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Unger JM, LeBlanc M, George S, Wolmark N, Curran WJ, O'Dwyer PJ, Schnall MD, Mannel RS, Mandrekar SJ, Gray RJ, Zhao F, Bah M, Vaidya R, Blanke CD. Population, Clinical, and Scientific Impact of National Cancer Institute's National Clinical Trials Network Treatment Studies. J Clin Oncol 2023; 41:2020-2028. [PMID: 36480773 PMCID: PMC10082246 DOI: 10.1200/jco.22.01826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE In the United States, the National Cancer Institute National Cancer Clinical Trials Network (NCTN) groups have conducted publicly funded oncology research for 50 years. The combined impact of all adult network group trials has never been systematically examined. METHODS We identified randomized, phase III trials from the adult NCTN groups, reported from 1980 onward, with statistically significant findings for ≥ 1 clinical, time-dependent outcomes. In the subset of trials in which the experimental arm improved overall survival, gains in population life-years were estimated by deriving trial-specific hazard functions and hazard ratios to estimate the experimental treatment benefit and then mapping this trial-level benefit onto the US cancer population using registry and life-table data. Scientific impact was based on citation data from Google Scholar. Federal investment costs per life-year gained were estimated. The results were derived through December 31, 2020. RESULTS One hundred sixty-two trials comprised of 108,334 patients were analyzed, representing 29.8% (162/544) of trials conducted. The most common cancers included breast (34), gynecologic (28), and lung (14). The trials were cited 165,336 times (mean, 62.2 citations/trial/year); 87.7% of trials were cited in cancer care guidelines in favor of the recommended treatment. These studies were estimated to have generated 14.2 million (95% CI, 11.5 to 16.5 million) additional life-years to patients with cancer, with projected gains of 24.1 million (95% CI, 19.7 to 28.2 million) life-years by 2030. The federal investment cost per life-year gained through 2020 was $326 in US dollars. CONCLUSION NCTN randomized trials have been widely cited and are routinely included in clinical guidelines. Moreover, their conduct has predicted substantial improvements in overall survival in the United States for patients with oncologic disease, suggesting they have contributed meaningfully to this nation's health. These findings demonstrate the critical role of government-sponsored research in extending the lives of patients with cancer.
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Affiliation(s)
- Joseph M. Unger
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA
| | - Michael LeBlanc
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA
| | - Suzanne George
- Office of the Alliance Group Chair, Brigham and Women's Hospital, Boston, MA
| | - Norman Wolmark
- NRG Oncology, Philadelphia, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Peter J. O'Dwyer
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mitchell D. Schnall
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert S. Mannel
- Stephenson Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK
| | - Sumithra J. Mandrekar
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Robert J. Gray
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network Biostatistics Center, Dana-Farber Cancer Institute, Boston, MA
| | - Fengmin Zhao
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network Biostatistics Center, Dana-Farber Cancer Institute, Boston, MA
| | - Mariama Bah
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA
| | - Riha Vaidya
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA
| | - Charles D. Blanke
- SWOG Cancer Research Group Chair's Office, Oregon Health and Science University Knight Cancer Institute, Portland, OR
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Jorge S, Masshoor S, Gray HJ, Swisher EM, Doll KM. Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials. J Natl Compr Canc Netw 2023; 21:27-32.e2. [PMID: 36634612 DOI: 10.6004/jnccn.2022.7068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Significant disparities exist in recruitment of minorities to clinical trials, with much of the prior literature focused on race/ethnicity only. Limited English proficiency (LEP) is a known barrier in healthcare that may also drive disparities in trial enrollment. We sought to determine participation rates in gynecologic oncology trials among patients with LEP and to explore barriers to their participation. METHODS In a retrospective cohort study, electronic health record data from >2,700 patients treated over 2 years at one academic gynecologic oncology practice were abstracted and the primary exposure of having LEP was identified. The primary outcome was enrollment in a clinical trial. Demographic, financial, clinical, and healthcare access-related covariates were also abstracted and considered as potential confounders in a multivariable logistic regression model. Age, race, ethnicity, and insurance status were further examined for evidence of effect modification. In addition, a survey was administered to all gynecologic oncology research staff and gynecologic oncology providers (n=25) to assess barriers to research participation among patients with LEP. RESULTS Clinical trial enrollment was 7.5% among fluent English speakers and 2.2% among patients with LEP (risk ratio, 0.29; 95% CI, 0.11-0.78; P=.007), and remained significantly lower in patients with LEP after adjusting for the identified confounders of Hispanic ethnicity and insurance payer (odds ratio, 0.34; 95% CI, 0.12-0.97; P=.043). There was a trend toward race and LEP interaction: Asian patients were equally likely to participate in research regardless of language fluency, whereas White and Black patients with LEP were less likely to participate than non-LEP patients in both groups (P=.07). Providers reported that the most significant barriers to enrollment of patients with LEP in research were unavailability of translated consent forms and increased time needed to enroll patients. CONCLUSIONS Patients with LEP were 3.4 times less likely to participate in gynecologic oncology trials than fluent English speakers. De-aggregation of race, ethnicity, and language proficiency yielded important information about enrollment disparities. These findings offer avenues for future interventions to correct disparities.
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Affiliation(s)
- Soledad Jorge
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | | | - Heidi J Gray
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Kemi M Doll
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
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Snyder RA, Katz MHG. Fundamentals of Conducting Cooperative Group Trials Through the National Clinical Trials Network. Surg Oncol Clin N Am 2023; 32:1-12. [PMID: 36410910 DOI: 10.1016/j.soc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review discusses the benefits of performing multidisciplinary trials through the cooperative group mechanism, outlines the process from trial concept to activation, and discusses opportunities for surgeons to become involved in cancer cooperative trials.
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Affiliation(s)
- Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite 4S-24, Greenville, NC 27834, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, Unit 1484, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Stensland KD, Damschroder LJ, Sales AE, Schott AF, Skolarus TA. Envisioning clinical trials as complex interventions. Cancer 2022; 128:3145-3151. [PMID: 35766902 PMCID: PMC9378578 DOI: 10.1002/cncr.34357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
Abstract
Clinical trials are critical components of modern health care and infrastructure. Trials benefit society through scientific advancement and individual patients through trial participation. In fact, billions of dollars are spent annually in support of these benefits. Despite the massive investments, clinical trials often fail to accomplish their primary aims and trial enrollment rates remain low. Prior efforts to improve trial conduct and enrollment have had limited success, perhaps due to oversimplification of the complex, multilevel nature of trials. For these reasons, the authors propose applying implementation science to the clinical trials context. In this commentary, the authors posit clinical trials as complex, multilevel evidence-based interventions with significant societal and individual benefits yet with persistent gaps in implementation. An application of implementation science concepts to the clinical trials context as means to build common vocabulary and establish a platform for applying implementation science and practice to improve clinical trial conduct is introduced. Applying implementation science to the clinical trials context can augment improvement efforts and build capacity for better and more efficient evidence-based care for all patients and trial stakeholders throughout the clinical trials enterprise.
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Affiliation(s)
- Kristian D. Stensland
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Laura J. Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Anne E. Sales
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management Research, VA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Sinclair School of Nursing, University of Missouri and Department of Family and Community MedicineUniversity of MissouriColumbiaMissouriUSA
| | - Anne F. Schott
- University of Michigan Rogel Cancer CenterAnn ArborMichiganUSA
| | - Ted A. Skolarus
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management Research, VA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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5
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Brawley OW, Goldberg P. The 50 years' war: The history and outcomes of the National Cancer Act of 1971. Cancer 2021; 127:4534-4540. [PMID: 34874558 DOI: 10.1002/cncr.34040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/09/2022]
Abstract
The National Cancer Act of 1971 instigated 50 years of momentum that raised the federal investment in cancer research from $500 million in 1972 to $6.5 billion in 2021. This investment has fueled basic, translational, and clinical research that has had a tremendous impact on our understanding of cancer and our ability to prevent, diagnose, and treat it. It has also affected many other diseases.
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Affiliation(s)
- Otis W Brawley
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland
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6
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Merkhofer C, Chennupati S, Sun Q, Eaton KD, Martins RG, Ramsey SD, Goulart BHL. Effect of Clinical Trial Participation on Costs to Payers in Metastatic Non-Small-Cell Lung Cancer. JCO Oncol Pract 2021; 17:e1225-e1234. [PMID: 34375561 PMCID: PMC8360452 DOI: 10.1200/op.20.01092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/06/2021] [Accepted: 06/22/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The costs associated with clinical trial enrollment remain uncertain. We hypothesized that trial participation is associated with decreased total direct medical costs to health care payers in metastatic non-small-cell lung cancer. METHODS In this retrospective cohort study, we linked clinical data from electronic medical records to sociodemographic data from a cancer registry and claims data from Medicare and two private insurance plans. We used a difference-in-difference analysis to estimate mean per patient per month total direct medical costs for patients enrolled on a second-line (2L) trial versus patients receiving standard-of-care 2L systemic therapy. RESULTS Among 70 eligible patients, the difference-in-difference of mean per patient per month total direct medical costs between 2L trial participants and nonparticipants was -$6,663 (P = .01), for a mean savings of $45,308 per patient for the duration of 2L trial therapy. In a secondary analysis by primary insurance payer, this difference-in-difference was -$5,526 (P = .26) for patients with commercial insurance and -$7,432 (P = .01) for patients with Medicare. CONCLUSION Participation in a 2L trial was associated with a $6,663 per month cost savings to health care payers for the duration of trial participation. Further studies are necessary to elucidate differences in cost savings from trial participation for Medicare and commercial payers. If confirmed, these results support health care payer investment in programs to improve clinical trial access and enrollment.
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Affiliation(s)
- Cristina Merkhofer
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Shasank Chennupati
- Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Keith D. Eaton
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Renato G. Martins
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA
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7
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Lawler M, Oliver K, Gijssels S, Aapro M, Abolina A, Albreht T, Erdem S, Geissler J, Jassem J, Karjalainen S, La Vecchia C, Lievens Y, Meunier F, Morrissey M, Naredi P, Oberst S, Poortmans P, Price R, Sullivan R, Velikova G, Vrdoljak E, Wilking N, Yared W, Selby P. The European Code of Cancer Practice. J Cancer Policy 2021; 28:100282. [DOI: 10.1016/j.jcpo.2021.100282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
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Acoba JD, Berenberg JL. University of Hawai'i Cancer Center Connection: University of Hawai'i Cancer Center: Collaboration Through Partnership with the National Cancer Institute. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:171-173. [PMID: 32432224 PMCID: PMC7226314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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9
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Good M, Castro K, Denicoff A, Finnigan S, Parreco L, Germain DS. National Cancer Institute: Restructuring to Support the Clinical Trials of the Future. Semin Oncol Nurs 2020; 36:151003. [PMID: 32265163 DOI: 10.1016/j.soncn.2020.151003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe the evolution and structure of the National Cancer Institute clinical trials programs, their notable accomplishments, nurses' roles in these accomplishments, and the essential role of nursing today and in the future. DATA SOURCES Manuscripts, government publications, websites, and professional communications. CONCLUSION Change is inevitable and a constant factor in the world of advancing science and clinical research. Nurses' contribution to research and evidence-based practice will continue to grow and is vital as the scientific landscape evolves. IMPLICATIONS FOR NURSING PRACTICE As the understanding of cancer biology increases and clinical trials evolve, nurses will need to remain key team members and leaders in National Cancer Institute Community Oncology Research Program and National Cancer Trials Network trials and their associated infrastructure.
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Affiliation(s)
- Marjorie Good
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD.
| | - Kathleen Castro
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Andrea Denicoff
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
| | - Shanda Finnigan
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
| | - Linda Parreco
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD
| | - Diane St Germain
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD
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10
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Unger JM, Blanke CD, LeBlanc M, Barlow WE, Vaidya R, Ramsey SD, Hershman DL. Association of Patient Demographic Characteristics and Insurance Status With Survival in Cancer Randomized Clinical Trials With Positive Findings. JAMA Netw Open 2020; 3:e203842. [PMID: 32352530 PMCID: PMC7193331 DOI: 10.1001/jamanetworkopen.2020.3842] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Few new treatments tested in phase 3 cancer randomized clinical trials show an overall survival benefit. Although understanding whether the benefits are consistent among all patient groups is critical for informing guideline care, individual trials are designed to assess the benefits of experimental treatments among all patients and are too small to reliably determine whether treatment benefits apply to demographic or insurance subgroups. OBJECTIVE To systematically examine whether positive treatment effects in cancer randomized clinical trials apply to specific demographic or insurance subgroups. DESIGN, SETTING, AND PARTICIPANTS Cohort study of pooled patient-level data from 10 804 patients in SWOG Cancer Research Network clinical treatment trials reported from 1985 onward with superior overall survival for those receiving experimental treatment. Patients were enrolled from 1984 to 2012. Maximum follow-up was 5 years. MAIN OUTCOMES AND MEASURES Interaction tests were used to assess whether hazard ratios (HRs) for death comparing standard group vs experimental group treatments were associated with age (≥65 vs <65 years), race/ethnicity (minority vs nonminority populations), sex, or insurance status among patients younger than 65 years (Medicaid or no insurance vs private insurance) in multivariable Cox regression frailty models. Progression- or relapse-free survival was also examined. Data analyses were conducted from August 2019 to February 2020. RESULTS In total, 19 trials including 10 804 patients were identified that reported superior overall survival for patients randomized to experimental treatment. Patients were predominantly younger than 65 years (67.3%) and female (66.3%); 11.4% were black patients, and 5.7% were Hispanic patients. There was evidence of added survival benefits associated with receipt of experimental therapy for all groups except for patients with Medicaid or no insurance (HR, 1.23; 95% CI, 0.97-1.56; P = .09) compared with those with private insurance (HR, 1.66; 95% CI, 1.44-1.92; P < .001; P = .03 for interaction). Receipt of experimental treatment was associated with reduced added overall survival benefits in patients 65 years or older (HR, 1.21; 95% CI, 1.11-1.32; P < .001) compared with patients younger than 65 years (HR, 1.41; 95% CI, 1.30-1.53; P < .001; P = .01 for interaction), although both older and younger patients appeared to strongly benefit from receipt of experimental treatment. The progression- or relapse-free survival HRs did not differ by age, sex, or race/ethnicity but differed between patients with Medicaid or no insurance (HR, 1.32; 95% CI, 1.06-1.64; P = .01) vs private insurance (HR, 1.74; 95% CI, 1.54-1.97; P < .001; P = .03 for interaction). CONCLUSIONS AND RELEVANCE Patients with Medicaid or no insurance may have smaller added benefits from experimental therapies compared with standard treatments in clinical trials. A better understanding of the quality of survivorship care that patients with suboptimal insurance receive, including supportive care and posttreatment care, could help establish how external factors may affect outcomes for these patients.
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Affiliation(s)
- Joseph M. Unger
- SWOG Cancer Research Network Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles D. Blanke
- SWOG Cancer Research Network Group Chair’s Office, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Michael LeBlanc
- SWOG Cancer Research Network Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - William E. Barlow
- SWOG Cancer Research Network Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Riha Vaidya
- SWOG Cancer Research Network Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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11
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Nevens H, Harrison J, Vrijens F, Verleye L, Stocquart N, Marynen E, Hulstaert F. Budgeting of non-commercial clinical trials: development of a budget tool by a public funding agency. Trials 2019; 20:714. [PMID: 31829233 PMCID: PMC6907219 DOI: 10.1186/s13063-019-3900-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/08/2019] [Indexed: 11/21/2022] Open
Abstract
Background Investigator-led multicentre randomised trials are essential to generate evidence on the optimal use of medical interventions. These non-commercial trials are often hampered by underfunding, which may lead to difficulties in gathering a team with the necessary expertise, a delayed trial start, slow recruitment and even early trial discontinuation. As a new public funder of pragmatic clinical trials, the KCE Trials programme was committed to correctly pay all trial activities in order to assure timely delivery of high-quality trial results. As no appropriate trial budget tool was readily publicly available that took into account the costs for the sponsor as well as the costs for participating sites, we developed a tool to make the budgeting of a clinical trial efficient, transparent and fair across applicants. Methods All trial-related activities of the sponsor and sites were categorised, and cost drivers were identified. All elements were included in a spreadsheet tool allowing the sponsor team to calculate in detail the various activities of a clinical trial and to appreciate the budget impact of specific cost drivers, e.g. a delay in recruitment. Hourly fees by role were adapted from published data. Fixed amounts per activity were developed when appropriate. Results This publicly available tool has already been used for 17 trials funded since the start of the KCE Trials programme in 2016, and it continues to be used and improved. This budget tool is used together with additional risk-reducing measures such as a multistep selection process with advance payments, a recruitment feasibility check by sponsor and funder, a close monitoring of study progress and a milestone-based payment schedule with the last payment made when the manuscript is submitted. Conclusions The budget tool helps the KCE Trials programme to answer relevant research questions in a timely way, within budget and with high quality, a necessary condition to achieve impact of this programme for patients, clinical practice and healthcare payers.
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Affiliation(s)
- Hilde Nevens
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium.
| | - Jillian Harrison
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - France Vrijens
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Leen Verleye
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Nelle Stocquart
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Elisabeth Marynen
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Frank Hulstaert
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
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12
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Implementation of the Australasian Teletrial Model: Lessons from practice. Asia Pac J Clin Oncol 2019; 15 Suppl 8:3-14. [DOI: 10.1111/ajco.13249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Obeng-Gyasi S, Kircher SM, Lipking KP, Keele BJ, Benson AB, Wagner LI, Carlos RC. Oncology clinical trials and insurance coverage: An update in a tenuous insurance landscape. Cancer 2019. [PMID: 31251394 DOI: 10.1002/cncr.32360.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Samilia Obeng-Gyasi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Kelsey P Lipking
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Benjamin J Keele
- Robert H. McKinney School of Law, Indiana University, Indianapolis, Indiana
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Lynne I Wagner
- Social Sciences and Health Policy Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
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14
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Winkfield KM. Improving access to cancer clinical trials by reducing the financial burden. Cancer 2019; 126:14-16. [PMID: 31581309 DOI: 10.1002/cncr.32523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Karen M Winkfield
- Department of Radiation Oncology, Wake Forest Baptist School of Medicine, Winston-Salem, North Carolina
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15
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Obeng-Gyasi S, Kircher SM, Lipking KP, Keele BJ, Benson AB, Wagner LI, Carlos RC. Oncology clinical trials and insurance coverage: An update in a tenuous insurance landscape. Cancer 2019; 125:3488-3493. [PMID: 31251394 DOI: 10.1002/cncr.32360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Samilia Obeng-Gyasi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Kelsey P Lipking
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Benjamin J Keele
- Robert H. McKinney School of Law, Indiana University, Indianapolis, Indiana
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Lynne I Wagner
- Social Sciences and Health Policy Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
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16
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Blanke CD, Crowley J, Baker LH, Fisher RI. In Memoriam: Charles A. Coltman, 1930 to 2018. J Clin Oncol 2019. [DOI: 10.1200/jco.19.00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Bertagnolli MM, Blaney SM, Blanke CD, Curran WJ, Dancey J, Mannel RS, O'Dwyer PJ, Schnall MD, Wolmark N. Current Activities of the Coalition of Cancer Cooperative Groups. J Natl Cancer Inst 2019; 111:11-18. [PMID: 30544145 DOI: 10.1093/jnci/djy190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 09/19/2018] [Indexed: 11/12/2022] Open
Abstract
The Coalition of Cancer Cooperative Groups is an organization representing the interests of patients and researchers who conduct research through the National Cancer Institute-supported National Clinical Trials Network (NCTN). The NCTN provides a crucial mechanism for executing practice-changing cancer clinical research to achieve both cancer control and development of new therapeutic agents or modality approaches. Public funding, largely through the National Cancer Institute, ensures that the work of the NCTN achieves important research that would not otherwise be accomplished in the private sector. In fall 2017, the Coalition of Cancer Cooperative Groups convened a Scientific Leadership Council to review the current state of the network with regard to research capabilities and to develop a list of research questions to be prioritized by the network. This report presents the results of this meeting, detailing a roadmap for future work by the NCTN.
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Affiliation(s)
- Monica M Bertagnolli
- Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, MA
| | - Susan M Blaney
- Department of Pediatrics, Division of Hematology and Oncology, Baylor School of Medicine, Houston, TX
| | - Charles D Blanke
- Department of Medicine, Division of Hematology and Oncology, Oregon Health and Science University's Knight Cancer Institute, Portland, OR
| | - Walter J Curran
- Department of Medicine, Division of Hematology and Oncology, Woodruff Health Sciences Center, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Janet Dancey
- Department of Oncology, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Robert S Mannel
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stephenson Cancer Institute, University of Oklahoma, Oklahoma City, OK
| | | | - Mitchell D Schnall
- Department of Radiology Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Norman Wolmark
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
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Abstract
Financial barriers to clinical trial enrollment are an area of active investigation. Financial toxicity as a concept describes how high costs and financial burden can lead to compromised care and outcomes. Despite the potential to yield large survival benefits and improved access to cutting-edge therapies, less than 5% of adult patients with cancer are enrolled in a clinical trial. Disparities in trial enrollment exist along age, ethnic, and sociodemographic lines, with younger, poorer, nonwhite patients with private insurance-the exact population who may be at highest risk for financial toxicity-less likely to participate. Cost and insurance concerns remain an obstacle for clinical trial enrollment for certain patient populations. Changing the clinical trial paradigm with a focus on addressing structural and clinical barriers to clinical trial enrollment is paramount. This includes expanding access to clinical trials within community populations, advocating for health policy changes to guarantee insurance coverage of clinical trial standard-of-care health care, and considering noncoercive financial assistance (particularly for indirect costs like travel and lodging) for participants to defray their additional costs of participation. Additional steps toward education, cost transparency, and expansion of foundation assistance may also improve equitable access to clinical trials for all.
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Affiliation(s)
- Fumiko Chino
- 1 Duke University Radiation Oncology, Durham, NC
| | - S Yousuf Zafar
- 2 Sanford School of Public Policy, Duke Cancer Institute, Durham, NC
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19
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Barrios CH, Reinert T, Werutsky G. Global Breast Cancer Research: Moving Forward. Am Soc Clin Oncol Educ Book 2018; 38:441-450. [PMID: 30231347 DOI: 10.1200/edbk_209183] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Breast cancer is a major global health problem and major cause of mortality. Although mortality trends are declining in high-income countries, trends are increasing in low- and middle-income countries (LMICs). Addressing global breast cancer research is a challenging endeavor, as notable disparities and extremely heterogeneous realities exist in different regions across the world. Basic global cancer health care needs have been addressed by the World Health Organization's (WHO) proposed list of essential medicines and by resource-stratified guidelines for screening and treatment. However, specific strategies are needed to address disparities in access to health care, particularly access to new therapies. Discussions about global research in breast cancer should take into account the ongoing globalization of clinical trials. Collaboration fostered by well-established research organizations in North America and Europe is essential for the development of infrastructure and human resources in LMICs so that researchers in these countries can begin to address regional questions. Specific challenges that impact the future of global breast cancer research include increasing the availability of trials in LMICs, developing strategies to increase patient participation in clinical trials, and creation of clear guidelines for the development of real-world evidence-based research. The main objective of this review is to encourage the discussion of challenges in global breast cancer research with the hope that collectively we will be able to generate workable proposals to advance the field.
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Affiliation(s)
- Carlos H Barrios
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Tomás Reinert
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Gustavo Werutsky
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
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20
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Ryan CW. Mechanisms and funding opportunities in genitourinary cancer clinical research. Urol Oncol 2018; 37:318-323. [PMID: 30072304 DOI: 10.1016/j.urolonc.2018.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/21/2018] [Accepted: 05/26/2018] [Indexed: 11/16/2022]
Abstract
Progress in the prevention, diagnosis, and treatment of genitourinary cancers is dependent on well-conducted clinical trials. The complexity and cost of clinical research continues to escalate, and success is dependent on adequate funding. Opportunities to fund such research include federal, industry, and private sources. The mechanisms whereby larger trials are conducted include contract research organizations, publically- and privately funded consortia, and the National Clinical Trials Network of the National Cancer Institute. The National Clinical Trials Network is the prime venue for investigators to conduct independent, phase III trials in the United States.
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Affiliation(s)
- Christopher W Ryan
- Professor of Medicine, Knight Cancer Center, Oregon Health & Science University, Portland, OR.
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21
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Ho G, Wun T, Muffly L, Li Q, Brunson A, Rosenberg AS, Jonas BA, Keegan TH. Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California. Cancer 2018; 124:1938-1945. [PMID: 29451695 PMCID: PMC6911353 DOI: 10.1002/cncr.31296] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/11/2018] [Accepted: 01/19/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML). METHODS Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute-designated cancer center (NCI-CC). Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ≤60 days from diagnosis). RESULTS Of the 7007 patients with AML, 1762 (25%) were treated at an NCI-CC. Patients with AML who were treated at NCI-CCs were more likely to be aged ≤65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI-CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38-0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non-NCI-CCs. CONCLUSIONS The initial treatment of adult patients with AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938-45. © 2018 American Cancer Society.
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Affiliation(s)
- Gwendolyn Ho
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
- Kaiser Permanente North Valley, Department of Hematology Oncology, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Aaron S. Rosenberg
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Brian A. Jonas
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
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Oosting SF, Fehrmann RS, de Vries EGE. Indispensable benefit of independent investigator-driven research in a changing clinical trial landscape. ESMO Open 2017; 2:e000272. [PMID: 29226919 PMCID: PMC5640100 DOI: 10.1136/esmoopen-2017-000272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sjoukje F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rudolf S Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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