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Selected winners of the ASCO 2008 Clinical Trials Participation Awards were asked to provide examples of how they increased minority accrual onto the clinical trials conducted by their practices.
Since 2003, the ASCO Cancer Foundation—the philanthropic affiliate of ASCO—has awarded Clinical Trials Participation Awards (CTPAs) to community-based oncology practices for their efforts to improve care of patients with cancer through participation in clinical trials. Journal of Oncology Practice has developed a series of articles highlighting these award-winning practices to provide insight into what makes them successful. Selected winners of the ASCO 2008 CTPAs were asked to provide examples of how they increased minority accrual onto the clinical trials conducted by their practices.
Sreenivasa Nattam, MD, of Fort Wayne Medical Oncology and Hematology (Fort Wayne, IN) says that although the practice is located in the heart of the Midwest, it has a diverse patient population, including African American, Hispanic, Burmese, and Vietnamese patients. Its physicians also represent a wide variety of ethnic groups, and many speak other languages in addition to English. The practice makes sure that patients with language barriers have interpreters and provides linguistically and culturally appropriate educational materials. He notes that there is a positive attitude toward clinical research in the community his practice serves. The main barrier to accrual of minority patients is financial. An increasing number of patients, including minorities, have no insurance or have insurance that does not provide adequate coverage. Fort Wayne Medical Oncology and Hematology has personnel who help patients complete drug assistance applications, explore other financial resources, and navigate the reimbursement system. Nattam points out that Indiana is one of approximately 30 states lacking a law that would require insurers to provide coverage for clinical trials. In an attempt to change this policy, his practice is helping to publicize this problem by contacting insurance carriers, legislators, and newspapers about patients with cancer who have been denied coverage.
Another strategy for increasing minority accrual is to remind physicians in primary care and specialty practices to talk with patients about the importance of enrolling onto clinical trials. The practice has entered into partnerships with two local hospitals (accredited by the Commission on Cancer of the American College of Surgeons) to make access to quality cancer care available to minorities. The practice is also a strong financial supporter and partner of Cancer Services of Northeast Indiana (Fort Wayne, IN), a local nonprofit agency that provides free resources and financial support to those in the community who have been diagnosed with cancer. Community outreach using strategies like mobile breast cancer screening programs also targets minority groups. Nattam concludes that the combination of these efforts is beginning to address minority accrual challenges.
Jeffrey J. Kirshner, MD, of Hematology and Oncology Associates of Central New York (East Syracuse, NY) says the patient population of the practice includes Native American, African American, and Asian patients. Kirshner notes that all new patients are screened for eligibility for and interest in all available clinical trials. He says that it may not always be possible to identify minorities in the patient population of the practice, particularly those who have some Native American heritage.
Members of the practice are informed about available protocols for patients, and the practice follows up on why patients are not enrolled. Often, says Kirshner, it is because they are not eligible. “Our nurses screen all patients for nausea, pain, sleep disruption, and breathing problems, and we have protocols for all of these symptoms,” he says. The practice has also participated in all of the CALGB (Cancer and Leukemia Group B) trials designed for African American patients with cancer and has made additional efforts to recruit minority patients for prevention trials. The presence of an African American woman on the Prevention Advisory Panel of the practice, who was also a member of the NSABP (National Surgical Adjuvant Breast and Bowel Project) P1 and P2 Participant Advisory Boards, has helped recruitment. As a community clinical oncology program, Kirshner's practice has a commitment to participate in all large prevention trials and is looking for future trials to be approved. “We don't have any formal minority recruitment program except to keep in touch with the community,” Kirshner concludes.
The physicians and staff of Medical Oncology Hematology Consultants (Newark, DE) are actively promoting minority population accrual onto clinical trials in Delaware. The practice has added an African American oncology nurse practitioner with special interest in clinical trial participation, who acts an advocate for African American patients regarding clinical trial accrual. The practice has two bilingual physician investigators and two oncology nurses who have become bilingual to assist in clinical trial recruitment of Spanish-speaking patients. Members of the practice participate in and are resources for the State of Delaware Cancer Consortium Disparity Committee. The goals of this committee include increasing clinical trial participation in underserved communities to eliminate cancer outcome disparities.
Investigators at Medical Oncology Hematology Consultants are active in clinical trial educational efforts in underserved communities. Opportunities for education in the last 3 years have included clinical trial seminars at the American Cancer Society–sponsored Annual Men's Health Conference targeting urban underserved men. Physicians provide educational forums on prevention and treatment trials at the Southbridge Clinic in underserved urban Wilmington, Delaware. The investigators also participate in interviews on local cable television forums that address the African American community. Investigators at the practice are also involved in developing new tools for clinical trial recruitment of underserved populations through the National Cancer Institute Community Cancer Center Program pilot.
Now in its sixth year of operation, the Annual Oncology Educational Program for African Americans implemented by William Beaumont Hospital (Royal Oak, MI) continues to meet with overwhelming success. The program, initiated on the Beaumont campus, is now offered in a community setting—the African American Museum in Detroit, Michigan. The educational program is hosted by a well-respected minority radio personality and provides presentations by minority Beaumont physicians who specialize in oncology, including gynecologic oncology, medical oncology, and radiology. In addition, the Beaumont community clinical oncology program has a minority nurse who discusses safeguards for patients enrolled onto clinical trials, and presenters answer questions posed by members of the audience. Annual attendance is currently 350 people, with new attendees coming each year.
Beaumont attributes the success of this program in part to involvement of representatives from all oncology services and community representatives on the planning committee. Information about the program is provided to churches and other community groups. The event includes speakers who demonstrate enthusiasm and commitment to clinical research and always volunteer to participate the next year.
Using the same model, the Beaumont Minority Planning Committee has now added presentations for other minorities, including Chaldean, Arab American, Native American, and Chinese patients. Each program is held in a community setting familiar to the population being served, with presenters who target their messages to that particular population.
For more information about the CTPAs, please visit http://http://www.asco.org/TACF/Awards/Award+Opportunities/Clinical+Trials+Participation+Award or contact Candice Griffin at CTPA@asco.org.