NCI–Clinical Trial Accrual in a Community Network Affiliated with a Designated Cancer Center

Abstract

Most cancer care is delivered in the community, while most clinical trials exist in academic centers. We analyzed clinical trial accrual of a tertiary care cancer center and its affiliated community sites to better understand what types of trials accrued at the community sites and whether community accrual increased ethnic diversity. The institutional clinical trial database was searched for solid tumor accruals during 2018–2019. Patient’s race was abstracted, and trial’s funding source, phase, and disease type/stage were tabulated. Of 3689 accruals, 133 were at community sites, representing 26 unique trials while the main campus accrued to 93 unique trials. Community site accruals were highest for breast and colorectal cancer, but patients with less common cancers such as renal, nasopharyngeal, and gastric cancer were also accrued at community sites. Accruals occurred to randomized trials, as well as phase Ib and translational biomarker studies. Minority patients constituted 20.0% and 32.5% of community site accruals for therapeutic and non-therapeutic trials respectively, compared to 20.6% and 29.8% of main campus accruals for therapeutic and non-therapeutic trials, respectively. We conclude that community sites affiliated with an academic cancer center can accrue to a broad spectrum of clinical trials while enhancing racial diversity in participation of clinical trials. Further expansion of access to clinical trials in community sites is necessary to broaden patient access to state-of-the-art and next-generation treatment options.

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

“…The City of Hope network consists of a tertiary center, designated as an NCI‐CCC, and 30 community practice sites within a 100 mile radius in Southern California. Recent reports from physicians in the City of Hope network have highlighted the efficiencies and limitations of this care model 20–26 …”

“…Recent reports from physicians in the City of Hope network have highlighted the efficiencies and limitations of this care model. 20 , 21 , 22 , 23 , 24 , 25 , 26 These pieces noted increased trial accrual, implementation of cancer screening programs, and integration of precision medicine efforts, among other collaborative measures, at affiliated community sites as favorable consequences of the tertiary–community partnership. The City of Hope model and similar partnerships nationwide may potentially ameliorate differences in oncology practice and outcomes between tertiary and community sites discussed in this study and other referenced publications.…”

The Midwest Sarcoma Trials Partnership: Bridging Academic and Community Networks in a Collaborative Approach to Sarcoma

“…Community sites have been shown to contribute up to one-third of total clinical trial accruals across DCC-associated networks [ 14 ]. The availability of clinical trials for patients who initially present to a community site associated with the City of Hope has led to increased access to clinical trials for patients of diverse backgrounds [ 15 ].…”

Challenges in Recruitment and Retention

“…Unless participation can take place remotely or there are the necessary resources available to support travel accommodations, participants must have access to a physical healthcare setting that can support research activities. As a result, most individuals who choose to enroll in cancer research studies live in larger metropolitan areas, where major and academic centers are located 34 . Healthcare deserts, or geographic locations that are medically underserved, pose a significant barrier to research participation 35,36 .…”