Jul 20, 2023
By Geraldine Carroll, ASCO Publishing
JCO Oncology Practice (JCO OP) is shining a spotlight on quality care with a selection of studies aimed at promoting high-quality and equitable care across the cancer trajectory, from diagnosis through treatment to survivorship and the end of life.
“Our hope is that researchers and clinicians will find these manuscripts helpful in addressing quality care and equity issues that transcend international borders,” said guest editor Fay J. Hlubocky, PhD, MA, clinical health psychologist and ethicist at the University of Chicago Medicine Comprehensive Cancer Center.
The interdisciplinary research featured in JCO OP includes impactful studies that were presented at the 2022 ASCO Quality Care Symposium.1
Decentralized Clinical Trials to Improve Diversity and Reduce Costs
There is a rising consensus that decentralized clinical trials (DCTs) have become increasingly important, especially since the COVID-19 pandemic. DCTs are patient-centered clinical trials characterized by the remote delivery of trial elements such as drug delivery, adverse event assessments, imaging, and lab draws.
One study explores DCTs as a patient-centered paradigm for enhancing accrual and diversity in surgical and multidisciplinary trials in oncology.2 “DCTs may offer significant advantages over traditional clinical trials including improved convenience for patients, faster patient accrual, cost savings, and expanded geographic reach,” said first author Taiwo Adesoye, MD, MPH, assistant professor in the Breast Surgical Oncology Department at the University of Texas MD Anderson Cancer Center.
The study cites recent analysis of global clinical trials that found 76% of participants were white, 11% were Asian, and only 7% were Black. Additionally, 13% of trial participants were Hispanic or Latino.3,4
“DCTs also have the potential to improve diversity (race, age, and gender) of clinical trial participants who have been typically excluded from traditional trials,” said Dr. Adesoye.
To effectively implement DCTs, a robust understanding of the potential barriers to success is key, Dr. Adesoye added. For example, patients impacted by the digital divide characterized by limited digital literacy and access to broadband may be underrepresented in DCTs, and not all aspects of a clinical trial are amenable to decentralization. However, a hybrid approach where certain conventional aspects of a clinical trial are preserved, Dr. Adesoye noted, is a viable option.
“Multi-level solutions locally and nationally are needed to address the long-standing digital divide by improving reliable access to information and communication technology as well as expanding effective digital literacy initiatives on a large scale,” Dr. Adesoye said, adding that patient input is critical to the success of this collaborative effort.
Socioeconomic and Health Literacy Factors as Predictors for Delayed Care
Understanding the patient-related factors that are associated with delays in cancer treatment will help tailor care delivery and provide support for at-risk patients, according to Vikas Mehta, MD, MPH, FACS, vice chair and associate professor in the Department of Otolaryngology at the Montefiore Medical Center. Dr. Mehta led a retrospective study that assessed patient-related factors associated with prolonged time to treatment initiation (≥30 days) in a racially diverse and socioeconomically challenged population.5
“We chose [patients with various solid tumors] where delays have been shown to adversely impact oncologic outcomes,” Dr. Mehta said. The study reported that delays in time to treatment initiation were correlated with receiving strictly outpatient care, increased medical comorbidities, Spanish language preference, lack of insurance, former tobacco use, younger age at the time of diagnosis, and residing in a zip code with a lower median household income.
“These results implicate several socioeconomic and health literacy factors as predictors for delays in care and further elucidate how these factors lead to disparate oncologic outcomes,” Dr. Mehta said. By further understanding which factors are associated with delayed or incomplete care, providers can direct more intensive care coordination for these at-risk patients and thus hope to close the disparity gap.
Dr. Mehta proposed strategies that include the expansion of navigation services, real-time patient tracking within the EHR to identify when they miss appointments, and value-based/bundled payment models that streamline the insurance approval process, thereby creating more efficiency with scheduling and reducing administrative burden.
Biopsychosocial Screening to Address Unmet Needs
There is a growing recognition in oncology of the importance of addressing the biopsychosocial needs of patients to improve health outcomes and reduce health care costs. In Brazil, Cristiane Decat Bergerot, PhD, and colleagues performed the first study in Latin America to evaluate the effectiveness of a biopsychosocial screening (BPS) program on hospital admissions and the length of stay among patients with cancer.6
“There is a need for more comprehensive and integrated approaches to patient care that not only consider physical well-being but also mental, social, and emotional well-being,” said Dr. Decat Bergerot, whose study found major patient- and system-level concerns of admission rates and length of stay for a cohort of patients in Brazil.
Additional research featured in JCO OP addresses the integration of remote symptom and biometric monitoring for patients receiving chemotherapy and early-phase clinical trial participants at risk for experiencing worse clinical outcomes. Studies also explore the potential to identify baseline characteristics of early-phase clinical trial participants that predict for poor clinical outcomes and highlight an opportunity for targeted supportive care interventions, and investigators in France report on proactive survivorship care planning for patients with breast cancer at a major French cancer center.7-9
References
- Hlubocky FJ , Peppercorn J. Advancing Health Equity through Quality Cancer Care and Solution-Driven Innovative Interventions: An Introduction to the JCO OP Quality Symposium 2022 Special Series. JCO Oncol Pract. 2023 Jun;19:311-2.
- Adesoye T, Katz MHG, Offodile AC 2nd. Meeting Trial Participants Where They Are: Decentralized Clinical Trials as a Patient-Centered Paradigm for Enhancing Accrual and Diversity in Surgical and Multidisciplinary Trials in Oncology. JCO Oncol Pract. 2023 Feb 23;OP2200702. Epub ahead of print.
- U.S. Food and Drug Administration. 2015–2019 Drug Trials Snapshots Summary Report. November 2020. Available at: https://www.fda.gov/media/143592/download. Accessed 9 May 2023.
- Sharma A, Palaniappan L. Improving diversity in medical research. Nat Rev Dis Primers. 2021;7:74.
- Sheni R, Qin J, Viswanathan S, et al. Predictive Factors for Cancer Treatment Delay in a Racially Diverse and Socioeconomically Disadvantaged Urban Population. JCO Oncol Pract. 2023 Mar 31:OP2200779. Epub ahead of print.
- Bergerot CD, Bergerot PG, Molina LNM, et al. The Impact of a Biopsychosocial Screening Program on Clinical and Hospital-Based Outcomes in Cancer. JCO Oncol Pract. 2023 Feb 8;OP2200751. Epub ahead of print.
- Offodile AC 2nd, Delgado D, Lin YL, et al. Integration of Remote Symptom and Biometric Monitoring Into the Care of Adult Patients With Cancer Receiving Chemotherapy - A Decentralized Feasibility Pilot Study. JCO Oncol Pract. 2023 Feb 23:OP2200676. Epub ahead of print.
- Lundquist DM, Jimenez R, Durbin S, et al. Identifying Early-Phase Clinical Trial Participants at Risk for Experiencing Worse Clinical Outcomes. JCO Oncol Pract. 2023 Feb 15:OP2200742. Epub ahead of print.
- Franzoi MA, Degousée L, Martin E, et al. Implementing a PROACTive care pathway to empower and support survivors of breast cancer. JCO Oncol Pract. 2023 Jun;19:353-61.