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Alexander M, Rogers J, Parakh S, Mitchell P, Clay TD, Kao S, Hughes BGM, Itchins M, Kong BY, Pavlakis N, Solomon BJ, John T. Lurbinectedin in small cell lung cancer: real-world experience of a multicentre national early access programme. Intern Med J 2024; 54:1087-1096. [PMID: 38369719 DOI: 10.1111/imj.16348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 01/24/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND AIMS Lurbinectedin is a novel oncogenic transcription inhibitor active in several cancers, including small cell lung cancer (SCLC). We aimed to describe the first Australian experience of the clinical efficacy and tolerability of lurbinectedin for the treatment of SCLC after progression on platinum-containing therapy. METHODS Multicentre real-world study of individuals with SCLC initiating lurbinectedin monotherapy (3.2 mg/m2 three-weekly) on an early access programme between May 2020 and December 2021. Key outcomes were clinical utilisation, efficacy and tolerability. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Outcome data were collected within the AUstralian Registry and biObank of thoRacic cAncers (AURORA). RESULTS Data were analysed for 46 individuals across seven sites. Lurbinectedin was given as second- (83%, 38/46) or subsequent- (17%, 8/46) line therapy, mostly with prior chemoimmunotherapy (87%, 40/46). We report dose modifications (17%, 8/46), interruptions/delays (24%, 11/46), high-grade toxicities (28%, 13/46) and hospitalisations (54%, 25/46) during active treatment. The overall response rate was 33% and the disease control rate was 50%. Six-month OS was 44% (95% confidence interval (CI): 29.0-57.1). Twelve-month OS was 15% (95% CI: 6.5-26.8). From lurbinectedin first dose, the median PFS was 2.5 months (95% CI: 1.8-2.9) and OS was 4.5 months (95% CI: 3.5-7.2). From SCLC diagnosis, the median OS was 12.9 months (95% CI: 11.0-17.2). Individuals with a longer chemotherapy-free interval prior to lurbinectedin had longer PFS and OS. CONCLUSION This real-world national experience of lurbinectedin post-platinum chemotherapy and immunotherapy for individuals with SCLC was similar to that reported in clinical trials.
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Affiliation(s)
- Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Rogers
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sagun Parakh
- Austin Hospital, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
| | - Paul Mitchell
- Austin Hospital, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
- Division of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy D Clay
- Saint John of God Subiaco Hospital, Perth, Western Australia, Australia
- Icon Cancer Care Midland, Perth, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Steven Kao
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brett G M Hughes
- The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Malinda Itchins
- Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Benjamin Y Kong
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nick Pavlakis
- Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Benjamin J Solomon
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas John
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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2
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Alexander M, Collins I, Abraham P, Underhill C, Harris S, Torres J, Sharma S, Solomon B, Tran‐Duy A, Burbury K. Telehealth in oncology: a cost analysis to evaluate the financial impact of implementing regional trial hubs within a phase 3 cancer clinical trial. Intern Med J 2023; 53:2346-2349. [PMID: 38130050 PMCID: PMC10946773 DOI: 10.1111/imj.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
This cost analysis, from a societal perspective, compared the cost difference of a networked teletrial model (NTTM) with four regional hubs versus conventional trial operation at a single metropolitan specialist centre. The Australian phase 3 cancer interventional randomised controlled trial included 152 of 328 regional participants (patient enrolment 2018-2021; 6-month primary end point). The NTTM significantly reduced (AU$2155 per patient) patient travel cost and time and lost productivity.
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Affiliation(s)
- Marliese Alexander
- Pharmacy DepartmentPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Ian Collins
- Victorian Comprehensive Cancer CentreMelbourneVictoriaAustralia
- Deakin UniversityMelbourneVictoriaAustralia
| | - Patrick Abraham
- Centre for Health Policy, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Craig Underhill
- Border Medical Oncology and Haematology Research UnitAlbury Wodonga Regional Cancer CentreAlbury WodongaNew South WalesAustralia
- Rural Medical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
| | - Sam Harris
- Bendigo Cancer CentreBendigo HealthBendigoVictoriaAustralia
| | - Javier Torres
- Peter Copulos Cancer and Wellness CentreGoulburn Valley HealthSheppartonVictoriaAustralia
- Shepparton Clinical SchoolThe University of MelbourneSheppartonVictoriaAustralia
| | - Sharad Sharma
- Ballarat Regional Integrated Cancer CentreGrampians HealthBallaratVictoriaAustralia
| | - Benjamin Solomon
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
- Department of Medical OncologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - An Tran‐Duy
- Centre for Health Policy, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Kate Burbury
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
- Department of HaematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
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3
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Sabesan S, Malica M, Gebbie C, Scott C, Thomas D, Zalcberg J. Implementation of the Australasian Teletrial Model: Translating ideas into action using implementation science frameworks. J Telemed Telecare 2023; 29:641-647. [PMID: 34233548 DOI: 10.1177/1357633x211017805] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Despite Government investment, disparity in access to clinical trials continue between metropolitan and regional & rural sectors (RRR) in Australia and around the world. To improve trial access closer to home for RRR communities and rare cancer patients even in metro settings, the Australasian Teletrial Model (ATM) was developed by Clinical Oncology Society of Australia and implemented in four states. Aim of this paper is to describe the steps and processes involved in the development and implementation of ATM guided by implementation science frameworks. Method: Two implementation science frameworks namely iPARIHS and Strategic Implementation Framework were chosen to guide the project. Details of steps and processes were extracted from COSA final report. Results: ATM met the criteria for worthy innovation. For the development and implementation of the ATM, stakeholders were at national, statewide and clinical levels. A co-design with end-users and inclusion of key stakeholders in steering committees and advisory groups made the implementation smoother. Clinician levers including advocacy were useful to overcome system barriers. During the project, more patients, and clinicians at RRR participated in trials, more primary sites collaborated with RRR sites and more RRR sites gained trial capabilities. Conclusion: Pilot project achieved its objectives including improved access to patients locally, creation of linkages between metro and RRR sites and enhanced capabilities of and access to RRR sites. Implementation science frameworks were useful for identifying the necessary steps and processes at the outset. Ownership by governments and creation of streamlined regulatory systems would enable broader adoption.
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Affiliation(s)
- Sabe Sabesan
- Department of Medical Oncology, Townsville Cancer Centre, Townsville, & James Cook University, Australia
| | - Marie Malica
- Clinical Oncology Society of Australia, Australia
| | | | - Clare Scott
- Clinical Translation Centre, Walter and Eliza Hall Institute of Medical Research, Australia
| | - David Thomas
- Genomic Cancer Medicine, Garvan Institute of Medical Research, Australia
| | - John Zalcberg
- Monash University Faculty of Medicine, Nursing and Health Sciences, Australia
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4
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Lim J, Akbar Ali S, Prawira A, Sim HW. Impact of travel distance on outcomes for clinical trial patients: the Kinghorn Cancer Centre experience. Intern Med J 2023; 53:242-249. [PMID: 34613656 DOI: 10.1111/imj.15561] [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: 07/01/2021] [Revised: 09/18/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Geographic isolation and travel distance to specialist care is a known social determinant of health and contributes to poorer oncology survival outcomes. AIMS To compare survival and toxicity outcomes for patients travelling long distances (>50 km) for treatment on clinical trials with local patients (<10 km and 10-50 km). METHODS We performed a retrospective cohort study based at the Kinghorn Cancer Centre, a comprehensive cancer care centre in metropolitan Sydney. We included adult patients with advanced solid-organ malignancies who were enrolled on therapeutic clinical trials between July 2015 and December 2017. Outcome measures included overall survival, progression-free survival, rates of grade 3-4 toxicity and unplanned hospital admissions for the duration of the clinical trial. RESULTS We included 173 patients, of whom 27% lived within 10 km, 29% lived between 10 and 50 km and 44% lived further than 50 km. We did not identify significant differences between survival or toxicity outcomes between patients travelling long distances and local patients. CONCLUSIONS All patients should be considered for clinical trial referral based on clinical parameters and preference, regardless of geographic proximity. In the meantime, improving access to clinical trials for rural and regional patients continues to be a priority.
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Affiliation(s)
- Jennifer Lim
- Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Syafiq Akbar Ali
- Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Prawira
- Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Hao-Wen Sim
- Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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5
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Thomas EE, Kelly JT, Taylor ML, Mendis R, Banbury A, Haydon H, Catto J, Der Vartanian C, Smith AC, Caffery LJ. Telehealth adoption in cancer clinical trials: An Australian perspective. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 10/22/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Emma E. Thomas
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Jaimon T. Kelly
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Monica L. Taylor
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Roshni Mendis
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Annie Banbury
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Helen Haydon
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | | | | | - Anthony C. Smith
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
- Centre for Innovative Medical Technology University of Southern Denmark Odense Denmark
| | - Liam J. Caffery
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
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6
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McPhee NJ, Nightingale CE, Harris SJ, Segelov E, Ristevski E. Barriers and enablers to cancer clinical trial participation and initiatives to improve opportunities for rural cancer patients: A scoping review. Clin Trials 2022; 19:464-476. [PMID: 35586873 DOI: 10.1177/17407745221090733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Claire E Nightingale
- Monash Rural Health, Monash University, Bendigo, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Samuel J Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - Eva Segelov
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, VIC, Australia.,Department of Oncology, Monash Health, Clayton, VIC, Australia
| | - Eli Ristevski
- Monash Rural Health, Monash University, Warragul, VIC, Australia
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7
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Roberts NA, Cubitt A, Lindsay D, Bury K, Dixon J, Gebbie C, Hawkins CA, Major T, Jenkins-Marsh S, Morris-Smith B, Poxton M, Richmond S, Smith D, Stoneley A, Thaker DA, Wilson E, Woollett A, Underhill C, Sabesan S. Teletrials, the new norm? Expert recommendations for teletrials into the future: Findings from the Clinical Oncology Society of Australia Clinical Trial Research Professionals Group Workshop. Asia Pac J Clin Oncol 2022; 18:650-659. [PMID: 35098670 DOI: 10.1111/ajco.13737] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The Australasian Teletrial Model was piloted in co-funded sites across Australia. The purpose was to extend the reach of clinical trials using telemedicine to improve equity and access to this treatment pathway for oncology patients. Experts across Australia gathered to share the learnings of implementation so that future directions can be effective and sustainable. METHODS The 1-day workshop was attended in person and virtually. Attendees were invited to analyze and disseminate the results. Recordings from the presentations were coded independently by three researchers and synthesized. The results were sent to the authorship team for further review to build consensus on the findings in three drafts. RESULTS Four key themes were identified: "Being on the Same Page," "Building Foundations," "Key Roles in Teletrials," and "Incentives." Although there were many successes that were accelerated by the COVID-19 pandemic, there is work still to be done. CONCLUSION The Australasian Teletrial Model has been identified as acceptable and feasible. Future directions need to continue to work on streamlining regulatory processes, implementation and monitoring, and build knowledge to further build networks across Australia.
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Affiliation(s)
- Natasha A Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,University of Queensland Clinical Centre for Research (UQCCR), Herston, Queensland, Australia.,Clinical Oncology Society of Australia Clinical Trials Research Professionals Group, Sydney, New South Wales, Australia
| | - Annette Cubitt
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Clinical Oncology Society of Australia Clinical Trials Research Professionals Group, Sydney, New South Wales, Australia
| | - Dianne Lindsay
- Clinical Oncology Society of Australia Clinical Trials Research Professionals Group, Sydney, New South Wales, Australia
| | - Kimberley Bury
- Townsville Cancer Centre, Townsville University Hospital, Townsville, Queensland, Australia
| | | | - Chantal Gebbie
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Cheryl-Ann Hawkins
- Alfred Health, Melbourne, Victoria, Australia.,Melanoma and Skin Cancer Trials Ltd, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Melanie Poxton
- Townsville Cancer Centre, Townsville University Hospital, Townsville, Queensland, Australia
| | - Sue Richmond
- Clinical Research Unit, Cairns Hospital, Cairns, Queensland, Australia
| | - Delaine Smith
- Australasian Leukaemia and Lymphoma Group, Melbourne, Victoria, Australia
| | | | - Darshit A Thaker
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Clinical School, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | | | - Anne Woollett
- TrialHub, Alfred Health, Melbourne, Victoria, Australia
| | - Craig Underhill
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, Albury, New South Wales, Australia.,Albury Campus, Regional Medical School, University of NSW, Albury, New South Wales, Australia
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville University Hospital, Townsville, Queensland, Australia
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8
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Sundquist S, Batist G, Brodeur-Robb K, Dyck K, Eigl BJ, Lee DK, Limoges J, Longstaff H, Pankovich J, Sadura A, Sullivan P, Dancey JE. CRAFT-A Proposed Framework for Decentralized Clinical Trials Participation in Canada. Curr Oncol 2021; 28:3857-3865. [PMID: 34677247 PMCID: PMC8534531 DOI: 10.3390/curroncol28050329] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Canada's vast geography, and centralized delivery of cancer care and clinical trials create barriers for trial participation for patients in remote and rural settings. The development and implementation of a framework that enables safe and regulatory compliant trial participation through local healthcare providers would benefit Canadian patients, clinicians, trial sponsors and the health care system. To address this issue, representatives of Canada's cancer clinical trial community met to identify key challenges and develop recommendations for remote patient participation in trials. A structured literature review identified remote/rural trial delivery models. A panel of expert stakeholders reviewed the models and participated in a workshop to assess health system readiness, identify needed processes, tools and mechanisms, and develop recommendations for a Canadian framework for decentralized clinical trial conduct. The Canadian Remote Access Framework for clinical Trials (CRAFT) represents a risk-based approach used by site investigators to delegate responsibilities for a given trial to satellite health centres within a hub-and-spoke "trial cluster". The Framework includes specific recommendations to ensure research experience, capacity, regulatory compliance and patient safety. Canada's cancer care and telemedicine systems can be leveraged to enable broader access to clinical trials for patients who are geographically remote from cancer centres. CRAFT's risk-based framework is based on other successful models of remote trial patient management and is in the pilot implementation phase in Canada.
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Affiliation(s)
- Stephen Sundquist
- Canadian Cancer Clinical Trials Network, Toronto, ON M5G 0A3, Canada;
| | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada;
| | - Kathy Brodeur-Robb
- C17 Council for Children’s Cancer and Blood Disorders, Edmonton, AB T6G 1C9, Canada;
| | - Kathryn Dyck
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Bernhard J. Eigl
- Division of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, Canada;
| | - David K. Lee
- Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada;
| | | | - Holly Longstaff
- Provincial Health Services Authority, Vancouver, BC V6H 4C1, Canada;
| | - Jim Pankovich
- Bold Therapeutics Inc., Vancouver, BC V6C 1E1, Canada;
| | - Anna Sadura
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | | | - Janet E. Dancey
- Canadian Cancer Clinical Trials Network, Toronto, ON M5G 0A3, Canada;
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada;
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9
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Ives A, Pusztai T, Keller J, Ahern E, Chan B, Gasper H, Wyld D, Kennedy G, Dickie G, Lwin Z, Roberts NA. Resilience and ongoing quality care for cancer clinical trials during COVID-19: Experience from a tertiary hospital in Australia. Asia Pac J Clin Oncol 2021; 18:e141-e147. [PMID: 33819387 PMCID: PMC8251164 DOI: 10.1111/ajco.13570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic has forced rapid system-wide changes to be implemented within cancer care at an alarming pace. Clinical trials are a key element of comprehensive cancer care. Ensuring the continuing safe conduct of cancer clinical trials in the context of a pandemic is challenging. METHODS We aimed to describe the COVID-19 pandemic response of a Cancer Care Clinical Research Unit (CRU) of a tertiary hospital in Queensland, Australia. We used a mixed methods approach for this case study. Emailed directives from CRU managers to all CRU staff sharing were qualitatively analysed and mapped against our unit activities over longitudinal time points. Data from patient recruitment and protocol deviations were analysed using descriptive statistics. RESULTS Mapping activity from 11 March to 30 September 2020 revealed rapid change during the first 2 weeks. Four key strategies to accommodate change were identified: supporting patients and families, introduction of telehealth, accessing investigational product, and social distancing. Early in the pandemic we recognised that our core key stakeholders were integral to our response. When compared to the previous 12 months, our recruitment numbers dropped markedly in early phases of the response but recovered over time, as we accommodated internal and external impacts. CONCLUSION Our experience of agility as a necessity, adapting to support patients, and managing both clinical research activity and sponsors during the height of the pandemic response is presented here in order to inform future disaster response planning by clinical trial organisations.
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Affiliation(s)
- Amy Ives
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tricia Pusztai
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Ahern
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Bryan Chan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia
| | - Harry Gasper
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Natasha A Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland Centre for Clinical Research (UQCCR), Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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10
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Lee JJ, Burbury K, Underhill C, Harris S, Shackleton K, McBurnie J, McPhee N, Osmond F, Wilkins K, Baden P, Krishnasamy M. Exploring Australian regional cancer patients' experiences of clinical trial participation via telemedicine technology. J Telemed Telecare 2020; 28:508-516. [PMID: 32811275 DOI: 10.1177/1357633x20950180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Regional cancer patients face various barriers in accessing specialist cancer services. Teletrials are a new model of care that utilise telemedicine technology to enable access to and participation in clinical trials close to home. The present study aimed to explore the experiences of regional cancer patients and their carers while participating in a teletrial, and those of regional patients who travelled to a metropolitan centre for trial participation. METHODS A concurrent, mixed methods study design was used to address the study aim. Patient quality of life data were gathered for both groups and an audio-recorded semi-structured interview undertaken to explore patients' and carers' experiences of the two modes of trial participation. Greater weighting was given to the qualitative data. RESULTS Participants described teletrials as an acceptable and valuable initiative that reduced overall burden of trial participation. Irrespective of mode of delivery, patients and carers identified access to trials and specialist cancer services as an important equity issue for regional cancer patients. DISCUSSION From the perspective of regional cancer patients and carers, a teletrial offers convenient, acceptable access to a clinical trial. Although not all patients may want to engage in a teletrial, patients and carers agree that it offers equity of opportunity for trial participation, irrespective of where people live.
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Affiliation(s)
- Jin Joo Lee
- Department of Nursing, University of Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Australia
| | | | | | | | | | | | | | | | | | - Paul Baden
- Victorian Comprehensive Cancer Centre, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Australia.,Peter MacCallum Cancer Centre, Australia
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11
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Segelov E, Underhill C, Prenen H, Karapetis C, Jackson C, Nott L, Clay T, Pavlakis N, Sabesan S, Heywood E, Steer C, Lethborg C, Gan HK, Yip D, Karanth N, Karikios D, MacIntyre CR. Practical Considerations for Treating Patients With Cancer in the COVID-19 Pandemic. JCO Oncol Pract 2020; 16:467-482. [PMID: 32401686 DOI: 10.1200/op.20.00229] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cancer has become a prevalent disease, affecting millions of new patients globally each year. The COVID-19 pandemic is having far-reaching impacts around the world, causing substantial disruptions to health and health care systems that are likely to last for a prolonged period. Early data have suggested that having cancer is a significant risk factor for mortality from severe COVID-19. A diverse group of medical oncologists met to formulate detailed practical advice on systemic anticancer treatments during this crisis. In the context of broad principles, issues including risks of treatment, principles of prioritizing resources, treatment of elderly patients, and psychosocial impact are discussed. Detailed treatment advice and options are given at a tumor stream level. We must maintain care for patients with cancer as best we can and recognize that COVID-19 poses a significant competing risk for death that changes conventional treatment paradigms.
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Affiliation(s)
- Eva Segelov
- Department of Oncology, Monash University and Monash Health, Melbourne, Victoria, Australia
| | - Craig Underhill
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, and University of NSW Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Hans Prenen
- Department of Oncology, University Hospital Antwerp, Edegem, Belgium
| | - Christos Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | | | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Tim Clay
- Department of Oncology, St John of God Subiaco Hospital and School of Medicine and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sabe Sabesan
- Department of Medical Oncology, Townsville Cancer Centre, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Ellen Heywood
- Cancer Services, Monash Health, Melbourne, Victoria, Australia
| | - Christopher Steer
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, and University of NSW Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Carrie Lethborg
- Inclusive Health Research, St Vincent's Health Australia, Melbourne, Victoria, Australia
| | - Hui K Gan
- Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia.,La Trobe University School of Cancer Medicine, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital and ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Narayan Karanth
- Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Deme Karikios
- Department of Medical Oncology, Nepean Hospital and Nepean Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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