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Mittal A, Moore S, Navani V, Jiang DM, Stewart DJ, Liu G, Wheatley-Price P. What Is Ailing Oncology Clinical Trials? Can We Fix Them? Curr Oncol 2024; 31:3738-3751. [PMID: 39057147 PMCID: PMC11276279 DOI: 10.3390/curroncol31070275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Evidence from phase three clinical trials helps shape clinical practice. However, a very small minority of patients with cancer participate in clinical trials and many trials are not completed on time due to slow accrual. Issues with restrictive eligibility criteria can severely limit the patients who can access trials, without any convincing evidence that these restrictions impact patient safety. Similarly, regulatory, organizational, and institutional hurdles can delay trial activation, ultimately making some studies irrelevant. Additional issues during trial conduct (e.g., mandatory in-person visits, central confirmation of standard biomarkers, and inflexible drug dosage modification) contribute to making trials non-patient-centric. These real-life observations from experienced clinical trialists can seem nonsensical to investigators and patients alike, who are trying to bring effective drugs to patients with cancer. In this review, we delve into these issues in detail, and discuss potential solutions to make clinical trials more accessible to patients.
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Affiliation(s)
- Abhenil Mittal
- North East Cancer Center, Health Sciences North, Northern Ontario School of Medicine (NOSM U), Sudbury, ON P3E5J1, Canada;
| | - Sara Moore
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H8L6, Canada
| | - Vishal Navani
- Tom Baker Cancer Center, Alberta Health Services, Calgary, AB T2N4N2, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N2, Canada
| | - Di Maria Jiang
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G2M9, Canada (G.L.)
| | - David J. Stewart
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H8L6, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G2M9, Canada (G.L.)
| | - Paul Wheatley-Price
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H8L6, Canada
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Lichtenstein MRL, Levit LA, Schenkel C, Kirkwood K, Fashoyin-Aje LA, Bruinooge SS, Kelley MJ, Mailman JA, Magnuson A, Mirda DP, Natesan D, Hershman DL. Researcher Experience and Comfort With Telemedicine and Remote Patient Monitoring in Cancer Treatment Trials. Oncologist 2024; 29:356-363. [PMID: 37676048 PMCID: PMC10994398 DOI: 10.1093/oncolo/oyad237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Since the onset of COVID-19, oncology practices across the US have integrated telemedicine (TM) and remote patient monitoring (RPM) into routine care and clinical trials. The extent of provider experience and comfort with TM/RPM in treatment trials, however, is unknown. We surveyed oncology researchers to assess experience and comfort with TM/RPM. METHODS Between April 10 and June 1, 2022, we distributed email surveys to US-based members of the American Society of Clinical Oncology (ASCO) whose member records indicated interest or specialization in clinical research. We collected respondent demographic data, clinical trial experience, workplace characteristics, and comfort and experience with TM/RPM use across trial components in phase I and phase II/III trials. TM/RPM was defined as clinical trial-related healthcare and monitoring for patients geographically separated from trial site. RESULTS There were 141 surveys analyzed (5.1% response rate). Ninety percent of respondents had been Principal Investigators, 98% practiced in a norural site. Most respondents had enrolled patients in phase I (82%) and phase II/III trials (99%). Across all phases and trial components, there was a higher frequency of researcher comfort compared to experience. Regarding remote care in treatment trials, 75% reported using TM, RPM, or both. Among these individuals, 62% had never provided remote care to trial patients before the pandemic. CONCLUSION COVID-19 spurred the rise of TM/RPM in cancer treatment trials, and some TM/RPM use continues in this context. Among oncology researchers, higher levels of comfort compared with real-world experience with TM/RPM reveal opportunities for expanding TM/RPM policies and guidelines in oncology research.
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Affiliation(s)
- Morgan R L Lichtenstein
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Laura A Levit
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Caroline Schenkel
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Kelsey Kirkwood
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Lola A Fashoyin-Aje
- Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Suanna S Bruinooge
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Michael J Kelley
- Department of Medicine, Duke Cancer Institute and Medical Oncology, Duke University Medical Center, and Hematology-Oncology, Durham VA Medical Center, Durham, NC, USA
| | | | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel P Mirda
- Providence Medical Group Northern California Napa, CA, USA
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
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Smith KL, Mead‐Harvey C, Mazza GL, Shinn EH, Frank ES, Melisko ME, Eaton C, Liu Y, Salamone JM, Pollastro T, Spears PA, Caston NE, Wolff AC, Rocque GB. TBCRC 057: Survey about willingness to participate in cancer clinical trials during the pandemic. Cancer Med 2024; 13:e7090. [PMID: 38466037 PMCID: PMC10926883 DOI: 10.1002/cam4.7090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Breast cancer patients experienced heightened anxiety during the pandemic. Also, modifications to clinical trial activities allowing for virtual platforms, local assessments, and greater flexibility were introduced to facilitate participation. We sought to evaluate the association between pandemic-related anxiety and willingness to participate in trials and how pandemic-era modifications to trial activities affect the decision to participate. METHODS We conducted an online survey from August to September, 2021 of patients with breast cancer assessing pandemic-related anxiety; clinical trials knowledge and attitudes; willingness to participate during and before the pandemic; and how each modification affects the decision to participate. Fisher's exact tests evaluated differences in proportions and two-sample t-tests evaluated differences in means. The association of pandemic-related anxiety with a decline in willingness to participate during compared to prior to the pandemic was modeled using logistic regression. RESULTS Among 385 respondents who completed the survey, 81% reported moderate-severe pandemic-related anxiety. Mean willingness to participate in a trial was lower during the pandemic than prior [2.97 (SD 1.17) vs. 3.10 (SD 1.09), (p < 0.001)]. Severe anxiety was associated with higher odds of diminished willingness to participate during the pandemic compared to prior (OR 5.07). Each of the modifications, with the exception of opting out of research-only blood tests, were endorsed by >50% of respondents as strategies that would increase their likelihood of deciding to participate. CONCLUSIONS While pandemic-related anxiety was associated with diminished willingness to participate in trials, the leading reasons for reluctance to consider trial participation were unrelated to the pandemic but included worries about not getting the best treatment, side effects, and delaying care. Patients view trial modifications favorably, supporting continuation of these modifications, as endorsed by the National Cancer Institute and others.
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Affiliation(s)
- Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease GroupJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Present address:
AstraZenecaGaithersburgMarylandUSA
| | | | - Gina L. Mazza
- Department of Quantitative Health SciencesMayo ClinicScottsdaleArizonaUSA
| | - Eileen H. Shinn
- Department of Behavioral Science, Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Michelle E. Melisko
- Department of Medicine (Hematology/Oncology)University of CaliforniaSan FranciscoCaliforniaUSA
| | - Cyd Eaton
- Biostatistics, Epidemiology and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Yisi Liu
- Biostatistics, Epidemiology and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | | | - Patricia A. Spears
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Nicole E. Caston
- Division of Hematology and OncologyUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
| | - Antonio C. Wolff
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease GroupJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Gabrielle Betty Rocque
- Division of Hematology and OncologyUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
- Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
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Andriani L, Oh J, McMinn E, Gleason E, Koelper NC, Chittams J, Simpkins F, Ko EM. Telehealth utilization in gynecologic oncology clinical trials. Gynecol Oncol 2023; 177:103-108. [PMID: 37659265 PMCID: PMC10591867 DOI: 10.1016/j.ygyno.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Prior to the COVID-19 pandemic, telehealth visits and remote clinical trial operations (such as local collection of laboratory tests or imaging studies) were underutilized in gynecologic oncology clinical trials. Current literature on these operational changes provides anecdotal experience and expert opinion with few studies describing patient-level safety data. We aimed to evaluate the safety and feasibility of telehealth and remote clinical trial operations during the COVID-19 Pandemic. METHODS Gynecologic oncology patients enrolled and actively receiving treatment on a clinical trial at a single, academic institution during the designated pre-Telehealth and Telehealth periods were identified. Patients with at least 1 provider or research coordinator telehealth visit were included. Patient demographics, health system encounters, adverse events, and protocol deviations were collected. Pairwise comparisons were performed between the pre-Telehealth and Telehealth period with each patient serving as their own control. RESULTS Thirty-one patients met inclusion criteria. Virtual provider visits and off-site laboratory testing increased during the Telehealth period. Delays in provider visits, imaging, and laboratory testing did not differ between time periods. Total and minor protocol deviations increased in incidence during the Telehealth period and were due to documentation of telehealth and deferment of non-therapeutic testing. Major protocol deviations, emergency department visits, admissions, and severe adverse events were of low incidence and did not differ between time periods. CONCLUSIONS Telehealth and remote clinical trial operations appeared safe and did not compromise clinical trial protocols in a small, single institutional study. Larger scale evaluations of such trial adaptations should be performed to determine continued utility following the Pandemic.
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Affiliation(s)
- Leslie Andriani
- Division of Gynecologic Oncology at Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jinhee Oh
- Brigham Obstetrics and Gynecology Group, Foxborough, MA, United States of America
| | - Erin McMinn
- Division of Gynecologic Oncology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Emily Gleason
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Nathanael C Koelper
- Women's Health Clinical Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jesse Chittams
- Women's Health Clinical Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Fiona Simpkins
- Division of Gynecologic Oncology at Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Emily M Ko
- Division of Gynecologic Oncology at Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America.
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Kaakoua M, Boufdil A, El Fadli M, Belbaraka R, Essadi I. Eighteen Years of Medical Oncology in Morocco: A Bibliometric Evaluation. Cureus 2023; 15:e38766. [PMID: 37303427 PMCID: PMC10249645 DOI: 10.7759/cureus.38766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Medical publications constitute an essential tool for sharing scientific advances in the medical field. They are also an educational tool of great significance in initial medical training, and also in further medical education. These publications are necessary to ensure an interface between the researchers and members of the medical scientific community, who are always looking for the correct and optimal treatment for their patients. Several golden rules have been laid out in terms of assessing the improvement in scientific productivity, namely the quality of the subject, the type of publication, the publication review and its impact factor, and the establishment of international collaborations. Bibliometrics is a quantitative and qualitative analysis of scientific publications, which aids in assessing the scientific productivity of a community or a scientific institution. To the best of our knowledge, this is the first bibliometric study to evaluate the scientific productivity in the field of medical oncology in Morocco.
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Affiliation(s)
- Mohamed Kaakoua
- Department of Medical Oncology, Ibn Sina Military Hospital, Marrakesh, MAR
| | - Aboubaker Boufdil
- Department of Medical Oncology, Ibn Sina Military Hospital, Marrakesh, MAR
| | - Mohammed El Fadli
- Department of Medical Oncology, Mohammed VI University Hospital Center, Marrakesh, MAR
| | - Rhizlane Belbaraka
- Department of Medical Oncology, Mohammed VI University Hospital Center, Marrakesh, MAR
| | - Ismail Essadi
- Department of Medical Oncology, Ibn Sina Military Hospital, Marrakesh, MAR
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Leroy V, Gana W, Aïdoud A, N'kodo JA, Balageas AC, Blanc P, Bomia D, Debacq C, Fougère B. Digital health technologies and Alzheimer's disease clinical trials: might decentralized clinical trials increase participation by people with cognitive impairment? Alzheimers Res Ther 2023; 15:87. [PMID: 37106429 PMCID: PMC10133908 DOI: 10.1186/s13195-023-01227-4] [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: 02/04/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Therapeutic trials in Alzheimer's disease (AD) face many obstacles-particularly with regard to screening and recruitment. DISCUSSION Decentralized clinical trials (DCTs) are being developed in other diseases and appear to be of value for overcoming these difficulties. The use of remote visits offers hope of broader recruitment and thus a reduction in inequalities due to age, geography, and ethnicity. Furthermore, it might be easier to involve primary care providers and caregivers in DCTs. However, further studies are needed to determine the feasibility of DCTs in AD. A mixed-model DCT might constitute the first step towards completely remote trials in AD and should be assessed first.
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Affiliation(s)
- Victoire Leroy
- Department of Geriatrics, Tours University Hospital, Tours, France.
- Memory Clinic, Tours University Hospital, Tours, France.
| | - Wassim Gana
- Department of Geriatrics, Tours University Hospital, Tours, France
| | - Amal Aïdoud
- Department of Geriatrics, Tours University Hospital, Tours, France
- EA4245 T2i, Université de Tours, Tours, France
| | | | | | - Pascal Blanc
- Department of Geriatrics, Tours University Hospital, Tours, France
- Memory Clinic, Tours University Hospital, Tours, France
| | | | - Camille Debacq
- Department of Geriatrics, Tours University Hospital, Tours, France
| | - Bertrand Fougère
- Department of Geriatrics, Tours University Hospital, Tours, France
- EA 7505 Education, Ethics, Health, Tours University, Tours, France
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Steinhilber KM, Chabria RS, Clara A, Temel JS, Greer JA, Traeger L, Jacobs JM. Shifting behavioral intervention research to virtual methods: Challenges and solutions in practice, during and after the COVID-19 pandemic. J Telemed Telecare 2023:1357633X231167899. [PMID: 37125429 PMCID: PMC10130932 DOI: 10.1177/1357633x231167899] [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: 05/02/2023]
Abstract
Behavioral medicine researchers have rapidly adapted study procedures and interventions to telehealth modalities during the pandemic. We rely heavily on telehealth research methods to avoid study delays and mitigate risk to chronically ill patients our studies aim to support. We implemented methods to virtually recruit, enroll, and retain patients and their families on clinical trials, and virtually deliver study interventions. These adaptations are likely to become permanent amid ongoing virus variants and surges in cases. However, little has been written about how remote methods apply in practice. This paper documents these processes to maximize efficiency across our research studies and systems and highlights the strengths and challenges of transitioning our research protocols to telehealth. We outline solutions to using remote methods across the entire span of the research process, including study recruitment, data collection, and intervention delivery. We offer insight into the implications of these transitions on research staff and interventionists. In providing a transparent review of the advantages and challenges of implementing remote methods, we encourage discourse around remote methods implementation, share the lessons we learned, and inform the design of future trials. Further research is needed to review the clinical feasibility and acceptability of these procedures.
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Affiliation(s)
- Kylie M Steinhilber
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Suffolk University, Department of Psychology, Boston, MA, USA
| | - Reena S Chabria
- Drexel University, Department of Psychology, Philadelphia, PA, USA
| | - Amy Clara
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Department of Medicine, Boston, MA, USA
| | - Jennifer S Temel
- Harvard Medical School, Department of Medicine, Boston, MA, USA
- Massachusetts General Hospital, Department of Medicine, Boston, MA, USA
| | - Joseph A Greer
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Department of Medicine, Boston, MA, USA
| | - Lara Traeger
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Department of Medicine, Boston, MA, USA
| | - Jamie M Jacobs
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Department of Medicine, Boston, MA, USA
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8
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Revitalising cancer clinical trials: definitely time for patient-centred reform. Br J Cancer 2023; 128:1407-1408. [PMID: 36882481 PMCID: PMC9989575 DOI: 10.1038/s41416-023-02198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/09/2023] Open
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Finnes HD, Child B, DeFrates S, Kinsman K, Thorne A, Lentz S, Lockhorst R, Murphy J, Urmanski A, Amin S, Barr H, Baviskar S, Beckman C, Chow N, Derba M, Erickson M, Hennes E, Heisey H, Lau R, Limvorasak S, Luckritz T, Mays T, Nzelibe CN, Romanowski T, Smith C, Tesoro D, Toeniskoetter K, Voytilla K. Adapting investigational drug services during a pandemic: Recommendations for future preparedness from the Hematology/Oncology Pharmacy Association Investigational Drug Services Special Interest Group. Am J Health Syst Pharm 2022; 80:e67-e73. [PMID: 36200957 PMCID: PMC9619665 DOI: 10.1093/ajhp/zxac267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Heidi D Finnes
- Address correspondence to Dr. Finnes (). Twitter: @HeidiDiann
| | - Berrie Child
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | | | | | | | | | - Angela Urmanski
- Froedtert Hospital & The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sapna Amin
- MD Anderson Cancer Center, Houston, TX, USA
| | - Hallie Barr
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Nicholas Chow
- Miami Cancer Institute Baptist Health South Florida, Miami, FL, USA
| | - Megan Derba
- Northern Light-Cancer Care of Maine, Brewer, ME, USA
| | | | | | - Heather Heisey
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Rebecca Lau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | | | - Tracy Romanowski
- Miami Cancer Institute Baptist Health South Florida, Coral Gables, FL, USA
| | - Camille Smith
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Debra Tesoro
- Washington University, Siteman Cancer Center, St. Louis, MO, USA
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Jensen-Roberts S, Myers TL, Auinger P, Cannon P, Rowbotham HM, Coker D, Chanoff E, Soto J, Pawlik M, Amodeo K, Sharma S, Valdovinos B, Wilson R, Sarkar A, McDermott MP, Alcalay RN, Biglan K, Kinel D, Tanner C, Winter-Evans R, Augustine EF, Holloway RG, Dorsey ER, Schneider RB. A Remote Longitudinal Observational Study of Individuals at Genetic Risk for Parkinson Disease. Neurol Genet 2022; 8:e200008. [PMID: 35966918 PMCID: PMC9372873 DOI: 10.1212/nxg.0000000000200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives To recruit and characterize a national cohort of individuals who have a genetic variant (LRRK2 G2019S) that increases risk of Parkinson disease (PD), assess participant satisfaction with a decentralized, remote research model, and evaluate interest in future clinical trials. Methods In partnership with 23andMe, Inc., a personal genetics company, LRRK2 G2019S carriers with and without PD were recruited to participate in an ongoing 36-month decentralized, remote natural history study. We examined concordance between self-reported and clinician-determined PD diagnosis. We applied the Movement Disorder Society Prodromal Parkinson's Disease Criteria and asked investigators to identify concern for parkinsonism to distinguish participants with probable prodromal PD. We compared baseline characteristics of LRRK2 G2019S carriers with PD, with prodromal PD, and without PD. Results Over 15 months, we enrolled 277 LRRK2 G2019S carriers from 34 states. At baseline, 60 had self-reported PD (mean [SD] age 67.8 years [8.4], 98% White, 52% female, 80% Ashkenazi Jewish, and 67% with a family history of PD), and 217 did not (mean [SD] age 53.7 years [15.1], 95% White, 59% female, 73% Ashkenazi Jewish, and 57% with a family history of PD). Agreement between self-reported and clinician-determined PD status was excellent (κ = 0.94, 95% confidence interval 0.89–0.99). Twenty-four participants had prodromal PD; 9 met criteria for probable prodromal PD and investigators identified concern for parkinsonism in 20 cases. Compared with those without prodromal PD, participants with prodromal PD were older (63.9 years [9.0] vs 51.9 years [15.1], p < 0.001), had higher modified Movement Disorders Society-Unified Parkinson's Disease Rating Scale motor scores (5.7 [4.3] vs 0.8 [2.1], p < 0.001), and had higher Scale for Outcomes in PD for Autonomic Symptoms scores (11.5 [6.2] vs 6.9 [5.7], p = 0.002). Two-thirds of participants enrolled were new to research, 97% were satisfied with the overall study, and 94% of those without PD would participate in future preventive clinical trials. Discussion An entirely remote national cohort of LRRK2 G2019S carriers was recruited from a single site. This study will prospectively characterize a large LRRK2 G2019S cohort, refine a new model of clinical research, and engage new research participants willing to participate in future therapeutic trials.
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11
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Sayyid RK, Hiffa A, Woodruff P, Oberle MD, Lambert JH, Terris MK, Wallis CJD, Klaassen Z. Suspension of Oncology Randomized Clinical Trials during the COVID-19 Pandemic: A Cross-Sectional Evaluation of COVID-Related Suspensions. Cancer Invest 2022; 40:743-749. [PMID: 35852930 DOI: 10.1080/07357907.2022.2104305] [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: 12/30/2022]
Abstract
We conducted a cross-sectional analysis of ClinicalTrials.gov-registered oncology randomized controlled trials between September 2019 and December 2021 to identify predictors of trial suspensions. The dataset included 1,183 oncology trials, of which 384 (32.5%) were suspended. COVID-19 accounted for 47 (12.2%) suspensions. Trials that were single center- or US-based had higher odds of COVID-19 (ORs: 3.85 and 2.48, 95% CIs: 1.60-11.50 and 1.28-4.93, respectively) or any-reason suspensions (ORs: 2.33 and 2.04, 95% CIs: 1.46-3.45 and 1.40-2.76, respectively). Phase two (OR 1.27), three (OR 6.45) and four trials (OR 11.5) had increased odds of COVID-19 suspensions, compared to phase one trials.
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Affiliation(s)
- Rashid K Sayyid
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Anthony Hiffa
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Phillip Woodruff
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Michael D Oberle
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Joshua H Lambert
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Martha K Terris
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | | | - Zachary Klaassen
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta University, Augusta, GA, USA
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Abstract
PURPOSE OF REVIEW The COVID-19 pandemic posed several challenges to cancer research including halting of trials, reduced recruitment and protocol violations related to inflexible processes followed in clinical trials. Researchers adopted innovative measures to mitigate these problems and continue studies without compromising their quality. This review collates these adaptations that could well continue after the pandemic. RECENT FINDINGS The COVID-19 pandemic forced researchers globally to adopt innovative measures to overcome the challenges of the pandemic. These included protocol amendments to adjust to the pandemic and travel restrictions, and increased use of digital technologies. 'Virtual' clinical trials were conducted increasingly with adaptations in ethics and regulatory approvals, patient recruitment and consenting, study interventions and delivery of study medications, trial assessments, and monitoring. Many of these adaptations are safe and feasible, without compromising study quality and data integrity. Although these may not be universally applicable in all types of research, they bring many benefits including more diverse patient participation, less burden on patients for study procedures and reduced resources to conduct trials. SUMMARY The COVID-19 pandemic has affected cancer research adversely; however, learnings from the pandemic and adaptations from researchers are likely to improve the efficiency of clinical research beyond the pandemic.
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Affiliation(s)
| | - C.S. Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Abstract
Purpose for Review This perspective piece aims to understand the impacts of the COVID-19 pandemic on the field of oncology, exploring the factors provoking a fall in cancer diagnostic rates, interruption of cancer screening programmes, disruption of oncological treatment and adjuvant care, and the necessary adaption oncological practice has undergone (and will be required to undergo) post-pandemic, including the shift to digital consultations. Recent Findings During the COVID-19 pandemic, the field of oncological research has faced significant challenges. Yet, innovation has prevailed with new developments being made across the globe. Looking to the future of oncology, this piece will also suggest potential solutions to overcome the late-stage ramifications of the COVID-19 pandemic. Summary The COVID-19 pandemic has triggered a global health crisis, the ramifications of which have reached every corner of the world and overwhelmed already overburdened healthcare systems. However, we are still yet to see the full domino effect of the pandemic as it continues to reveal and exacerbate pre-existing weaknesses in healthcare systems across the world.
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Affiliation(s)
- Danielle Boniface
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | - Gonzalo Tapia-Rico
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Icon Cancer Centre Adelaide, Kurralta Park, South Australia, 5037, Australia
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14
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de las Heras B, Daehnke A, Saini KS, Harris M, Morrison K, Aguilo A, Chico I, Vidal L, Marcus R. Role of decentralized clinical trials in cancer drug development: Results from a survey of oncologists and patients. Digit Health 2022; 8:20552076221099997. [PMID: 35646380 PMCID: PMC9136463 DOI: 10.1177/20552076221099997] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 04/24/2022] [Indexed: 01/09/2023] Open
Abstract
As a result of the unprecedented challenges imposed by the COVID-19 pandemic on enrollment to cancer clinical trials, there has been an urgency to identify and incorporate new solutions to mitigate these difficulties. The concept of decentralized or hybrid clinical trials has rapidly gained currency, given that it aims to reduce patient burden, increase patient enrollment and retention, and preserve quality of life, while also increasing the efficiency of trial logistics. Therefore, the clinical trial environment is moving toward remote collection and assessment of data, transitioning from the classic site-centric model to one that is more patient-centric.
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Affiliation(s)
- Begoña de las Heras
- Labcorp Drug Development Inc., Burlington, North Carolina, USA,Madrid Medical Doctors Association, Spain,Begoña de las Heras
| | - Adam Daehnke
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Kamal S Saini
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Melissa Harris
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | | | - Ariel Aguilo
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Isagani Chico
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Laura Vidal
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Robin Marcus
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
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15
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Lew LC, Mat Ludin AF, Shahar S, Abdul Manaf Z, Mohd Tohit N. Efficacy and Sustainability of Diabetes-Specific Meal Replacement on Obese and Overweight Type-2 Diabetes Mellitus Patients: Study Approaches for a Randomised Controlled Trial and Impact of COVID-19 on Trial Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074188. [PMID: 35409872 PMCID: PMC8998339 DOI: 10.3390/ijerph19074188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/26/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
Meal replacement (MR) is widely used in weight and diabetes management programs due to its ease of compliance and handling. However, little is known about its impact on outcomes other than glycaemic control and weight loss. Furthermore, not many studies evaluate its cost-effectiveness and sustainability. This study aimed to evaluate the efficacy of a diabetes-specific MR for the weight reduction and glycaemic controls of overweight and obese T2DM patients, as compared to routine dietary consultation. Other health outcomes, the cost effectiveness, and the sustainability of the MR will also be evaluated. Materials and Methods: This randomised controlled clinical trial will involve 156 participants who have been randomised equally into the intervention and control groups. As a baseline, both groups will receive diet consultation. Additionally, the intervention group will receive an MR to replace one meal for 5 days a week. The duration of intervention will be 12 weeks, with 36 weeks of follow-up to monitor the sustainability of the MR. The primary endpoints are weight and Hemoglobin A1c (HbA1c) reduction, while the secondary endpoints are anthropometry, biochemical measurements, satiety, hormone changes, quality of life, and cost-effectiveness. The impact of the COVID-19 pandemic on study design is also discussed in this paper. This study has obtained human ethics approval from RECUKM (JEP-2019-566) and is registered at the Thai Clinical Trials Registry (TCTR ID: TCTR20210921004).
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Affiliation(s)
- Leong Chen Lew
- Biomedical Science Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
| | - Arimi Fitri Mat Ludin
- Biomedical Science Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Correspondence: ; Tel.: +603-92898043
| | - Suzana Shahar
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Dietetic Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Zahara Abdul Manaf
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Dietetic Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, University Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur 56000, Malaysia;
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16
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Hoenemeyer TW, Cole WW, Oster RA, Pekmezi DW, Pye A, Demark-Wahnefried W. Test/Retest Reliability and Validity of Remote vs. In-Person Anthropometric and Physical Performance Assessments in Cancer Survivors and Supportive Partners. Cancers (Basel) 2022; 14:1075. [PMID: 35205823 PMCID: PMC8869803 DOI: 10.3390/cancers14041075] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Anthropometric and physical performance testing is commonly done in lifestyle research and is traditionally performed in-person. To expand the scalability of lifestyle interventions among cancer survivors, in-person assessments were adapted to remote means and evaluated for feasibility, safety, validity, and reliability. (2) Methods: Cancer survivors and supportive partners were approached to participate in three anthropometric and physical performance testing sessions (two remote/one in-person). Correlations, concordance, and differences between testing modes were evaluated. (3) Results: 110-of-112 individuals approached for testing participated (98% uptake); the sample was 78% female, 64% non-Hispanic White, of mean age 58 years and body mass index = 32.4 kg/m2. ICCs for remote assessments ranged from moderate (8' walk = 0.47), to strong (8' get-up-and-go = 0.74), to very strong (30 s chair stand = 0.80; sit-and-reach = 0.86; 2 min step test = 0.87; back scratch = 0.90; weight = 0.93; waist circumference = 0.98) (p-values < 0.001). Perfect concordance (100%) was found for side-by-side and semi-tandem balance, and 87.5-90.3% for tandem balance. No significant differences between remote and in-person assessments were found for weight, 8' walk, and 8' get-up-and-go. No adverse events occurred and 75% indicated no preference or preferred virtual testing to in-person. (4) Conclusions: Remote anthropometric and physical performance assessments are reliable, valid, acceptable, and safe among cancer survivors and supportive partners.
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Affiliation(s)
- Teri W. Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (W.W.C.); (A.P.); (W.D.-W.)
| | - William W. Cole
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (W.W.C.); (A.P.); (W.D.-W.)
| | - Robert A. Oster
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA; (R.A.O.); (D.W.P.)
- Department of Preventive Medicine, UAB School of Medicine, Birmingham, AL 35233, USA
| | - Dorothy W. Pekmezi
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA; (R.A.O.); (D.W.P.)
- Department of Health Behavior, UAB School of Public Health, Birmingham, AL 35233, USA
| | - Andrea Pye
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (W.W.C.); (A.P.); (W.D.-W.)
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (W.W.C.); (A.P.); (W.D.-W.)
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA; (R.A.O.); (D.W.P.)
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Basu Roy U, Baird AM, Ciupek A, Fox J, Manley E, Norris, XX K, Scagliotti GV, Wakelee HA, Mitsudomi T, Clark RC, Arndt R, Hirsch FR, Bunn PA, Smeltzer MP. Impact of the Coronavirus Disease 2019 Pandemic on Global Lung Cancer Clinical Trials: Why It Matters to People With Lung Cancer. JTO Clin Res Rep 2022; 3:100269. [PMID: 34961851 PMCID: PMC8695593 DOI: 10.1016/j.jtocrr.2021.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Andrew Ciupek
- GO2 Foundation for Lung Cancer, Washington, District of Columbia
| | - Jesme Fox
- Roy Castle Lung Cancer Foundation, Liverpool, United Kingdom
| | | | | | | | | | | | | | - Renee Arndt
- Cancer Technology Applications, LLC, San Diego, California
| | - Fred R. Hirsch
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul A. Bunn
- University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
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18
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Improving clinical paediatric research and learning from COVID-19: recommendations by the Conect4Children expert advice group. Pediatr Res 2022; 91:1069-1077. [PMID: 34099854 PMCID: PMC8184051 DOI: 10.1038/s41390-021-01587-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had a devastating impact on multiple aspects of healthcare, but has also triggered new ways of working, stimulated novel approaches in clinical research and reinforced the value of previous innovations. Conect4children (c4c, www.conect4children.org ) is a large collaborative European network to facilitate the development of new medicines for paediatric populations, and is made up of 35 academic and 10 industry partners from 20 European countries, more than 50 third parties, and around 500 affiliated partners. METHODS We summarise aspects of clinical research in paediatrics stimulated and reinforced by COVID-19 that the Conect4children group recommends regulators, sponsors, and investigators retain for the future, to enhance the efficiency, reduce the cost and burden of medicines and non-interventional studies, and deliver research-equity. FINDINGS We summarise aspects of clinical research in paediatrics stimulated and reinforced by COVID-19 that the Conect4children group recommends regulators, sponsors, and investigators retain for the future, to enhance the efficiency, reduce the cost and burden of medicines and non-interventional studies, and deliver research-equityWe provide examples of research innovation, and follow this with recommendations to improve the efficiency of future trials, drawing on industry perspectives, regulatory considerations, infrastructure requirements and parent-patient-public involvement. We end with a comment on progress made towards greater international harmonisation of paediatric research and how lessons learned from COVID-19 studies might assist in further improvements in this important area.
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19
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McCarthy CJ, Sheth RA, Patel RJ, Cheung SH, Simon NZ, Huang SY, Gupta S. Deployment of an Interventional Radiology Telemedicine Program During the COVID-19 Pandemic: Initial Experience With 10,056 Visits. J Am Coll Radiol 2021; 19:243-250. [PMID: 35016874 PMCID: PMC8651524 DOI: 10.1016/j.jacr.2021.10.022] [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: 06/29/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
Objective To evaluate the clinical, operational, and financial effects of using telemedicine services in an academic interventional radiology setting during the coronavirus disease 2019 pandemic and to identify potential barriers to equitable telemedicine access for patients. Methods Evaluation and management (E&M) data over a 104-week period from September 2019 to August 2021 were reviewed. Data related to the visits were recorded including visit type, billing provider, patient demographic information, Current Procedural Terminology code charged, and reimbursement received. The ZIP code pertaining to the patient’s primary residence was matched with median household income from the US Census Bureau. Results In all, 14,754 E&M encounters were performed over the study period, of which 10,056 were conducted using telemedicine. Twenty-two percent of visits were performed with interactive video; the remainder were performed using audio only. Female patients were more likely than male patients to use interactive video visits for telemedicine encounters (23.7% versus 20.4%, P < .001). Patients availing of video visits (mean age, 58.1 years, SD = 14.0) were also significantly younger than those patients who used audio-only (telephone) encounters (mean age, 62.5 years, SD = 13.3). Patients with private insurance and those living in neighborhoods with higher median household income were more likely to avail of interactive video visits (P < .001). Professional E&M monthly revenue was between 23.3% and 53.2% of peak prepandemic levels (mean 37.7%). Conclusion Telemedicine services allowed for rapid restoration of E&M encounter volumes over the study period. Further work is required to determine the potential implementation barriers to increasing the use of video visits.
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Affiliation(s)
- Colin J McCarthy
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rakhi J Patel
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheree H Cheung
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicole Z Simon
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven Y Huang
- Clinical Operations Director, Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanjay Gupta
- Department Chair, Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
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20
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The Impact of the COVID-19 Pandemic on Oncology Care and Clinical Trials. Cancers (Basel) 2021; 13:cancers13235924. [PMID: 34885038 PMCID: PMC8656780 DOI: 10.3390/cancers13235924] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary The coronavirus pandemic has had a considerable impact on all parts of society. Unsurprisingly, healthcare has been particularly affected, including cancer care and trials of new drugs. This article will summarize the impact the pandemic has had on cancer healthcare taking into consideration how the pandemic affected potential cancer patients and stopped them seeking medical advice for new symptoms. The pandemic also affected the ability of people to access healthcare services and undergo the tests necessary to diagnose cancer. This article will also discuss the impact of the pandemic on existing treatments and the trials of new drugs. In light of the unprecedented speed of development of new treatments and vaccines for the virus itself, it will also review whether some of these adaptations could be used to accelerate the development of novel cancer therapies. Abstract The coronavirus disease 2019 (COVID-19) pandemic has caused considerable global disruption to clinical practice. This article will review the impact that the pandemic has had on oncology clinical trials. It will assess the effect of the COVID-19 situation on the initial presentation and investigation of patients with suspected cancer. It will also review the impact of the pandemic on the subsequent management of cancer patients, and how clinical trial approval, recruitment, and conduct were affected during the pandemic. An intriguing aspect of the pandemic is that clinical trials investigating treatments for COVID-19 and vaccinations against the causative virus, SARS-CoV-2, have been approved and conducted at an unprecedented speed. In light of this, this review will also discuss the potential that this enhanced regulatory environment could have on the running of oncology clinical trials in the future.
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21
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Sessa C, Cortes J, Conte P, Cardoso F, Choueiri T, Dummer R, Lorusso P, Ottmann O, Ryll B, Mok T, Tempero M, Comis S, Oliva C, Peters S, Tabernero J. The impact of COVID-19 on cancer care and oncology clinical research: an experts' perspective. ESMO Open 2021; 7:100339. [PMID: 34953404 PMCID: PMC8608656 DOI: 10.1016/j.esmoop.2021.100339] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 01/09/2023] Open
Abstract
The coronavirus disease-19 (COVID-19) pandemic promises to have lasting impacts on cancer clinical trials that could lead to faster patient access to new treatments. In this article, an international panel of oncology experts discusses the lasting impacts of the pandemic on oncology clinical trials and proposes solutions for clinical trial stakeholders, with the support of recent data on worldwide clinical trials collected by IQVIA. These lasting impacts and proposed solutions encompass three topic areas. Firstly, acceleration and implementation of new operational approaches to oncology trials with patient-centric, fully decentralized virtual approaches that include remote assessments via telemedicine and remote devices. Geographical differences in the uptake of remote technology, including telemedicine, are discussed in the article, focusing on the impact of the local adoption of new operational approaches. Secondly, innovative clinical trials. The pandemic has highlighted the need for new trial designs that accelerate research and limit risks and burden for patients while driving optimization of clinical trial objectives and endpoints, while testing is being minimized. Areas of considerations for clinical trial stakeholders are discussed in detail. In addition, the COVID-19 pandemic has exposed the underrepresentation of minority groups in clinical trials; the approach for oncology clinical trials to improve generalizability of efficacy and outcomes data is discussed. Thirdly, a new problem-focused collaborative framework between oncology trial stakeholders, including decision makers, to leverage and further accelerate the innovative approaches in clinical research developed during the COVID-19 pandemic. This could shorten timelines for patient access to new treatments by addressing the cultural and technological barriers to adopting new operational approaches and innovative clinical trials. The role of the different stakeholders is described, with the aim of making COVID-19 a catalyst for positive change in oncology clinical research and eventually in cancer care.
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Affiliation(s)
- C. Sessa
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland,Correspondence to: Dr Cristiana Sessa, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Via A. Gallino 12, 6500 Bellinzona, Switzerland. Tel: +4191 811 81 81
| | | | - P. Conte
- University of Padova, Padova, Italy
| | - F. Cardoso
- Champalimaud Cancer Center, Lisbon, Portugal
| | | | - R. Dummer
- University Hospital of Zurich, Zurich, Switzerland
| | - P. Lorusso
- Yale Cancer Center, Yale University, New Haven, USA
| | | | - B. Ryll
- Melanoma Patient Network Europe, Uppsala, Sweden
| | - T. Mok
- The Chinese University of Hong Kong, Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong
| | - M. Tempero
- University of California, San Francisco, Pancreas Center, San Francisco, USA
| | | | | | - S. Peters
- Centre d’Oncologie CHUV, Lausanne, Switzerland
| | - J. Tabernero
- Vall d’Hebron Institute of Oncology, Barcelona, Spain
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22
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Gandhi M, Ling WH, Chen CH, Lee JH, Kudo M, Chanwat R, Strasser SI, Xu Z, Lai SH, Chow PKH. Impact of COVID-19 on Hepatocellular Carcinoma Management: A Multicountry and Region Study. J Hepatocell Carcinoma 2021; 8:1159-1167. [PMID: 34589445 PMCID: PMC8475812 DOI: 10.2147/jhc.s329018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/24/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has altered healthcare priorities which may adversely impact cancer management. We aimed to evaluate the impact of the pandemic on the diagnosis, treatment, and consultation methods for patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS We conducted a survey among 27 hospitals from 14 Asia-Pacific countries, collecting hospital-level information on the number of newly diagnosed HCC cases during a pre-pandemic period (February to May 2019) and for the same period during the pandemic (February to May 2020). Information was also collected on delays in diagnosis and treatment, changes in treatment modalities and complication rates, changes in patient enrollment in clinical trials, and modes of patient consultation. The information was stratified by the Barcelona Clinic Liver Cancer (BCLC) stage. RESULTS The survey included cohorts of 2789 and 2045 patients newly diagnosed with HCC during the pre- and pandemic period, respectively. A decline of 26.7% in new HCC cases was reported during the pandemic compared to the pre-pandemic. A sizable proportion of institutions reported delays in diagnosis (48.2% in BCLC 0/A/B and 51.9% in BCLC C), delays in treatment (66.7% in BCLC 0/A/B and 63.0% in BCLC C), changes in treatment modality (33.3% in BCLC 0/A/B and 18.5% in BCLC C), an increase in treatment complications (about 15% across all BCLC stages), and no growth in clinical trial enrollments during the pandemic. Furthermore, there was a decline of 27.3% in face-to-face patient consultations and an increase of 18.3% in video/telephonic consultations during the pandemic. A considerable variation in changes in HCC management was observed among countries. CONCLUSION The COVID-19 pandemic has significantly impacted the management of HCC among Asia-Pacific countries. The impact varies according to the disease stage and country. Well thought-through long-term strategies are required to ameliorate the negative impact of the pandemic on HCC patients.
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Affiliation(s)
- Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore,Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore,Tampere Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
| | - Wen-Huan Ling
- Programme in Translational and Clinical Liver Research, National Cancer Centre Singapore, Singapore
| | - Chien-Hung Chen
- Department of Internal Medicine, National Taiwan University Hospital, Douliu City, Yunlin, Taiwan
| | - Joon Hyeok Lee
- Division of Gastroenterology, Sungkyunkwan University School of Medicine, Samsung Medical Centre, Seoul, Korea
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Hospital, Osaka, Japan
| | - Rawisak Chanwat
- Department of Surgery, National Cancer Institute, Bangkok, Thailand
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Zhu Xu
- Department of Interventional Therapy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China
| | - Soh-Han Lai
- Programme in Translational and Clinical Liver Research, National Cancer Centre Singapore, Singapore
| | - Pierce Kah-Hoe Chow
- Department of Hepatopancreatobiliary and Transplant Surgery, National Cancer Centre Singapore and Singapore General Hospital, Singapore,Surgery Academic Clinical Programme, Duke-NUS Medical School, Singapore,Correspondence: Pierce Kah-Hoe Chow Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, SingaporeTel +65 6576 2151 Email
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23
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Castelo-Branco L, Awada A, Pentheroudakis G, Perez-Gracia JL, Mateo J, Curigliano G, Banerjee S, Giuliani R, Lordick F, Cervantes A, Tabernero J, Peters S. Beyond the lessons learned from the COVID-19 pandemic: opportunities to optimize clinical trial implementation in oncology. ESMO Open 2021; 6:100237. [PMID: 34411971 PMCID: PMC8302832 DOI: 10.1016/j.esmoop.2021.100237] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- L Castelo-Branco
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Awada
- Head of the Oncology Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, Belgium
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland.
| | - J L Perez-Gracia
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
| | - J Mateo
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS and University of Milano, Milano, Italy
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London
| | - R Giuliani
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - F Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - A Cervantes
- Hospital Clinic Universitario, Biomedical Research institute INCLIVA, University of Valencia, Valencia, Spain
| | - J Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), UVic-UCC, Barcelona, Spain
| | - S Peters
- Oncology Department - CHUV, Lausanne University, Lausanne, Switzerland
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24
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Parks RM, Holmes HM, Cheung KL. Current Challenges Faced by Cancer Clinical Trials in Addressing the Problem of Under-Representation of Older Adults: A Narrative Review. Oncol Ther 2021; 9:55-67. [PMID: 33481206 PMCID: PMC7820837 DOI: 10.1007/s40487-021-00140-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/09/2021] [Indexed: 12/11/2022] Open
Abstract
The number of older adults living with cancer is increasing. There is a clear lack of representation of older adults in clinical trials, including cancer trials. Reasons for this are multifactorial and complex and include protocol, patient and sponsor factors. Potential solutions to overcome issues with trial design include varied methods of recruitment with flexible inclusion criteria. Possible alternatives to randomised trials include prospective cohort studies, pragmatic trials and the use of national population-based data sets. Patient factors may be addressed by integration of geriatric assessment, so patients can be randomised or treated based on their individual needs. Additionally, standard protocols for including older adults with cognitive impairment should be developed, rather than automatic exclusion. Increased effort is needed from sponsors and governing health care bodies to make recruitment of older adults to clinical trials standard.
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Affiliation(s)
- Ruth M Parks
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas Health Science Center McGovern Medical School, Houston, USA
| | - Kwok-Leung Cheung
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.
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Gupta D, Kato S, Kurzrock R. The Impact of COVID-19 on Cancer Clinical Trials Conducted by NCI-Designated Comprehensive Cancer Centers. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2021; 4:56-63. [PMID: 34337550 PMCID: PMC8320380 DOI: 10.36401/jipo-20-30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Diviya Gupta
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Shumei Kato
- Center for Personalized Cancer Therapy and Division of Hematology/Oncology, University of California San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology/Oncology, University of California San Diego Moores Cancer Center, La Jolla, CA, USA
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26
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Desai A, Subbiah V. COVID-19 Pandemic and Cancer Clinical Trial Pandemonium: Finding the Silver Lining. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2021; 4:64-66. [PMID: 35663538 DOI: 10.36401/jipo-20-x7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Aakash Desai
- Department of Hematology and Medical Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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27
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Lara Gongora AB, Werutsky G, Jardim DL, Nogueira-Rodrigues A, Barrios CH, Mathias C, Maluf F, Riechelmann R, Fraga M, Gomes H, William WN, Yamada CAF, de Castro Jr G, Rosa DD, de Melo AC, Sala R, Bustamante E, Bretel D, Arrieta O, Cardona AF, Bastos DA. Impact of the COVID-19 Pandemic on Oncology Clinical Research in Latin America (LACOG 0420). JCO Glob Oncol 2021; 7:649-658. [PMID: 33956499 PMCID: PMC8162498 DOI: 10.1200/go.20.00663] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE COVID-19 has affected cancer care worldwide. Clinical trials are an important alternative for the treatment of oncologic patients, especially in Latin America, where trials can be the only opportunity for some of them to access novel and, sometimes, standard treatments. METHODS This was a cross-sectional study, in which a 22-question survey regarding the impact of the COVID-19 pandemic on oncology clinical trials was sent to 350 representatives of research programs in selected Latin American institutions, members of the Latin American Cooperative Oncology Group. RESULTS There were 90 research centers participating in the survey, with 70 of them from Brazil. The majority were partly private or fully private (n = 77; 85.6%) and had confirmed COVID-19 cases at the institution (n = 57; 63.3%). Accruals were suspended at least for some studies in 80% (n = 72) of the responses, mostly because of sponsors' decision. Clinical trials' routine was affected by medical visits cancelation, reduction of patients' attendance, reduction of other specialties' availability, and/or alterations on follow-up processes. Formal COVID-19 mitigation policies were adopted in 96.7% of the centers, including remote monitoring and remote site initiation visits, telemedicine visits, reduction of research team workdays or home office, special consent procedures, shipment of oral drugs directly to patients' home, and increase in outpatient diagnostic studies. Importantly, some of these changes were suggested to be part of future oncology clinical trials' routine, particularly the ones regarding remote methods, such as telemedicine. CONCLUSION To our knowledge, this was the first survey to evaluate the impact of COVID-19 on Latin American oncology clinical trials. The results are consistent with surveys from other world regions. These findings may endorse improvements in clinical trials' processes and management in the postpandemic period.
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Affiliation(s)
- Aline B. Lara Gongora
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Denis L. Jardim
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Angelica Nogueira-Rodrigues
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Brazilian Group of Gynecologic Oncology (EVA), Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carlos H. Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Clarissa Mathias
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Núcleo de Oncologia da Bahia (NOB)/Oncoclínicas, Salvador, Brazil
- Sociedade Brasileira de Oncologia Clínica (SBOC), São Paulo, Brazil
| | - Fernando Maluf
- Hospital Sírio-Libanês, São Paulo, Brazil
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rachel Riechelmann
- A.C. Camargo Cancer Center, São Paulo, Brazil
- Brazilian Gastrointestinal Tumors Group (GTG), Porto Alegre, Brazil
| | - Maurício Fraga
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Henry Gomes
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - William N. William
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Brazilian Group of Thoracic Oncology (GBOT), Porto Alegre, Brazil
| | - Camilla A. F. Yamada
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Gilberto de Castro Jr
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
- Brazilian Group of Thoracic Oncology (GBOT), Porto Alegre, Brazil
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Daniela D. Rosa
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Brazilian Group of Breast Cancer Studies (GBECAM), Porto Alegre, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Andreia C. de Melo
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Brazilian Group of Gynecologic Oncology (EVA), Belo Horizonte, Brazil
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Raul Sala
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Grupo Argentino de Investigación Clínica en Oncología, Rosario, Argentina
| | - Eva Bustamante
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Santiago, Chile
| | - Denisse Bretel
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Grupo de Estudios Clínicos Oncológicos Peruano (GECOPERU), Lima, Peru
| | - Oscar Arrieta
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Instituto Nacional de Cancerología, Ciudad del México, México City, México
| | - Andrés F. Cardona
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Diogo A. Bastos
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
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Walker RJ, Jackson JL, Asch SM, Egede LE. Mitigating the Impact of COVID-19 on Funded Clinical Research: Crucial Next Steps. J Gen Intern Med 2021; 36:518-520. [PMID: 33201425 PMCID: PMC7670836 DOI: 10.1007/s11606-020-06342-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/31/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey L Jackson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), Veteran Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
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Camilleri M, Sive J, Wilson W, Pang G, Jenner R, Phillips E, Popat R, Ramasamy K, Bygrave C, Dadaga T, Streetly M, Cavenagh J, Chapman M, Barrington S, Pike L, Owen R, Clifton‐Hadley L, Yong K. COVID-19 and myeloma clinical research - experience from the CARDAMON clinical trial. Br J Haematol 2021; 192:e14-e16. [PMID: 33222153 PMCID: PMC7753290 DOI: 10.1111/bjh.17168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Marquita Camilleri
- Haematology DepartmentUniversity College HospitalsLondonUK
- Cancer InstituteUniversity College LondonLondonUK
| | - Jonathan Sive
- Haematology DepartmentUniversity College HospitalsLondonUK
| | - William Wilson
- Cancer Research UK and UCL Cancer Trials CentreUniversity College LondonLondonUK
| | - Gavin Pang
- Cancer Research UK and UCL Cancer Trials CentreUniversity College LondonLondonUK
| | - Richard Jenner
- Cancer Research UK and UCL Cancer Trials CentreUniversity College LondonLondonUK
| | - Elizabeth Phillips
- Division of Cancer SciencesManchester Cancer Research CentreUniversity of ManchesterManchesterUK
| | - Rakesh Popat
- Haematology DepartmentUniversity College HospitalsLondonUK
- Cancer InstituteUniversity College LondonLondonUK
| | - Karthik Ramasamy
- Haematology DepartmentOxford University Hospitals NHS TrustOxfordUK
- Radcliffe Department of MedicineOxford UniversityOxfordUK
| | - Ceri Bygrave
- Haematology DepartmentUniversity Hospital of WalesWalesUK
| | - Tushhar Dadaga
- Cancer Research UK and UCL Cancer Trials CentreUniversity College LondonLondonUK
| | | | | | - Mike Chapman
- Haematology DepartmentCambridge Institute for Medical ResearchCambridgeUK
| | - Sally Barrington
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Lucy Pike
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Roger Owen
- HMDS LaboratorySt James’ Institute of OncologyLeedsUK
| | - Laura Clifton‐Hadley
- Cancer Research UK and UCL Cancer Trials CentreUniversity College LondonLondonUK
| | - Kwee Yong
- Haematology DepartmentUniversity College HospitalsLondonUK
- Cancer InstituteUniversity College LondonLondonUK
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30
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Pennell NA, Dillmon M, Levit LA, Moushey EA, Alva AS, Blau S, Cannon TL, Dickson NR, Diehn M, Gonen M, Gonzalez MM, Hensold JO, Hinyard LJ, King T, Lindsey SC, Magnuson A, Marron J, McAneny BL, McDonnell TM, Mileham KF, Nasso SF, Nowakowski GS, Oettel KR, Patel MI, Patt DA, Perlmutter J, Pickard TA, Rodriguez G, Rosenberg AR, Russo B, Szczepanek C, Smith CB, Srivastava P, Teplinsky E, Thota R, Traina TA, Zon R, Bourbeau B, Bruinooge SS, Foster S, Grubbs S, Hagerty K, Hurley P, Kamin D, Phillips J, Schenkel C, Schilsky RL, Burris HA. American Society of Clinical Oncology Road to Recovery Report: Learning From the COVID-19 Experience to Improve Clinical Research and Cancer Care. J Clin Oncol 2020; 39:155-169. [PMID: 33290128 DOI: 10.1200/jco.20.02953] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This report presents the American Society of Clinical Oncology's (ASCO's) evaluation of the adaptations in care delivery, research operations, and regulatory oversight made in response to the coronavirus pandemic and presents recommendations for moving forward as the pandemic recedes. ASCO organized its recommendations for clinical research around five goals to ensure lessons learned from the COVID-19 experience are used to craft a more equitable, accessible, and efficient clinical research system that protects patient safety, ensures scientific integrity, and maintains data quality. The specific goals are: (1) ensure that clinical research is accessible, affordable, and equitable; (2) design more pragmatic and efficient clinical trials; (3) minimize administrative and regulatory burdens on research sites; (4) recruit, retain, and support a well-trained clinical research workforce; and (5) promote appropriate oversight and review of clinical trial conduct and results. Similarly, ASCO also organized its recommendations regarding cancer care delivery around five goals: (1) promote and protect equitable access to high-quality cancer care; (2) support safe delivery of high-quality cancer care; (3) advance policies to ensure oncology providers have sufficient resources to provide high-quality patient care; (4) recognize and address threats to clinician, provider, and patient well-being; and (5) improve patient access to high-quality cancer care via telemedicine. ASCO will work at all levels to advance the recommendations made in this report.
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Affiliation(s)
| | | | - Laura A Levit
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Sibel Blau
- Northwest Medical Specialties, Seattle, WA
| | | | | | | | - Mithat Gonen
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Tari King
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Todd A Pickard
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Barry Russo
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | | | | | | | | | | | | | - Robin Zon
- Michiana Hematology Oncology, Niles, MI
| | | | | | | | | | | | | | - Deborah Kamin
- American Society of Clinical Oncology, Alexandria, VA
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Rubio-San-Simón A, André N, Cefalo MG, Aerts I, Castañeda A, Benezech S, Makin G, van Eijkelenburg N, Nysom K, Marshall L, Gambart M, Hladun R, Rossig C, Bergamaschi L, Fagioli F, Carpenter B, Ducassou S, Owens C, Øra I, Ribelles AJ, De Wilde B, Guerra-García P, Strullu M, Rizzari C, Ek T, Hettmer S, Gerber NU, Rawlings C, Diezi M, Palmu S, Ruggiero A, Verdú J, de Rojas T, Vassal G, Geoerger B, Moreno L, Bautista F. Impact of COVID-19 in paediatric early-phase cancer clinical trials in Europe: A report from the Innovative Therapies for Children with Cancer (ITCC) consortium. Eur J Cancer 2020; 141:82-91. [PMID: 33129040 PMCID: PMC7546235 DOI: 10.1016/j.ejca.2020.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Data regarding real-world impact on cancer clinical research during COVID-19 are scarce. We analysed the impact of the COVID-19 pandemic on the conduct of paediatric cancer phase I-II trials in Europe through the experience of the Innovative Therapies for Children with Cancer (ITCC). METHODS A survey was sent to all ITCC-accredited early-phase clinical trial hospitals including questions about impact on staff activities, recruitment, patient care, supply of investigational products and legal aspects, between 1st March and 30th April 2020. RESULTS Thirty-one of 53 hospitals from 12 countries participated. Challenges reported included staff constraints (30% drop), reduction in planned monitoring activity (67% drop of site initiation visits and 64% of monitoring visits) and patient recruitment (61% drop compared with that in 2019). The percentage of phase I, phase II trials and molecular platforms closing to recruitment in at least one site was 48.5%, 61.3% and 64.3%, respectively. In addition, 26% of sites had restrictions on performing trial assessments because of local contingency plans. Almost half of the units suffered impact upon pending contracts. Most hospitals (65%) are planning on improving organisational and structural changes. CONCLUSION The study reveals a profound disruption of paediatric cancer early-phase clinical research due to the COVID-19 pandemic across Europe. Reported difficulties affected both patient care and monitoring activity. Efforts should be made to reallocate resources to avoid lost opportunities for patients and to allow the continued advancement of oncology research. Identified adaptations to clinical trial procedures may be integrated to increase preparedness of clinical research to futures crises.
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Affiliation(s)
- Alba Rubio-San-Simón
- Paediatric Haematology-Oncology Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Nicolas André
- Paediatric Haematology-Oncology Department, Hôpital pour enfant de La Timone, AP-HM, Marseille, France
| | - Maria Giuseppina Cefalo
- Onco-Hematology, Cell and Gene Therapy Department, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Isabelle Aerts
- Paediatric Haematology-Oncology Department, Institut Curie, Paris, France
| | - Alicia Castañeda
- Paediatric Haematology-Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sarah Benezech
- Paediatric Haematology-Oncology Department, Institut d’Hematologie et Oncologie Pédiatrique IHOPe, Lyon, France
| | - Guy Makin
- Paediatric Haematology-Oncology Department, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Lynley Marshall
- Paediatric Haematology-Oncology Department, Oak Centre for Children & Young People, The Royal Marsden Hospital & the Institute of Cancer Research, London, United Kingdom
| | - Marion Gambart
- Paediatric Haematology-Oncology Department, Hôpital des enfants CHU, Toulouse, France
| | - Raquel Hladun
- Division of Paediatric Haematology and Oncology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Claudia Rossig
- Paediatric Haematology-Oncology Department, University Children´s Hospital, Muenster, Germany
| | - Luca Bergamaschi
- Paediatric Haematology-Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Franca Fagioli
- Paediatric Haematology-Oncology Department, Regina Margherita Children's Hospital, A.O.U. Citta della Salute di Torino, Torino, Italy
| | - Ben Carpenter
- Paediatric Haematology-Oncology Department, University College London Hospitals, London, United Kingdom
| | - Stephane Ducassou
- Paediatric Haematology-Oncology Department, Centre Hospitalier Universitaire (CHU), Bordeaux, France
| | - Cormac Owens
- Paediatric Haematology-Oncology Department, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Ingrid Øra
- Department of Paediatric Haematology-Oncology, University Hospital, Stockholm, Sweden
| | - Antonio Juan Ribelles
- Paediatric Haematology-Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bram De Wilde
- Paediatric Haematology-Oncology Department, Ghent University Hospital, Ghent, Belgium
| | - Pilar Guerra-García
- Paediatric Haematology-Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Marion Strullu
- Paediatric Haematology-Oncology Department, Hôpital Robert-Debré Ap-Hp, Paris, France
| | - Carmelo Rizzari
- Paediatric Haematology-Oncology Department, Clinica Pediatrica Fondazione MBBM, Monza, Italy
| | - Torben Ek
- Paediatric Haematology-Oncology Department, Childhood Cancer Centre, Gothenburg, Sweden
| | - Simone Hettmer
- Division of Paediatric Haematology-Oncology Department, Department of Paediatric and Adolescent Medicine, Faculty of Medicine, University of Freiburg, Germany
| | - Nicolas U. Gerber
- Department of Paediatric Oncology, University Children's Hospital, Zurich, Switzerland
| | - Christine Rawlings
- Paediatric Haematology-Oncology Department, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Manuel Diezi
- Pediatric Hematology-Oncology Unit, Division of Paediatrics, Department “Woman-Mother-Child”, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Sauli Palmu
- Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antonio Ruggiero
- Paediatric Haematology-Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS -Universita’ Cattolica Sacro Cuore, Rome Italy
| | - Jaime Verdú
- Paediatric Haematology-Oncology Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Teresa de Rojas
- Paediatric Haematology-Oncology Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Gilles Vassal
- Paediatric and Adolescent Oncology Department Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Birgit Geoerger
- Paediatric and Adolescent Oncology Department Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Lucas Moreno
- Division of Paediatric Haematology and Oncology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francisco Bautista
- Paediatric Haematology-Oncology Department, Children's University Hospital Niño Jesús, Madrid, Spain,Corresponding author: Paediatric Oncology, Haematology and Haematopoietic Stem Cell Transplant Department, Hospital Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain
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32
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Dorsey ER, Kluger B, Lipset CH. The New Normal in Clinical Trials: Decentralized Studies. Ann Neurol 2020; 88:863-866. [PMID: 32869367 DOI: 10.1002/ana.25892] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/14/2020] [Accepted: 08/23/2020] [Indexed: 12/11/2022]
Affiliation(s)
- E Ray Dorsey
- Center for Health and Technology (CHeT) and Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Benzi Kluger
- Center for Health and Technology (CHeT) and Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Craig H Lipset
- Clinical Innovation Partners LLC, Basking Ridge, NJ, USA
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Saini KS, de las Heras B, Plummer R, Moreno V, Romano M, de Castro J, Aftimos P, Fredriksson J, Bhattacharyya GS, Olivo MS, Schiavon G, Punie K, Garcia-Foncillas J, Rogata E, Pfeiffer R, Orbegoso C, Morrison K, Curigliano G, Chin L, Saini ML, Rekdal Ø, Anderson S, Cortes J, Leone M, Dancey J, Twelves C, Awada A. Reimagining Global Oncology Clinical Trials for the Postpandemic Era: A Call to Arms. JCO Glob Oncol 2020; 6:1357-1362. [PMID: 32897732 PMCID: PMC7529519 DOI: 10.1200/go.20.00346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Kamal S. Saini
- Covance, Princeton, NJ,East Suffolk and North Essex NHS Foundation Trust, Ipswich, United Kingdom,Kamal S. Saini, MD, MBBS, Covance, 206 Carnegie Center, Princeton, NJ 08540-6233; Twitter: @KSainiMD; e-mail:
| | | | - Ruth Plummer
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Victor Moreno
- START Madrid-FJD, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Philippe Aftimos
- Oncology Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | - Gaia Schiavon
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jesus Garcia-Foncillas
- University Hospital Fundacion Jimenez Diaz, Autonomous University of Madrid, Madrid, Spain
| | - Ernesto Rogata
- Leeds Cancer Centre, Patient and Public Involvement Group, Leeds, United Kingdom
| | | | | | | | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy,University of Milano, Milan, Italy
| | - Lynda Chin
- Apricity Health, Houston, TX,Dell Medical School at the University of Texas at Austin, Austin, TX
| | | | | | | | - Javier Cortes
- IOB Institute of Oncology, Quiron Group, Madrid, Spain
| | | | - Janet Dancey
- Canadian Cancer Trials Group, Queen’s University, Kingston, Ontario, Canada
| | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Ahmad Awada
- Oncology Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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