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Sheikh S, Bruno DS, Sun Y, Deng V, McClelland S, Obi E, Vinson V, Firstencel A, Lanese B, Lausin L, Dorth JA, Zaorsky NG, Hoy K, Krishnamurthi S. Impact of Clinical Trial Design on Recruitment of Racial and Ethnic Minorities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02440-x. [PMID: 38637443 DOI: 10.1007/s13187-024-02440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
Knowledge related to how oncology treatment trial design influences enrollment of racial and ethnic minorities is limited. Rigorous identification of clinical trial design parameters that associate favorably with minority accrual provides educational opportunities for individuals interested in designing more representative treatment trials. We identified oncology trials with a minimum of 10 patients at an NCI-Designated Comprehensive Cancer Center from 2010 to 2021. We defined a study endpoint of racial and ethnic minority accrual greater than zero. Multivariable logistic regression was used to determine whether co-variables predicted our study endpoint. P-values of less than 0.05 were considered significant. A total of 352 cancer trials met eligibility criteria. These studies enrolled a total of 7981 patients with a total of 926 racial and ethnic minorities leading to a median enrollment of 10%. Trials open in community sites (yes versus no) were more likely to have a minority patient (OR, 2.21; 95% CI, 1.02-4.96) as well as pilot/phase I studies compared to phase II/III (OR, 3.19; 95% CI, 1.34-8.26). Trials incorporating immunotherapy (yes versus no) were less likely to have a minority patient (OR, 0.47; 95% CI, 0.23-0.94). Trials open in community sites as well as early phase treatment studies were more likely to accrue minority patients. However, studies including immunotherapy were less likely to accrue racial and ethnic minorities. Knowledge gained from our analysis may help individuals design oncology treatment trials that are representative of more diverse populations.
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Affiliation(s)
- Saad Sheikh
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh PA, 15232, USA.
| | - Debora S Bruno
- Department of Hematology and Medical Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Yilun Sun
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Victoria Deng
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Shearwood McClelland
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Elizabeth Obi
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Valerie Vinson
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - April Firstencel
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Bob Lanese
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Loretta Lausin
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Jennifer A Dorth
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Kevin Hoy
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Smitha Krishnamurthi
- Department of Hematology and Medical Oncology, Case Comprehensive Cancer Center, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, 44195, USA
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Silverwood S, Lichter K, Conway A, Drew T, McComas KN, Zhang S, Gopakumar GM, Abdulbaki H, Smolen KA, Mohamad O, Grover S. Distance Traveled by Patients Globally to Access Radiation Therapy: A Systematic Review. Int J Radiat Oncol Biol Phys 2024; 118:891-899. [PMID: 37949324 DOI: 10.1016/j.ijrobp.2023.10.030] [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: 04/24/2023] [Revised: 09/30/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This study aimed to systematically review the literature on the travel patterns of patients seeking radiation therapy globally. It examined the distance patients travel for radiation therapy as well as secondary outcomes, including travel time. METHODS AND MATERIALS A comprehensive search of 4 databases was conducted from June 2022 to August 2022. Studies were included in the review if they were observational, retrospective, randomized/nonrandomized, published between June 2000 and June 2022, and if they reported on the global distance traveled for radiation therapy in the treatment of malignant or benign disease. Studies were excluded if they did not report travel distance or were not written in English. RESULTS Of the 168 studies, most were conducted in North America (76.3%), with 90.7% based in the United States. Radiation therapy studies for treating patients with breast cancer were the most common (26.6%), while external beam radiation therapy was the most prevalent treatment modality (16.6%). Forty-six studies reported the mean distance traveled for radiation therapy, with the shortest being 4.8 miles in the United States and the longest being 276.5 miles in Iran. It was observed that patients outside of the United States traveled greater distances than those living within the United States. Geographic location, urban versus rural residence, and patient population characteristics affected the distance patients traveled for radiation therapy. CONCLUSIONS This systematic review provides the most extensive summary to date of the travel patterns of patients seeking radiation therapy globally. The results suggest that various factors may contribute to the variability in travel distance patterns, including treatment center location, patient residence, and treatment modality. Overall, the study highlights the need for more research to explore these factors and to develop effective strategies for improving radiation therapy access and reducing travel burden.
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Affiliation(s)
- Sierra Silverwood
- Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| | - Katie Lichter
- Department of Radiation Oncology, University of California, San Francisco, California
| | | | - Taylor Drew
- Stritch School of Medicine, Maywood, Illinois
| | - Kyra N McComas
- Department of Radiation Oncology Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siqi Zhang
- Biostatistics Analysis Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hasan Abdulbaki
- University of California, San Francisco, School of Medicine, San Francisco, California
| | | | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Botswana-UPenn Partnership, Philadelphia, Pennsylvania
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McIntire RK, Keith SW, Nowlan T, Butt S, Cambareri K, Callaghan J, Halstead T, Chandrasekar T, Kelly WK, Leader AE. Predictors of consenting to participate in a clinical trial among urban cancer patients. Contemp Clin Trials 2023; 125:107061. [PMID: 36567059 DOI: 10.1016/j.cct.2022.107061] [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: 09/06/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patient participation in clinical trials is influenced by demographic and other individual level characteristics. However, there is less research on the role of geography and neighborhood-level factors on clinical trial participation. This study identifies the demographic, clinical, geographic, and neighborhood predictors of consenting to a clinical trial among cancer patients at a large, urban, NCI-designated cancer center in the Mid-Atlantic region. METHODS We used demographic and clinical data from patients diagnosed with cancer between 2015 and 2017. We geocoded patient addresses and calculated driving distance to the cancer center. Additionally, we linked patient data to neighborhood-level educational attainment, social capital and cancer prevalence. Finally, we used generalized linear mixed-effects conditional logistic regression to identify individual and neighborhood-level predictors of consenting to a clinical trial. RESULTS Patients with higher odds of consenting to trials were: Non-Hispanic White, aged 50-69, diagnosed with breast, GI, head/neck, hematologic, or certain solid tumor cancers, those with cancers at regional stage, never/former tobacco users, and those with the highest neighborhood social capital index. Patients who lived further from the cancer center had higher odds of consenting to a trial. With every 1-km increase in residential distance, there was a 4% increase in the odds that patients would consent to a trial. Neither of the additional neighborhood-level variables predicted consenting to a clinical trial. CONCLUSIONS This study identifies important demographic, patient-level, and geographic factors associated with consenting to cancer clinical trials, and lays the groundwork for future research exploring the role of neighborhood-level factors in clinical trial participation.
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Affiliation(s)
- Russell K McIntire
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America.
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology, Physiology, & Cancer Biology, Thomas Jefferson University, 130 S 9(th) St., 17(th) Floor, Philadelphia, PA 19107, United States of America
| | - Thomas Nowlan
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Seif Butt
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Katherine Cambareri
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Joseph Callaghan
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Tiara Halstead
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10(th) Floor, Philadelphia, PA 19107, United States of America
| | - Thenappan Chandrasekar
- Department of Urology, Thomas Jefferson University, 1025 Walnut Street, Suite 1112, Philadelphia, PA 19107, United States of America
| | - Wm Kevin Kelly
- Division of Solid Tumor Oncology, Department of Medical Oncology, Thomas Jefferson University, 925 Chestnut Street, Suite 220A, Philadelphia, PA 19107, United States of America
| | - Amy E Leader
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Benjamin Franklin House, Suite 320, Philadelphia, PA 19107, United States of America
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Jan J, Osho A, Murphy CC, Mazure CM, Singal AG, Rich NE. Gender, Age, Racial and Ethnic Disparities in Clinical Trial Enrollment for Primary Liver Cancer. Gastroenterology 2022; 163:14-20.e2. [PMID: 35288115 PMCID: PMC9232956 DOI: 10.1053/j.gastro.2022.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Jenny Jan
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - Azeez Osho
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Carolyn M. Mazure
- Department of Psychiatry; Women’s Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX
| | - Nicole E. Rich
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX
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Rogers CC, Pope S, Whitfield F, Cohn WF, Valdez RS. The lived experience during the peri-diagnostic period of breast cancer: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:547-585. [PMID: 34210570 DOI: 10.1016/j.pec.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer. METHODS Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches. RESULTS A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period. CONCLUSIONS The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity. PRACTICE IMPLICATIONS Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.
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Affiliation(s)
- Courtney C Rogers
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Shannon Pope
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Francesca Whitfield
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Rupa S Valdez
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
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Swaby J, Kaninjing E, Ogunsanya M. African American participation in cancer clinical trials. Ecancermedicalscience 2021; 15:1307. [PMID: 34824630 PMCID: PMC8580719 DOI: 10.3332/ecancer.2021.1307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background According to the Food and Drug Administration, African Americans (AAs) have been habitually underrepresented in cancer clinical trials (CCTs). This under-enrolment has contributed to cancer disparities despite the implementation of policies to improve AA accrual. This systematic review aimed to determine (1) Why AAs are participating in CCT at lower rates compared to other ethnic/racial groups and (2) Are there any tools that have definitively improved AA participation or addressed the barriers associated with their lack of participation. Methods Searches were carried out in PubMed, Project MUSE and EBSCO which were confined to four databases (BASE, PsycINFO, CINAHL and MEDLINE). Literature published between 2010 and 2020 were filtered with the inclusion and exclusion criteria and then a mixed methods appraisal tool was used to check the quality of the articles. Studies were separated into two categories to extract and synthesise data based on the emerging themes. Results Frequent reasons for a lack of participation involved provider related issues, family concerns, health literacy and trust among others. Interventions cited as successful in improving AA participation or addressing a barrier often revolved around community-based participatory research and educational CCT videos/tools. Recommendations/Conclusion Educating AA patients about the biomedical research process, addressing concerns about CCTs, building trust with community members and improving communication with healthcare providers could improve AA participation in CCTs. Future interventions should consider the effect of diversified healthcare teams in addressing trust deficit in CCTs among AAs. Healthcare practitioners seeking to consent AA into CCTs and biomedical research could consider incorporating cultural competence into their practice for effective interaction with this population and to address their questions about biomedical research.
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Affiliation(s)
- Jordan Swaby
- Department of Health Sciences, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, USA
| | - Ernie Kaninjing
- Department of Health Sciences, School of Health & Human Performance, Georgia College and State University, 231 W Hancock St, Milledgeville, GA 31061, USA
| | - Motolani Ogunsanya
- Department of Pharmacy, Clinical & Administrative Sciences, The University of Oklahoma Health Sciences Center, 1110 N. Stonewall Ave. Oklahoma City, OK 73117, USA
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Soares RR, Gopal AD, Parikh D, Shields CN, Patel S, Hinkle J, Sharpe J, Ho AC, Regillo CD, Haller J, Yonekawa Y. Geographic Access Disparities of Clinical Trials in Neovascular Age-Related Macular Degeneration in the United States. Am J Ophthalmol 2021; 229:160-168. [PMID: 33848533 DOI: 10.1016/j.ajo.2021.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
To identify geographic and socioeconomic variables predictive of residential proximity to neovascular age-related macular degeneration (nAMD) clinical trial locations. DESIGN Retrospective, cross-sectional study. METHODS Census tract-level data from public datasets and trial-level data from ClinicalTrials.gov were analyzed. We calculated the driving distance (>60 miles) and time (>60 minutes) from the population-weighted US census tract centroid to the nearest clinical trial site. RESULTS We identified 42 trials studying nAMD across 829 unique clinical trial sites in the United States. In a multivariable model, driving distance >60 miles had a significant association with rural location (adjusted odds ratio [aOR] 5.54; 95% confidence interval [CI] 3.86-7.96, P < .0001) and with Midwest (aOR 2.30; 95% CI 1.21-4.38, P = .01) and South (aOR 2.43; 95% CI 1.21-4.91, P = .01) as compared to the Northeast region, and with some college or an associate's degree, as compared to a bachelor's degree (aOR 1.02; 95% CI 1.01-1.04, P = .0007, and aOR 1.05; 95% CI 1.00-1.10, P = .04, respectively). Lower odds of traveling >60 miles to the nearest nAMD trial site were associated with census tracts with a higher percentage of blacks (aOR 0.98; 95% CI 0.97-0.99, P < .0001), Hispanics (aOR 0.97; 95% CI 0.95-0.99, P = .002), and Asians (aOR 0.90; 95% CI 0.88-0.93, P < .0001), as compared to whites, and with a lower percentage of the population <200% of the federal poverty level. Similar predictors were found in time traveled >60 minutes. CONCLUSIONS There are geographic access disparities of clinical trial sites for nAMD in the United States.
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Affiliation(s)
- Rebecca R Soares
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anand D Gopal
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Devayu Parikh
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Charlotte N Shields
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samir Patel
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John Hinkle
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James Sharpe
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Allen C Ho
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julia Haller
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yoshihiro Yonekawa
- From Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Arsyad M, Pulubuhu DAT, Kawamura Y, Maria IL, Dirpan A, Unde AA, Nuddin A, Yusuf S. The role of public health services (PHS) in agricultural poverty alleviation. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Lal L, Ryan K, Liu IY, Price B, Lockwood T, Aguirre I, Slobodian P, Lam A, Vassan M, Lim K, Silverii J, Tesoriero J, Phu J, Lim W, Naidoo B, Russell N, Rundle M, Sewell R, Cooper C, Hardman A, Quinn M, Mak A, Wright EJ. Transformation of Australian Community Pharmacies Into Good Clinical Practice Compliant Trial Pharmacies for HIV Pre-Exposure Prophylaxis. Front Pharmacol 2019; 10:1269. [PMID: 31787893 PMCID: PMC6854879 DOI: 10.3389/fphar.2019.01269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: In Australia, clinical trial drugs are conventionally dispensed through clinical trial pharmacies only, while community pharmacies dispense drugs approved by Australia’s regulatory body. A large HIV pre-exposure prophylaxis study aimed to deliver clinical trial drug through community pharmacies to improve convenience and mimic real world prescribing. This paper describes the process of making community trials compliant with good clinical practice and reports outcomes of delivering clinical trial drug through community pharmacies. Methods: Eight community and four clinical trial pharmacies across three Australian states were approached to participate. A good clinical practice checklist was generated and pharmacies underwent a number of changes to meet clinical trial pharmacy requirements prior to study opening. Changes were made to community pharmacies to make them compliant with good clinical trial practice including; staff training, structural changes, and implementing monitoring of study drug and prescribing practices. Study drug was ordered through standard clinical trial processes and dispensed from study pharmacies by accredited pharmacists. Throughout the trial, record logs for training, prescriber signature and delegation, temperature, participant, and drug accountability were maintained at each pharmacy. The study team monitored each log and delivered on-site training to correct protocol variations. Results: Each pharmacy that was approached agreed to participate. All community pharmacies achieved good clinical practice compliance prior to dispensing study drug. Over the course of the study, 20,152 dispensations of study drug occurred, 83% of these occurred at community pharmacies. Only 2.0% of dispensations had an error, and errors were predominantly minor. On five occasions a pharmacist who was not accredited dispensed study drug. Conclusions: Community based pharmacies can undergo training and modifications to achieve good clinical practice compliance and dispense clinical trial study drug. Community based pharmacies recorded few variations from study protocol. Community based pharmacies offer a useful alternative to clinical trial pharmacies to increase convenience for study participants and expanded use of these pharmacies should be considered for large clinical trials, including HIV prevention trials.
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Affiliation(s)
- Luxi Lal
- Alfred Health, Melbourne, VIC, Australia.,Burnet Institute, HIV Elimination Program, Melbourne, VIC, Australia.,Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, VIC, Australia
| | - Kathleen Ryan
- Alfred Health, Melbourne, VIC, Australia.,Burnet Institute, HIV Elimination Program, Melbourne, VIC, Australia
| | | | | | | | | | - Peter Slobodian
- Clinical Trials Pharmacy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ada Lam
- Clinical Trials Pharmacy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Manoj Vassan
- Prahran Central Pharmacy, South Yarra, VIC, Australia
| | - Kie Lim
- Prahran Central Pharmacy, South Yarra, VIC, Australia
| | - John Silverii
- John Silverii's Pharmacy, Fitzroy North, VIC, Australia
| | | | - Johnny Phu
- Newton & Leung Pharmacy, Collingwood, VIC, Australia
| | - Wan Lim
- Newton & Leung Pharmacy, Collingwood, VIC, Australia
| | | | - Nick Russell
- Centre Pharmacy, Central Market Arcade, Adelaide, SA, Australia
| | | | | | | | | | - Martin Quinn
- Epic Pharmacy Kings Meadows, Launceston, TAS, Australia
| | - Anne Mak
- Alfred Health, Melbourne, VIC, Australia
| | - Edwina J Wright
- Alfred Health, Melbourne, VIC, Australia.,Burnet Institute, HIV Elimination Program, Melbourne, VIC, Australia.,Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, VIC, Australia.,The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
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Walker R, Paskausky AL, Chambers S. What You Cannot See Can Still Kill You: On the Use of Latent Constructs. Oncol Nurs Forum 2019; 46:523-528. [PMID: 31424448 DOI: 10.1188/19.onf.523-528] [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: 11/17/2022]
Abstract
Nursing research relies heavily on the use of latent constructs to describe and understand phenomena that cannot be measured through direct observation. In statistical models, variables representing these constructs, often operationalized and represented as scores on self-report measures, stand in as symbolic representations of real forces having an impact on patients' experiences of living and dying. In this sense, latent constructs represent real phenomena that cannot always be seen directly.
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Coco L, Titlow KS, Marrone N. Geographic Distribution of the Hearing Aid Dispensing Workforce: A Teleaudiology Planning Assessment for Arizona. Am J Audiol 2018; 27:462-473. [PMID: 30452750 DOI: 10.1044/2018_aja-imia3-18-0012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/20/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Teleaudiology helps connect patients in rural and underresourced areas to hearing health care providers, minimizing the barrier of geography (Swanepoel et al., 2010). In the United States, teleaudiology is at the initial stages of implementation (Bush, Thompson, Irungu, & Ayugi, 2016). Telehealth researchers recommend conducting a comprehensive planning assessment to optimize implementation and adoption (AlDossary, Martin-Khan, Bradford, Armfield, & Smith, 2017; Alverson et al., 2008; Krupinski, 2015). A geographic analysis of the hearing aid dispensing workforce served as the initial stage of a teleaudiology planning assessment in Arizona. METHOD The analysis used publically available data sets from the U.S. Census, Arizona Department of Health Services, and the U.S. Veterans Administration. Geographic information system tools were used to analyze and visually represent population, potential teleaudiology site data, and hearing aid dispensing workforce (defined as audiologists and hearing instrument specialists licensed to dispense hearing aids in Arizona). ArcGIS was used to generate road networks and travel distance estimations. RESULTS The number of audiologists per county ranged from 0 to 216 (average 22.1). Six out of Arizona's 15 counties lacked a single audiologist, and 2 counties lacked a hearing instrument specialist. Potential expansion sites for teleaudiology were located in areas of the state that lacked practice locations for hearing aid services. CONCLUSIONS There are geographic areas of Arizona that lack licensed hearing aid locations yet are populated by individuals who may need services. Resource availability data inform teleaudiology program expansion. Future research will include data from providers and community members on their perceived needs for services.
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Affiliation(s)
- Laura Coco
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | | | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
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Chen YW, Ornstein MC, Wood LS, Allman KD, Martin A, Beach J, Gilligan T, Garcia JA, Rini BI. The association between facility case volume and overall survival in patients with metastatic renal cell carcinoma in the targeted therapy era. Urol Oncol 2018; 36:470.e19-470.e29. [DOI: 10.1016/j.urolonc.2018.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/27/2018] [Accepted: 06/27/2018] [Indexed: 12/25/2022]
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Raheja D, Davila EP, Johnson ET, Deović R, Paine M, Rouphael N. Willingness to Participate in Vaccine-Related Clinical Trials among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081743. [PMID: 30110896 PMCID: PMC6121248 DOI: 10.3390/ijerph15081743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to understand among a convenience sample of 400 adults aged 60 years of age or older (1) reasons for being willing or unwilling to participate in a vaccine clinical research study and (2) overall perceptions about vaccine clinical research. A cross-sectional study using a sample of older adults residing in the metro-Atlanta area and surrounding neighborhoods was conducted. The study questionnaire contained 37 questions, including questions about socio-demographics and perceptions about clinical trial processes. Statistical analysis was conducted using logistic regression. The adjusted modeling results indicated that sex, distance to research clinic, and being informed about the research findings played a role in the likelihood of an elderly person participating in a vaccine study. Males were more likely to participate in clinical trials as compared to females (OR: 2.486; CI: 1.042–5.934). Most participants were willing to travel up to 25 miles from the research clinic. Of the respondents, 45% were unlikely to participate if the results of the current trial are not shared. Improving access to clinical trials in terms of distance traveled and ensuring streamlined processes to inform participants about the results of the trial in the future would increase willingness to participate in vaccine clinical trials. The survey could serve as a useful tool for conducting vaccine studies and other clinical trials by understanding the barriers specific to the elderly.
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Affiliation(s)
- Divyanshu Raheja
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30329, USA.
| | - Evelyn P Davila
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30329, USA.
| | - Eric T Johnson
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30329, USA.
| | - Rijalda Deović
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30329, USA.
| | - Michele Paine
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30329, USA.
| | - Nadine Rouphael
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30329, USA.
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Optimizing Travel Time to Outpatient Interventional Radiology Procedures in a Multi-Site Hospital System Using a Google Maps Application. J Digit Imaging 2018; 31:591-595. [PMID: 29464433 DOI: 10.1007/s10278-018-0054-2] [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: 10/18/2022] Open
Abstract
The purpose of this study is to determine whether a custom Google Maps application can optimize site selection when scheduling outpatient interventional radiology (IR) procedures within a multi-site hospital system. The Google Maps for Business Application Programming Interface (API) was used to develop an internal web application that uses real-time traffic data to determine estimated travel time (ETT; minutes) and estimated travel distance (ETD; miles) from a patient's home to each a nearby IR facility in our hospital system. Hypothetical patient home addresses based on the 33 cities comprising our institution's catchment area were used to determine the optimal IR site for hypothetical patients traveling from each city based on real-time traffic conditions. For 10/33 (30%) cities, there was discordance between the optimal IR site based on ETT and the optimal IR site based on ETD at non-rush hour time or rush hour time. By choosing to travel to an IR site based on ETT rather than ETD, patients from discordant cities were predicted to save an average of 7.29 min during non-rush hour (p = 0.03), and 28.80 min during rush hour (p < 0.001). Using a custom Google Maps application to schedule outpatients for IR procedures can effectively reduce patient travel time when more than one location providing IR procedures is available within the same hospital system.
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Nieder C, Syed MA, Dalhaug A, Pawinski A, Norum J. Eligibility for phase 3 clinical trials of systemic therapy in real-world patients with metastatic renal cell cancer managed in a rural region. Med Oncol 2017; 34:149. [PMID: 28748331 DOI: 10.1007/s12032-017-1002-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/14/2017] [Indexed: 01/05/2023]
Abstract
Previous research has identified disparities between urban and rural cancer care, including clinical trial access. Therefore, we addressed three different questions in patients with metastatic renal cell cancer managed according to national guidelines in a rural Norwegian standard practice setting. (1) How many patients would have been eligible for three recent landmark randomized clinical trials? (2) Is survival different between eligible and non-eligible patients receiving first-line systemic therapy? (3) Is survival different between eligible patients and published trial results? We performed a retrospective analysis of 101 consecutive patients (2006-2016). Only 52% of the patients were eligible for the first-line study of pazopanib versus sunitinib. The main reasons for violating inclusion or exclusion criteria were presence of brain metastases, absence of clear cell histology, and poor performance status. Even fewer patients were eligible for trials of nivolumab and cabozantinib in pre-treated patients. Eligible patients had significantly better survival than non-eligible patients, median 29.2 versus 8.5 months (p = 0.0001). These results confirm that many patients from rural practices do not fulfill all mandatory trial eligibility criteria. However, eligible patients managed according to national guidelines had survival outcomes in line with published first-line trial results.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsö, Norway.
| | - Mohsan A Syed
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsö, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway
| | - Jan Norum
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsö, Norway.,Northern Norway Regional Health Authority Trust, 8006, Bodø, Norway
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The generalizability of NCI-sponsored clinical trials accrual among women with gynecologic malignancies. Gynecol Oncol 2016; 143:611-616. [PMID: 27697287 DOI: 10.1016/j.ygyno.2016.09.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/24/2016] [Accepted: 09/27/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Enrollment of a representative population to cancer clinical trials ensures scientific reliability and generalizability of results. This study evaluated the similarity of patients enrolled in NCI-supported group gynecologic cancer trials to the incident US population. METHODS Accrual to NCI-sponsored ovarian, uterine, and cervical cancer treatment trials between 2003 and 2012 were examined. Race, ethnicity, age, and insurance status were compared to the analogous US patient population estimated using adjusted SEER incidence data. RESULTS There were 18,913 accruals to 156 NCI-sponsored gynecologic cancer treatment trials, ovarian (56%), uterine (32%), and cervical cancers (12%). Ovarian cancer trials included the least racial, ethnic and age diversity. Black women were notably underrepresented in ovarian trials (4% versus 11%). Hispanic patients were underrepresented in ovarian and uterine trials (4% and 5% versus 18% and 19%, respectively), but not in cervical cancer trials (14 versus 11%). Elderly patients were underrepresented in each disease area, with the greatest underrepresentation seen in ovarian cancer patients over the age of 75 (7% versus 29%). Privately insured women were overrepresented among accrued ovarian cancer patients (87% versus 76%), and the uninsured were overrepresented among women with uterine or cervical cancers. These patterns did not change over time. CONCLUSIONS Several notable differences were observed between the patients accrued to NCI funded trials and the incident population. Improving representation of racial and ethnic minorities and elderly patients on cancer clinical trials continues to be a challenge and priority.
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Ohri N, Kalnicki S, Sparano JA, Garg M. In Regard to Bruner et al. Int J Radiat Oncol Biol Phys 2016; 94:1220-1. [DOI: 10.1016/j.ijrobp.2015.12.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022]
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