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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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Leggett H, Vinall-Collier K, Csikar J, Barber S, Carr R, Bhatti A, Pavitt S. Legacy lessons from the COVID-19 era to improve trial participation and retention: Views from trial participants, PPIE contributors and trial staff across the NIHR portfolio. PLoS One 2024; 19:e0296343. [PMID: 38381743 PMCID: PMC10880997 DOI: 10.1371/journal.pone.0296343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The Covid-19 pandemic had a profound effect on the delivery of healthcare research. Covid-19 research was prioritised and many non-essential trials were paused. This study explores the engagement experiences of trial participants', PPIE contributors' and trial staff during the Covid-19 pandemic and towards recovery and restoring a diverse and balanced UK clinical trials portfolio. METHODS Interviews and focus groups were undertaken with PPIE contributors, trial participants and trial staff members from NIHR research trials across the UK (November 2020-June 2021) across portfolio specialities: Cancer, Oral and Dental Health, Musculoskeletal Disorders, Cardiovascular Disease, Neurological Disorders, Primary Care, and Conditions associated with susceptibility to Covid-19 (Diabetes, Stroke, Respiratory Disorders). Topic guides were developed for each participant group and interviews were conducted over Zoom. The transcripts were analysed using codebook thematic analysis in NVivo (V.12). RESULTS 106 participants comprising, 45 PPIE contributors, 27 trial participants and 34 trial staff members were recruited. Three themes to engagement with trials during Covid-19 were developed. 1) Ensuring continued contact. Continued and tailored communication, having a trial point of contact and regular updates all enhanced trial engagement and retention. Patients' unfamiliarity with materials being sent electronically reduced engagement and trust. 2) A balanced move to remote consultations. Remote follow-up and monitoring were convenient and allowed for wider recruitment across the UK. Participants were more likely to discuss personal subjects in their own homes. Remote visits lacked a personal touch, some concerns over missed diagnoses or being unable to appreciate the situation, technical abilities or equipment failures were seen as barriers, especially for disadvantaged or older people. 3) The importance of feeling fully informed. Factors that supported attendance were knowledge about trial conduct adherence to Covid-19 regulations, social distancing, clear signage at the site and opportunities to ask questions. Barriers included not knowing what to expect and not feeling safe with rules and regulations. CONCLUSIONS Our findings highlight a number of ways to future proof trial delivery against future pandemics or disruptions such as offering online options to participate in research, ensuring consistent communication between participants and the research team, making sure participants feel fully informed and the continued reassurance of safety in the clinical setting.
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Affiliation(s)
- Heather Leggett
- York Trials Unit, The University of York, York, United Kingdom
| | | | - Julia Csikar
- School of Dentistry, The University of Leeds, Leeds, United Kingdom
| | - Sophy Barber
- School of Dentistry, The University of Leeds, Leeds, United Kingdom
| | - Rachel Carr
- York Trials Unit, The University of York, York, United Kingdom
| | - Amrit Bhatti
- School of Dentistry, The University of Leeds, Leeds, United Kingdom
| | - Sue Pavitt
- School of Dentistry, The University of Leeds, Leeds, United Kingdom
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von Itzstein MS, Gwin ME, Gupta A, Gerber DE. Telemedicine and Cancer Clinical Research: Opportunities for Transformation. Cancer J 2024; 30:22-26. [PMID: 38265922 PMCID: PMC10827351 DOI: 10.1097/ppo.0000000000000695] [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] [Indexed: 01/26/2024]
Abstract
ABSTRACT Telemedicine represents an established mode of patient care delivery that has and will continue to transform cancer clinical research. Through telemedicine, opportunities exist to improve patient care, enhance access to novel therapies, streamline data collection and monitoring, support communication, and increase trial efficiency. Potential challenges include disparities in technology access and literacy, physical examination performance, biospecimen collection, privacy and security concerns, coverage of services by insurance, and regulatory considerations. Coupled with artificial intelligence, telemedicine may offer ways to reach geographically dispersed candidates for narrowly focused cancer clinical trials, such as those targeting rare genomic subsets. Collaboration among clinical trial staff, clinicians, regulators, professional societies, patients, and their advocates is critical to optimize the benefits of telemedicine for clinical cancer research.
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Affiliation(s)
- Mitchell S. von Itzstein
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mary E. Gwin
- Department of Internal Medicine, University of Texas Southwestern Medical Center. Dallas, Texas, USA
| | - Arjun Gupta
- Department of Internal Medicine (Division of Hematology-Oncology), University of Minnesota, Minneapolis, Minnesota, USA
| | - David E. Gerber
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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4
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Durden K, Hurley P, Butler DL, Farner A, Shriver SP, Fleury ME. Provider motivations and barriers to cancer clinical trial screening, referral, and operations: Findings from a survey. Cancer 2024; 130:68-76. [PMID: 37851511 DOI: 10.1002/cncr.35044] [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: 04/20/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Provider and institutional practices have been shown to have a large impact on cancer clinical trial enrollment. Understanding provider perspectives on screening for trial eligibility is necessary to improve enrollment. METHODS A questionnaire about incentives, barriers, process tools, and infrastructure related to opening trials and referring patients to onsite and offsite trials was administered to diverse stakeholders, including professional societies, advocacy organizations, and industry networks. Descriptive statistics were used to summarize findings. RESULTS Overall, 693 responses were received, primarily from physicians (42.7%) and nurses (35.6%) employed at hospital health systems (43.7%) and academic centers (36.5%). Approximately half (49.2%) screened all patients for onsite clinical trials with screening typically done by manual chart review (81.9%). The greatest incentive reported for offering trials was providing the best treatment options for patients (67.7%). Contracting and paperwork (48.5%) were the greatest barriers to opening more onsite trials. Offsite referrals were rare. CONCLUSIONS Screening for trial eligibility is a largely manual and ad hoc process, with screening and referral to offsite trials occurring infrequently. Administrative and infrastructure barriers commonly prevent sites from opening more onsite trials. These findings suggest that automated trial screening tools built into workflows that screen in a site-agnostic manner could result in more frequent trial eligibility screening, especially for offsite trials. With recent momentum, in part in response to the COVID-19 pandemic, to improve clinical trial efficiencies and broaden access and participant diversity, implementing tools to improve screening and referral processes is timely and essential. PLAIN LANGUAGE SUMMARY There are many factors that contribute to low adult enrollment in cancer clinical trials, but previous research has indicated that provider and institutional barriers are the largest contributors to low cancer clinical trial enrollment. In this survey, we sought to gain insight into cancer clinical trial enrollment practices from the perspective of health care providers such as physicians and nurses. We found that only approximately half of respondents indicated their institution systematically screens their patients for clinical trials and this process is manual and time consuming. Furthermore, we found that providers infrequently search for and refer patients to clinical trials at other sites. Creating better screening methods could improve enrollment in clinical trials.
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Affiliation(s)
- Kelly Durden
- Department of Prevention and Early Detection, American Cancer Society (ACS), Atlanta, Georgia, USA
| | - Patricia Hurley
- American Society of Clinical Oncology (ASCO), Alexandria, Virginia, USA
| | - Dorothy L Butler
- American Cancer Society Cancer Action Network (ACS CAN), Washington, DC, USA
| | - Amy Farner
- American Cancer Society Cancer Action Network (ACS CAN), Washington, DC, USA
- Josh Bersin Academy, Oakland, California, USA
| | - Sharon P Shriver
- American Cancer Society Cancer Action Network (ACS CAN), Washington, DC, USA
| | - Mark E Fleury
- American Cancer Society Cancer Action Network (ACS CAN), Washington, DC, USA
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5
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Gerber DE, Barksdale EKS. Approaches to Continuing COVID-19-Related Clinical Research Practices After the Pandemic-Must Cinderella Leave the Ball? JAMA Oncol 2023; 9:1027-1028. [PMID: 37261818 DOI: 10.1001/jamaoncol.2023.1514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This Viewpoint reviews relevant components of federal regulation and guidance followed during the COVID-19 pandemic that may still be feasible and beneficial after the public health emergency ends.
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Affiliation(s)
- David E Gerber
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas
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6
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Burnett WJ, Agbali R, Silva J, De Leo G. Impact of the COVID-19 Pandemic on National Institutes of Health-Funded Researchers and Their Projects: The Role of Age, Sex, Experience, and Team Size. Public Health Rep 2023; 138:315-322. [PMID: 36354213 PMCID: PMC9659696 DOI: 10.1177/00333549221133809] [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] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has disrupted the social life, work environment, and well-being of millions of people. We examined COVID-19's impact on National Institutes of Health (NIH)-funded extramural principal investigators (PIs) affiliated with public health and preventive medicine departments across the country and their projects; assessed PIs' confidence in achieving project goals; and investigated the role of age, sex, experience, and team size on PIs' confidence in achieving project goals during the pandemic. METHODS We sent an anonymous online survey in January 2021 to 1076 extramural PIs affiliated with public health and preventive medicine departments at US institutions; 133 (12.4%) responded. We examined the impact of COVID-19 on the PIs, their project team operations, and their confidence that project objectives would be met, using Likert scales based on age, sex, team size, and PI experience. RESULTS Of 126 PIs, 94 (74.6%) felt that their day-to-day professional life was impacted a lot or a great deal by COVID-19. More female PIs than male PIs reported that their level of stress changed because of the COVID-19 pandemic. Of 125 PIs, 67 (53.6%) made major adjustments to research operations, 46 (36.8%) made minor adjustments, 5 (4.0%) halted research, and 7 (5.6%) reported not being affected. Of 123 PIs, 89 (72.4%) reported not using NIH COVID-19 accommodations. PIs who led projects 4 or 5 times felt more confident about meeting their research objectives than PIs who led projects 2 or 3 times. CONCLUSIONS Future studies should investigate how to develop more engaging support and communication strategies to assist NIH researchers in mitigating the effects of pandemics or large-scale emergencies.
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Affiliation(s)
- Wendy J. Burnett
- Department of Interdisciplinary Health
Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA,
USA
- Wendy J. Burnett, MS, Augusta University,
College of Allied Health Sciences, Department of Interdisciplinary Health
Sciences, 1120 15th St, EB205, Augusta, GA 30912, USA.
| | - Raphael Agbali
- Department of Interdisciplinary Health
Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA,
USA
| | - Jeane Silva
- Department of Interdisciplinary Health
Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA,
USA
| | - Gianluca De Leo
- Department of Interdisciplinary Health
Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA,
USA
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7
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Ragavan MV, Legaspi N, LaLanne A, Hong JC, Small EJ, Borno HT. Analysis of Serious Adverse Event Reporting for Patients Enrolled in Cancer Clinical Trials During the COVID-19 Pandemic. JAMA Oncol 2022; 8:1849-1851. [PMID: 36301577 PMCID: PMC9614670 DOI: 10.1001/jamaoncol.2022.4919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This cross-sectional study assesses whether a change occurred in reporting of serious adverse events for patients in oncology clinical trials in the US during the COVID-19 pandemic.
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Affiliation(s)
- Meera V. Ragavan
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Nichole Legaspi
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Alyssa LaLanne
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - Julian C. Hong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco,Department of Radiation Oncology, University of California, San Francisco, San Francisco,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco
| | - Eric J. Small
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - Hala T. Borno
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco,Trial Library, San Francisco, California
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8
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Gerber DE, Tiro JA, McNeill LH, Williams EL, Zhu H, Lee SJC, Leavey PJ, Sadeghi N, Kapinos KA, Dornsife DL, Nguyen V, Wileyto EP, Guerra CE. Enhancing access to and diversity in cancer clinical trials through a financial reimbursement program: Protocol to evaluate a novel program. Contemp Clin Trials 2022; 121:106922. [PMID: 36096281 DOI: 10.1016/j.cct.2022.106922] [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: 03/11/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
As clinical trials have become more complex, with increasing numbers of required procedures and clinic visits, gaining access to promising new treatments has become even more challenging for many individuals. To address these barriers, we implemented a financial reimbursement and outreach program designed to increase the number and diversity of participants in cancer clinical trials at centers in Dallas, Houston, and Philadelphia. As endorsed by U.S. Food and Drug Administration (FDA) and the Texas and Pennsylvania State Legislatures, the program provides financial reimbursement for non-clinical costs (e.g., travel, lodging) to patients on cancer clinical trials with household income up to 700% the Federal poverty rate. The research study described here, centered at the Dallas site, evaluates program impact by assessing (1) numbers and diversity of patients enrolled to cancer clinical trials before and after program implementation; (2) characteristics of patients offered participation in the program who do versus do not enroll; (3) characteristics of patients enrolled in the program who do versus do not complete the reimbursement process. To evaluate perceived barriers and facilitators of program participation, we will conduct semi-structured interviews and administer the Comprehensive Score for Financial Toxicity Patient Reported Outcome Measure (COST PROM) and the Short Assessment of Health Literacy (SAHL). This program will examine how reimbursement of non-clinical costs can improve access to cancer clinical trials, with the eventual goal of increasing trial enrollment, diversity, representativeness, and generalizability.
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Affiliation(s)
- David E Gerber
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Jasmin A Tiro
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Lorna H McNeill
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX, USA.
| | - Erin L Williams
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Hong Zhu
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Patrick J Leavey
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA; Children's Health, Dallas, TX, USA.
| | - Navid Sadeghi
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA; Parkland Health and Hospital System, Dallas, TX, USA.
| | - Kandice A Kapinos
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA; RAND Corporation, Santa Monica, CA, USA.
| | | | - Vivian Nguyen
- Abramson Cancer Center and the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Carmen E Guerra
- Abramson Cancer Center and the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Sridhara R, Barksdale E, Marchenko O, Jiang Q, Ando Y, Bloomquist E, Coory M, Crouse M, Degtyarev E, Framke T, Freidlin B, Gerber DE, Gwise T, Josephson F, Hess L, Kluetz P, Li D, Mandrekar S, Posch M, Rantell K, Ratitch B, Raven A, Roes K, Rufibach K, Sarac SB, Simon R, Singh H, Theoret M, Thomson A, Zuber E, Shen YL, Pazdur R. Cancer Clinical Trials Beyond Pandemic: Report of an American Statistical Association Biopharmaceutical Section Open Forum Discussion. Stat Biopharm Res 2022. [DOI: 10.1080/19466315.2022.2103181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center at UT Southwestern
| | | | | | | | | | | | | | - Martin Posch
- Institute for Medical Statistics at the Medical University of Vienna
| | | | | | | | - Kit Roes
- Radboud University Medical Center
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Participant and Research Team Perspectives on the Conduct of a Remote Therapeutic COVID-19 Clinical Trial: A Mixed Methods Approach. J Clin Transl Sci 2022; 6:e69. [PMID: 35836793 PMCID: PMC9257771 DOI: 10.1017/cts.2022.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Responding to the need to investigate potential treatments of COVID-19, a research team employed a telehealth platform to determine whether niclosamide, an oral anthelmintic drug that had shown antiviral activity, reduced SARS-CoV-2 shedding and duration of symptoms in patients with mild-to-moderate symptoms of COVID-19. To encourage compliance with patient self-quarantine, this randomized placebo-controlled clinical trial was conducted utilizing a remote telehealth design to complete all study visits, monitor symptoms, and coordinate participant self-collected specimens. Methods: A mixed methods approach employing surveys and interviews of trial participants and interviews of research team members was used to collect their experiences with and perspectives on the acceptability of the remote clinical trial design and delivery. Results: Of the 67 eligible trial participants invited to take part in a study to evaluate the telehealth platform, 46% (n = 31) completed a post-participation survey. While 97% (n = 30) of respondents had not previously participated in a clinical trial, 77% (n = 24) reported they would consider taking part in a future remote research study. The majority of respondents were moderately or very comfortable (93%) with using the technology. Conclusions: The COVID-19 crisis was a call to action to expand understanding of the conduct of remote clinical trials, including the experiences of research participants. Our findings showed that this approach can be both effective for the conduct of research and positive for participants. Further research on the use of telehealth research platforms seems warranted in rural, underserved populations, and remote trials of prevention, screening, and treatment.
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11
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O'Reilly S, Murphy V, Mulroe E, Tucker L, Carragher F, Marron J, Shannon AM, Rogan K, Connolly RM, Hennessy BT, McDermott RS. The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy. Cancers (Basel) 2022; 14:2247. [PMID: 35565375 PMCID: PMC9101172 DOI: 10.3390/cancers14092247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. METHODS A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. RESULTS In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. CONCLUSION The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem.
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Affiliation(s)
- Seamus O'Reilly
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
| | | | | | - Lisa Tucker
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | | | | | | | - Ken Rogan
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | - Roisin M Connolly
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
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12
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Insights for Oncology Trials Garnered From the Rapid Development of an mRNA COVID-19 Vaccine. Cancer J 2022; 28:146-150. [PMID: 35333501 PMCID: PMC8974181 DOI: 10.1097/ppo.0000000000000587] [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] [Indexed: 11/26/2022]
Abstract
The sudden emergence of the coronavirus disease 2019 (COVID-19) pandemic in early 2020 stimulated unprecedented scientific initiatives to rapidly develop effective treatments and vaccines. One example was the development of vaccines based on messenger RNA platforms, which received emergency use authorization in the United States less than 1 year after the primary sequence of the severe acute respiratory syndrome coronavirus 2 virus was published. Novel practices arose from the collaborative efforts and inclusive clinical studies that facilitated the vaccines' rapid development and clinical testing. I describe insights gained from the experience of mRNA-1273 vaccine development that may be applied to or adapted for oncology research. These insights include clinical study design, diversity and inclusion initiatives, speed, and real-world evidence generation, as well as close partnership among regulatory agencies, government, and pharmaceutical companies.
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13
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Williams EF, Gerber DE. Reply to A. Grand et al. JCO Oncol Pract 2022; 18:243. [PMID: 34990277 DOI: 10.1200/op.21.00821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Erin F Williams
- Erin F. Williams, MBA, Harold C. Simmons Comprehensive Cancer Center and David E. Gerber, MD, Harold C. Simmons Comprehensive Cancer Center
| | - David E Gerber
- Erin F. Williams, MBA, Harold C. Simmons Comprehensive Cancer Center and David E. Gerber, MD, Harold C. Simmons Comprehensive Cancer Center
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Gerber DE, Clark VL, Sheffield TY, Beg MS, Xie Y, Holbein MEB, Skinner CS, Lee SJC, Williams EL. Longitudinal Experience With and Impressions of COVID-19-Related Clinical Research Changes. JCO Oncol Pract 2022; 18:e98-e107. [PMID: 34324403 PMCID: PMC8757963 DOI: 10.1200/op.21.00169] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has led to profound changes in clinical research, including remote consent, telehealth, off-site procedures, shipment of therapy, and remote study monitoring. We assessed longitudinal perceptions of these adjustments among clinical research professionals. METHODS We distributed an anonymous survey assessing experiences, perceptions, and recommendations regarding COVID-19-related clinical research adjustments to cancer clinical research office personnel in May 2020 and again in November 2020. Responses were compared using Fisher's exact and Mann-Whitney U tests. RESULTS A total of 90 of 102 invited research personnel (88%) responded. Fifty-three (59%) reported participating in both initial and follow-up surveys. The proportion of respondents reporting personal experience with COVID-19-related adjustments increased over time, particularly for remote initial consent (29% v 4%), remote reconsent (24% v 9%), and remote study monitoring (36% v 22%). Perceived impact of COVID-19-related adjustments on data quality (P = .02) and patient experience (P = .002) improved significantly. However, perceived effect on patient safety (P = .02) and respondent's experience (P = .09) became less favorable. Individuals with personal experience with the adjustment were more likely to recommend continuing remote consent (62% v 38%; P = .04), remote monitoring (69% v 45%; P = .05), and therapy shipment (67% v 35%; P = .01) after the COVID-19 pandemic, with nonsignificant trends for off-site diagnostics (44% v 24%; P = .13) and telehealth visits (66% v 45%; P = .08). CONCLUSION More than 6 months into the global pandemic, perceptions of COVID-19-related clinical research changes remain favorable. Experienced individuals are more likely to recommend that these changes continue in the future.
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Affiliation(s)
- David E. Gerber
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,David E. Gerber, MD, Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Mail Code 8852, Dallas, TX 75390; e-mail:
| | - Valerie L. Clark
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas Y. Sheffield
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - M. Shaalan Beg
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yang Xie
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - M. E. Blair Holbein
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Celette Sugg Skinner
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Simon J. Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Erin L. Williams
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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15
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O’Malley DM, Alfano CM, Doose M, Kinney AY, Lee SJC, Nekhlyudov L, Duberstein P, Hudson SV. Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research. Transl Behav Med 2021; 11:1989-1997. [PMID: 34850934 PMCID: PMC8634312 DOI: 10.1093/tbm/ibab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.
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Affiliation(s)
- Denalee M O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Catherine M Alfano
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anita Y Kinney
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Department of Population and Data Sciences, UT-Southwestern, Dallas, TX, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Brigham & Womens’ Primary Care Medical Associates, Boston, MA, USA
| | - Paul Duberstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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16
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Williams EL, Pierre DL, Martin ME, Beg MS, Gerber DE. Taking Tele Behind the Scenes: Remote Clinical Trial Monitoring Comes of Age During the COVID-19 Pandemic. JCO Oncol Pract 2021; 17:577-579. [PMID: 34379519 PMCID: PMC8457794 DOI: 10.1200/op.21.00524] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Erin L. Williams
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX,Erin L. Williams, MBA, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Mail Code 9179, Dallas, TX 75390; e-mail:
| | - Desiree L. Pierre
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mary E. Martin
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Muhammad S. Beg
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
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