Among the many factors at play in overcoming cancer care gaps in the U.S., increased screening and access to care are top of mind. However, cancer trial participation is also crucial.
Marie Rahne, director, and Douglas Yee, MD, interim medical director of the Minnesota Cancer Clinical Trial Network spoke to Becker's about how their organization is broadening the scope of cancer trials.
Editor's note: Responses have been lightly edited for clarity and length.
Question: What is your perspective on the term "cancer care desert?"
Marie Rahne and Dr. Douglas Yee: Cancer care deserts define geographic locations where cancer care providers are not locally available and/or choices of providers are limited. Further, some cancer care deserts exist because of inequities in health care access, even in areas of high population density. These deserts are a reality for not only cancer treatment but cancer research as well. Clinical trials are not accessible to many populations who already face cancer disparities, including BIPOC, low income and rural populations.
Q: Are cancer care deserts a new phenomenon, or is it an issue that has been going on for a long time?
MR and DY: It's a little bit of both. Cancer care deserts have existed for a long time, but there are also newer factors that offer increased challenges as well as opportunities. We know that there is a decreasing number of oncology providers in rural areas of the state and that the ones practicing in rural areas are aging. The goal of the Minneapolis-based University of Minnesota Health Sciences' strategic plan is to ensure that all Minnesotans have access to exceptional healthcare, which includes improving health care quality close to home.
Q: How is the MNCCTN addressing access to cancer trials?
MR and DY: The MNCCTN is a partnership of several health care systems and research organizations that collaborate together to bring cancer clinical trials to underrepresented populations. MNCCTN is led by the Masonic Cancer Center and the University of Minnesota, both based in Minneapolis. We bring cancer clinical trials from academic institutions to 24 rural community sites in Greater Minnesota. MNCCTN provides funding for infrastructure, staffing, training, equipment and more to make research possible at these clinics.
Q: What is unique about the MNCCTN patient population in terms of barriers to access?
MR and DY: Prior to MNCCTN, most of our sites did not offer any cancer research opportunities because of lack of research staffing. By providing clinical trial research support, MNCCTN hopes to overcome barriers to clinical trial participation, including transportation, cost, time away from work, finding child care and more by allowing patients to participate in studies closer to home. There is also a lack of awareness about cancer clinical trials and trust that inhibits trial participation. MNCCTN aims to increase comfort and knowledge of clinical trials through community outreach and engagement and other education and communication initiatives.
Q: What are the biggest challenges or opportunities for growth in improving access to cancer trials?
MR and DY: A significant challenge is lack of awareness of the purpose and value of clinical trials across all communities. Many people don't know that cancer clinical trials are an important, and sometimes the best, treatment option available to them. People are most likely to join a clinical trial when it's discussed with them by their provider whom they trust. When providers are champions for clinical research, the other barriers become surmountable.
There is also a lack of inclusion in clinical trials, especially in terms of diverse populations. There are many factors that play into this, including trial designs, eligibility criteria, cost, distrust, health literacy and providers not offering trial opportunities to diverse communities. Interested and engaged providers with the appropriate supporting teams are essential to improving access to cancer clinical trials.
Q: What does the future of cancer trials look like to you?
MR and DY: Sponsors and regulators are increasingly looking at ways to decentralize clinical trials so that more of the study activities can be done at home or closer to home for participants. Decentralization might include remote consent, shipping study agents to participants' homes, conducting visits over the phone or telehealth, or utilizing in-home nursing services. The pandemic necessitated many of these changes and there is a lot of effort now to continue these practices that can decrease the participation burden. Building greater awareness in primary care and among other healthcare providers so more health care systems are invested and offer trial opportunities to patients, especially in the area of prevention and cancer survivorship, are important as well. Some cancer therapies, especially immuno- and cellular therapies, may be highly effective but are associated with a need for close monitoring for side effects. Delivering these types of therapies to cancer deserts will require thought and planning to ensure patient safety.