is designed to identify and implement novel strategies and practical solutions to increase the participation in clinical trials of groups underrepresented in cancer research.