A Close Look at Clinical Trials in Oncology and Beyond: Barriers to Participation

In this episode of OncChats: A Close Look at Clinical Trials in Oncology and Beyond, Christina Brennan, MD,MBA, FACRP, and Richard D. Carvajal, MD, of Northwell Health and Northwell’s Feinstein Institutes for Medical Research, discuss the challenges of increasing awareness and participation in clinical trials, underscoring the need for education and support for community physicians, as well as making clinical trials more accessible and less burdensome for busy providers.

Brennan: Patients trust their providers the most, but yet we have challenges still when providers don’t bring up clinical trials as an option. How do you think that we can move the needle more for community physicians and others to really bring up clinical trials as part of their conversations? Do you think it’s education awareness? I’m still trying to figure out why we’re not doing a better job with this.

Carvajal: I wish I had that magic bullet answer for you. But part of this is examining, what are the barriers [to doing this,] right? We know there are many, many barriers that providers and patients have [with regard to] clinical trial participation, etc. Part of this is just awareness on both sides.

Brennan:Yeah.

Carvajal: But how do our physicians know what the appropriate trial portfolio is for each clinical scenario? And again, our general practitioners, for instance, in internal medicine, are not going to know all the hypertension and diabetes and cholesterol trials that are ongoing, whereas our cardiologists, who focus on hypertension would. So, how do we make sure our generalists have access to the expertise and knowledge that the subspecialists might have?

Brennan: I agree. When you say the word “awareness,” it became clear to me and others a few years ago that even our own employees and faculty were not aware of the breadth of clinical trials that Northwell was participating in. If we don’t have our own employees as our ambassadors to [ensure] patients themselves or in the communities [are] having these discussions, we’re not going to be able to do a good job for [them]. We [must] have our own awareness [first]. When I walk through the halls of the cancer Institute, I love to see the banners that are [placed] high up [and spread from] the ceiling down [that tell us that] clinical trials are happening there. You want that to become a part of the practice and the discussions.

One thing that I think about for these community providers—and not everyone can be an investigator on a trial, we know that—[is that] a lot of them are not having the opportunity to participate. When you mention some of the basic trials on hypertension, cardiac prevention around lipids, etc. [some are] not getting an opportunity to participate, and there is still that resistance of referral, because they feel sometimes that they will lose their patients to that clinical trial list. I would look at this as an opportunity in the industry. Although we want to go back to our key opinion leaders on a lot of these trials, we have to give opportunities to new investigators, young and growing investigators, to be able to reach them, as well. I don’t know, what are your thoughts on that?

Carvajal: That is so critical. What would the ideal state be for clinical trials? A potential ideal state is that every healthcare organization is a trial site, and every clinician is an investigator, right? Within the cancer institute, what we’ve done is try to move in that direction, where 8 of our 10 cancer centers are actually clinical trial sites and all our cancer institute members are investigators.

Brennan: That’s so important.

Carvajal: Right? Now, just because someone’s an investigator and we can do trials at a site still does not mean it’s going to happen, because of all the work that’s involved to do this. As such, another important piece is, that we have to take all the complexities—which are increasing, of course—that are involved with these trials and make it simple for the clinicians to actually participate. So, within cancer, within our Cancer Clinical Trials Office, we have an enormous staff of research nurses, healthcare professionals, coordinators, and so forth, who are able to really lift that burden of identifying consenting patients and take the documentation from the physicians who are very busy. Even if [those busy physicians] want to participate, it’s just very challenging [for them so] let’s take as much of the burden as possible off of them and make it easier for them to enroll their patients so their patients get the benefit from that study.