Increasing Physician Awareness of Clinical Trials Through Oncology Pathways

J Clin Pathways. 2021;7(8):22.

Geisinger’s Cancer Institute serves more than 3 million people in 45 counties across Pennsylvania through its 11 hematology/oncology, six radiation oncology, and four palliative medicine sites. Geisinger is an active member of the National Cancer Institute Community Research Program, a collaborative network designed to conduct oncology clinical trials and generate new knowledge through cancer care delivery research.

With this focus on cancer research, it is critical that Geisinger oncologists are aware of clinical trials being conducted across our institution. We are a geographically distributed cancer institute; our portfolio of clinical trials is rapidly expanding; and physicians may see patients with less common cancer diagnoses—all of which can make it difficult for our oncologists to stay abreast of the latest trials

Geisinger implemented oncology pathways in 2019, supporting our oncologists with the challenge of staying informed and standardizing high-quality care delivered across our cancer network. We chose Elsevier’s ClinicalPath solution, which provides evidence-based medical and radiation oncology pathways and embeds our clinical trials ahead of standard-of-care recommendations. This reminds our medical and radiation oncologists of available clinical trials at the point of clinical care.

Recently, I saw a patient with carboplatin-resistant, primary peritoneal carcinoma and was considering treating her with second-line therapy with pegylated doxorubicin and bevacizumab. However, as I navigated our oncology pathways, I came across a clinical trial we had available, testing pegylated doxorubicin and bevacizumab +/- atezolizumab. I had been unaware that this trial was available at our institution, and this trial could provide my patient with an opportunity to receive immunotherapy, which is not yet standard care for her disease. I selected my patient to be screened for this trial from within the oncology pathways, and our team promptly screened for clinical trial enrollment.

Embedding research trials into the clinical workflow—at the point of treatment decision-making—and allowing oncologists to select a patient to be screened for a trial directly from the oncology pathways tool increases the ease of coordinating with the research team and adds to the number of patients accrued to trials. This is particularly important given recent study findings that found over 70% of cancer patients are interested in participating in a clinical trial,¹ but only 2% to 4% are accrued on average.^2,3 In addition to higher patient accrual in trials, Geisinger is also committed to improving health equity among our patients. Our patients are geographically, economically, and socially diverse, and we are focused on providing equal access to treatment options, such as clinical trials, regardless of these factors.

Our oncology pathways provide detailed analytics, which allow us to optimize our trial portfolio based on our patient population. Data on patient presentation details can be used to determine the optimal trials and treatment sites to maximize the likelihood of accruing sufficient patients. We can also review data on patient screening rates by clinical trial, provider, and treatment site to identify opportunities to improve trial accruals.

In summary, embedding clinical trials into our oncology pathways has increased awareness of our clinical research program. Our oncologists identify appropriate trials for their patients at the point of treatment selection, and our research team can focus on trial operations rather than relying on manual processes to identify patients for trials. Furthermore, incorporating trials into pathways allows our oncologists to present consistent treatment options to patients, improving health equity and increasing the diversity of patients accrued to trials. Finally, we can use the analytics from our pathways to optimize our clinical research program, efficiently open trials, and increase patient accruals. This approach enables Geisinger to provide patients with innovative treatment options and advance the quality of cancer care.

References

1. Clinical Trials in Immunotherapy. Association of Community Cancer Centers. July 27, 2017. Accessed September 24, 2021. https://www.accc-cancer.org/home/learn/immunotherapy/resource-detail/Clinical-Trials-in-Immunotherapy
2. Rimel BJ. Clinical trial accrual: obstacles and opportunities. Front Oncol. 2016;6:103. doi:10.3389/fonc.2016.00103
3. Unger JM, Cook E, Tai E, Bleyer A. Role of clinical trial participation in cancer research: barriers, evidence, and strategies. Am Soc Clin Oncol Educ Book. 2016;35:185-198. doi:10.1200/EDBK_156686

Disclaimer

This article is sponsored by Elsevier. The opinions and statements of the clinicians are specific to the respective authors and not necessarily those of Elsevier, Journal of Clinical Pathways, or HMP Global.