Characterizing the relationships between tertiary and community cancer providers: Results from a survey of medical oncologists in Southern California

Abstract

Background Tertiary cancer centers offer clinical expertise and multi‐modal approaches to treatment alongside the integration of research protocols. Nevertheless, most patients receive their cancer care at community practices. A better understanding of the relationships between tertiary and community practice environments may enhance collaborations and advance patient care. Methods A 31‐item survey was distributed to community and tertiary oncologists in Southern California using REDCap. Survey questions assessed the following attributes: demographics and features of clinical practice, referral patterns, availability and knowledge of clinical trials and precision medicine, strategies for knowledge acquisition, and integration of community and tertiary practices. Results The survey was distributed to 98 oncologists, 85 (87%) of whom completed it. In total, 52 (61%) respondents were community practitioners and 33 (38%) were tertiary oncologists. A majority (56%) of community oncologists defined themselves as general oncologists, whereas almost all (97%) tertiary oncologists reported a subspecialty. Clinical trial availability was the most common reason for patient referrals to tertiary centers (73%). The most frequent barrier to tertiary referral was financial considerations (59%). Clinical trials were offered by 97% of tertiary practitioners compared to 67% of community oncologists (p = 0.001). Most oncologists (82%) reported only a minimal‐to‐moderate understanding of clinical trials available at regional tertiary centers. Conclusions Community oncologists refer patients to tertiary centers primarily with the intent of clinical trial enrollment; however, significant gaps exist in their knowledge of trial availability. Our results identify the need for enhanced communication and collaboration between community and tertiary providers to expand patients’ access to clinical trials.

Barriers to Clinical Trial Implementation Among Community Care Centers

“…10 This study was reviewed and determined to meet the criteria for exemption for review and the requirement for informed consent by the institutional review board at City of Hope Comprehensive Cancer Center. Building from our group’s prior experience of evaluating clinical trial barriers specific to Southern California, 11 the questionnaire herein consisted of three broad categories: cancer center demographic characteristics, clinical trial characteristics, and referral practices. Demographic variables of interest included survey respondents’ role at their center, geographic location, patient volume, academic or nonacademic affiliation, and availability of cancer research at their centers.…”

“…10 This study was reviewed and determined to meet the criteria for exemption for review and the requirement for informed consent by the institutional review board at City of Hope Comprehensive Cancer Center. Building from our group's prior experience of evaluating clinical trial barriers specific to Southern California, 11…”

Clinical Network Systems Biology: Traversing the Cancer Multiverse

“…Oncology pathways that guide physicians have been implemented across the City of Hope network, and applying such a strategy can ensure that patients are assigned appropriate therapies based on their biomarker profile both in the academic and community practice settings [ 66 , 67 ]. Most cancer patients start their cancer journey with a community oncologist, and the main reason they are referred to an academic site is to enroll in a clinical trial; nevertheless, cooperation and communication between sites needs to increase [ 68 ]. The complete incorporation and cross-collaboration of clinical trial systems from the lowest levels (e.g., community sites) to the highest levels (e.g., national networks) is critical in expanding access to clinical trials, which are specifically biomarker-driven [ 30 , 67 ].…”