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Caston NE, Williams CP, Levitan EB, Griffin R, Azuero A, Wheeler SB, Rocque GB. Why location matters: associations between county-level characteristics and availability of National Cancer Oncology Research Program and National Cancer Institute sites. JNCI Cancer Spectr 2024; 8:pkae038. [PMID: 38745369 PMCID: PMC11163183 DOI: 10.1093/jncics/pkae038] [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: 11/14/2023] [Revised: 01/30/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The majority of patients with cancer seek care at community oncology sites; however, most clinical trials are available at National Cancer Institute (NCI)-designated sites. Although the NCI National Cancer Oncology Research Program (NCORP) was designed to address this problem, little is known about the county-level characteristics of NCORP site locations. METHODS This cross-sectional analysis determined the association between availability of NCORP or NCI sites and county-level characteristic theme percentile scores from the Center for Disease Control and Prevention's Social Vulnerability Index themes. Health Resources and Services Administration's Area Health Resource Files were used to determine contiguous counties. We estimated risk ratios and 95% confidence intervals (CIs) using modified Poisson regression models to evaluate the association between county-level characteristics and site availability within singular and singular and contiguous counties. RESULTS Of 3141 included counties, 14% had an NCORP, 2% had an NCI, and 1% had both sites. Among singular counties, for a standard deviation increase in the racial and ethnic theme score, there was a 22% higher likelihood of NCORP site availability (95% CI = 1.10 to 1.36); for a standard deviation increase in the socioeconomic status theme score, there was a 24% lower likelihood of NCORP site availability (95% CI = 0.67 to 0.87). Associations were of smaller magnitude when including contiguous counties. NCI sites were located in more vulnerable counties. CONCLUSIONS NCORP sites were more often in racially diverse counties and less often in socioeconomically vulnerable counties. Research is needed to understand how clinical trial representation will increase if NCORP sites strategically increase their locations in more vulnerable counties.
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Affiliation(s)
- Nicole E Caston
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Courtney P Williams
- Division of Preventive Medicine, University of Alabama at Birmingham Department of Medicine, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Russell Griffin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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2
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Shi X, Mudaranthakam DP, Wick JA, Streeter D, Thompson JA, Streeter NR, Lin TL, Hines J, Mayo MS, Gajewski BJ. Using Bayesian hierarchical modeling for performance evaluation of clinical trial accrual for a cancer center. Contemp Clin Trials Commun 2024; 38:101281. [PMID: 38419809 PMCID: PMC10900093 DOI: 10.1016/j.conctc.2024.101281] [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: 12/07/2022] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Slow patient accrual in cancer clinical trials is always a concern. In 2021, the University of Kansas Comprehensive Cancer Center (KUCC), an NCI-designated comprehensive cancer center, implemented the Curated Cancer Clinical Outcomes Database (C3OD) to perform trial feasibility analyses using real-time electronic medical record data. In this study, we proposed a Bayesian hierarchical model to evaluate annual cancer clinical trial accrual performance. Methods The Bayesian hierarchical model uses Poisson models to describe the accrual performance of individual cancer clinical trials and a hierarchical component to describe the variation in performance across studies. Additionally, this model evaluates the impacts of the C3OD and the COVID-19 pandemic using posterior probabilities across evaluation years. The performance metric is the ratio of the observed accrual rate to the target accrual rate. Results Posterior medians of the annual accrual performance at the KUCC from 2018 to 2023 are 0.233, 0.246, 0.197, 0.150, 0.254, and 0.340. The COVID-19 pandemic partly explains the drop in performance in 2020 and 2021. The posterior probability that annual accrual performance is better with C3OD in 2023 than pre-pandemic (2019) is 0.935. Conclusions This study comprehensively evaluates the annual performance of clinical trial accrual at the KUCC, revealing a negative impact of COVID-19 and an ongoing positive impact of C3OD implementation. Two sensitivity analyses further validate the robustness of our model. Evaluating annual accrual performance across clinical trials is essential for a cancer center. The performance evaluation tools described in this paper are highly recommended for monitoring clinical trial accrual.
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Affiliation(s)
- Xiaosong Shi
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jo A Wick
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - David Streeter
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jeffrey A Thompson
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Natalie R Streeter
- University of Kansas Cancer Center, Kansas City, KS, USA
- Clinical Trials Office, University of Kansas Cancer Center, Fairway, KS, USA
| | - Tara L Lin
- University of Kansas Cancer Center, Kansas City, KS, USA
- Clinical Trials Office, University of Kansas Cancer Center, Fairway, KS, USA
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA
| | - Joseph Hines
- University of Kansas Cancer Center, Kansas City, KS, USA
- Clinical Trials Office, University of Kansas Cancer Center, Fairway, KS, USA
| | - Matthew S Mayo
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Byron J Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
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3
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Sturz JL, Boughey JC. Lasting Impacts of the COVID-19 Pandemic on Breast Cancer Diagnosis and Treatment in the United States. Surg Oncol Clin N Am 2023; 32:811-819. [PMID: 37714645 PMCID: PMC10169575 DOI: 10.1016/j.soc.2023.05.010] [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: 09/17/2023]
Abstract
The COVID-19 pandemic was an unprecedented time that placed unique challenges on the screening and treatment of breast cancer in the United States. Collaboration among medical disciplines and societies provided guidelines and strategies to mitigate the exposure of patients and medical providers to the virus and provide optimal care. We discuss the changes that the pandemic had on the multidisciplinary management of breast cancer.
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Affiliation(s)
- Jenna L Sturz
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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4
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Unger JM, Stires H, Levit LA, Stewart M, McKelvey BA, Canin B, Dressler E, Flaherty K, Fredette P, Jones L, McCann P, Miller T, Onitilo AA, Palmieri F, Patel T, Paul R, Smith GL, Bruinooge SS, Garrett-Mayer E, Lei XJ, Alva A, Schenkel C. Sponsor Perspectives on the Impact of the COVID-19 Pandemic on Interventional Cancer Clinical Trial Protocols and Data Quality. JCO Oncol Pract 2023; 19:907-916. [PMID: 37643386 PMCID: PMC10615547 DOI: 10.1200/op.23.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE The onset of the COVID-19 pandemic created major disruptions in the conduct of cancer clinical trials. In response, regulators and sponsors allowed modifications to traditional trial processes to enable clinical research and care to continue. We systematically evaluated how these mitigation strategies affected data quality and overall trial conduct. METHODS This study used surveys and live interviews. Forty-one major industry and National Cancer Institute Network groups (sponsors) overseeing anticancer treatment trials open in the United States from January 2015 to May 2022 were invited to participate. Descriptive statistics were used for survey data summaries. Key themes from interviews were identified. RESULTS Twenty sponsors (48.8%; 15 industry and five Network groups) completed the survey; 11/20 (55.0%) participated in interviews. Sponsors predominantly (n = 12; 60.0%) reported large (≥11 trials) portfolios of phase II and/or phase III trials. The proportion of sponsors reporting a moderate (9) or substantial (8) increase in protocol deviations in the initial pandemic wave versus the pre-pandemic period was 89.5% (17/19); the proportion reporting a substantial increased dropped from 42.1% (n = 8/19) in the initial wave to 15.8% (n = 3/19) thereafter. The most commonly adopted mitigation strategies were remote distribution of oral anticancer therapies (70.0%), remote adverse event monitoring (65.0%), and remote consenting (65.0%). Most respondents (15/18; 83.3%) reported that the pandemic had minimal (n = 14) or no impact (n = 1) on overall data integrity. CONCLUSION Despite nearly all sponsors observing a temporary increase in protocol deviations, most reported the pandemic had minimal/no impact on overall data integrity. The COVID-19 pandemic accelerated an emerging trend toward greater flexibility in trial conduct, with potential benefits of reduced burden on trial participants and sites and improved patient access to research.
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Affiliation(s)
| | | | - Laura A. Levit
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | | | | | - Peter Fredette
- EQRx (employed by IQVIA during study design phase), Cambridge, MA
| | - Lee Jones
- Fight Colorectal Cancer, Arlington, VA
| | | | - Therica Miller
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Timil Patel
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD
| | - Rocio Paul
- National Cancer Institute, Cancer Therapy Evaluation Program, Clinical Trials Monitoring Branch, Bethesda, MD
| | - Gary L. Smith
- National Cancer Institute, Cancer Therapy Evaluation Program, Clinical Trials Monitoring Branch, Bethesda, MD
| | | | | | - Xiudong Jennifer Lei
- University of Texas MD Anderson Cancer Center (employed by ASCO during study design phase), Houston, TX
| | - Ajjai Alva
- University of Michigan Medical Center, Ann Arbor, MI
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5
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Bogaert B, Kozlakidis Z, Caboux E, Péron J, Saintingy P. What went right during the COVID crisis: The capabilities of local actors and lasting innovations in oncology care and research. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002366. [PMID: 37747872 PMCID: PMC10519589 DOI: 10.1371/journal.pgph.0002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/16/2023] [Indexed: 09/27/2023]
Abstract
This article will elaborate how oncology care and research was adapted during the COVID pandemic in the Metropole of Lyon (France), including the lasting innovations that came out of the crisis. The research method involved 22 semi-structured qualitative interviews of healthcare professionals, managers, and researchers in the Lyon, France region coming from both public and private academic hospitals. The interviews took place from February 2021-December 2022 in order to assess the long-term adaptations and innovations in cancer care organization in the post-COVID era. The main results show adaptations and innovations in 1) new processes and resources to facilitate disciplinary and interdisciplinary work; 2) harmonization and streamlining of patient journeys. In the discussion section, we will mobilize the capabilities approach, an interdisciplinary social sciences approach that focuses on the capabilities of persons to be and to do, to elaborate the conditions by which local actors were able to be agile, to adapt and to innovate in spite of the healthcare emergency and in coherence with their professional and personal values.
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Affiliation(s)
- Brenda Bogaert
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France and Institut des Humanités en Médecine, UNIL/CHUV, Lausanne, Switzerland
| | - Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Elodie Caboux
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Julien Péron
- Department of Medical Oncology and Research Center on Healthcare Performance (RESHAPE) INSERM U1290, Hospices Civils de Lyon, Pierre-Benite, France
| | - Pierre Saintingy
- Department of Medical Oncology, Centre Léon Bérard and Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Lyon, France
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6
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Sun G, Dizon DS, Szczepanek CM, Petrylak DP, Sparks DB, Tangen C, Lara P“LN, Thompson IM, Blanke CD. Crisis of the Clinical Trials Staff Attrition After the COVID-19 Pandemic. JCO Oncol Pract 2023; 19:533-535. [PMID: 37285550 PMCID: PMC10424897 DOI: 10.1200/op.23.00152] [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: 03/14/2023] [Revised: 03/21/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
A survey of clinical research professionals @SWOG indicate that 80% of clinical trial offices are understaffed. Addressing this is critical so progress for people with cancer continues. Read more about lessons learned in the #COVID19 pandemic and how it informs a path forward.
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Affiliation(s)
- Grace Sun
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Don S. Dizon
- Warren Alpert Medical School of Brown University, Providence, RI
- Lifespan Cancer Institute and Legorreta Cancer Center at Brown University, Providence, RI
| | | | | | | | | | | | | | - Charles David Blanke
- SWOG Cancer Research Network, San Antonio, TX
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
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7
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Carraça EV, Rodrigues B, Franco S, Nobre I, Jerónimo F, Ilharco V, Gabriel F, Ribeiro L, Palmeira AL, Silva MN. Promoting physical activity through supervised vs motivational behavior change interventions in breast cancer survivors on aromatase inhibitors (PAC-WOMAN): protocol for a 3-arm pragmatic randomized controlled trial. BMC Cancer 2023; 23:632. [PMID: 37407950 DOI: 10.1186/s12885-023-11137-1] [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: 06/09/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Aromatase inhibitors (AI) are frequently used to treat hormone-receptor-positive breast cancer, but they have multiple adverse effects (e.g., osteoporosis, arthralgia), resulting in premature therapy discontinuation/switch. Physical activity (PA) can attenuate these negative effects and improve quality of life (QoL). However, most cancer survivors fail to perform/sustain adequate PA levels, especially in the long-term. Theory-based interventions, using evidence-based behavior change techniques, aimed at promoting long-term behavior change in breast cancer survivors are effective, but remain scarce and fail to promote self-regulatory skills and better-quality motivations associated with sustained PA adoption. This paper describes the design of the PAC-WOMAN trial, which will test the long-term effectiveness and cost-effectiveness of two state of the art, group-based interventions encouraging sustained changes in PA, sedentary behavior, and QoL. Additional aims include examining the impact of both interventions on secondary outcomes (e.g., body composition, physical function), and key moderators/mediators of short and long-term changes in primary outcomes. METHODS A 3-arm pragmatic randomized controlled trial, involving a 4-month intervention and a 12-month follow-up, will be implemented, in a real exercise setting, to compare: 1) brief PA counseling/motivational intervention; 2) structured exercise program vs. waiting-list control group. Study recruitment goal is 122 hormone-receptor-positive breast cancer survivors (stage I-III), on AI therapy (post-primary treatment completion) ≥ 1 month, ECOG 0-1. Outcome measures will be obtained at baseline, 4 months (i.e., post-intervention), 10 and 16 months. Process evaluation, analyzing implementation determinants, will also be conducted. DISCUSSION PAC-WOMAN is expected to have a relevant impact on participants PA and QoL and provide insights for the improvement of interventions designed to promote sustained adherence to active lifestyle behaviors, facilitating its translation to community settings. TRIAL REGISTRATION April 20, 2023 - NCT05860621. April 21, 2023 - https://doi.org/10.17605/OSF.IO/ZAQ9N April 27, 2023 - UMIN000050945.
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Affiliation(s)
- Eliana V Carraça
- Centro de Investigação Em Educação Física, Desporto, Saúde e Exercício (CIDEFES), Universidade Lusófona, Campo Grande 376, Lisboa, 1749-024, Portugal.
| | - Bruno Rodrigues
- CIAFEL, Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral Saúde, Portugal
| | - Sofia Franco
- Centro de Investigação Em Educação Física, Desporto, Saúde e Exercício (CIDEFES), Universidade Lusófona, Campo Grande 376, Lisboa, 1749-024, Portugal
| | - Inês Nobre
- Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Lisboa, Portugal
| | - Flávio Jerónimo
- Centro de Investigação Em Educação Física, Desporto, Saúde e Exercício (CIDEFES), Universidade Lusófona, Campo Grande 376, Lisboa, 1749-024, Portugal
| | - Vítor Ilharco
- Centro de Investigação Em Educação Física, Desporto, Saúde e Exercício (CIDEFES), Universidade Lusófona, Campo Grande 376, Lisboa, 1749-024, Portugal
| | - Fernanda Gabriel
- Centro Hospitalar Universitário Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal
| | - Leonor Ribeiro
- Centro Hospitalar Universitário Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal
| | - António L Palmeira
- Centro de Investigação Em Educação Física, Desporto, Saúde e Exercício (CIDEFES), Universidade Lusófona, Campo Grande 376, Lisboa, 1749-024, Portugal
| | - Marlene N Silva
- Centro de Investigação Em Educação Física, Desporto, Saúde e Exercício (CIDEFES), Universidade Lusófona, Campo Grande 376, Lisboa, 1749-024, Portugal
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral Saúde, Portugal
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8
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George TJ, Lin TL, Adrales Bentz T, Grant S, Houston CM, Nashawati MA, Pappu B, Peck H, Zafirovski A, Kerstann K, LoRusso P, Schnatterly A, Hofacker J, Cameron K, Honeycutt H, Werner TL. Quantifying the impact of the COVID-19 pandemic on cancer center clinical trial operations. JNCI Cancer Spectr 2023; 7:pkad048. [PMID: 37467065 PMCID: PMC10463546 DOI: 10.1093/jncics/pkad048] [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: 12/06/2022] [Revised: 04/12/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Oncology clinical trials are complex, and the COVID-19 pandemic caused major disruptions in 2020. METHODS Using its networking and sharing of best practices, the Association of American Cancer Institutes, comprising 105 cancer centers, solicited a longitudinal series of voluntary surveys from members to assess how clinical trial office operations were affected. The surveys showed that centers were able to keep oncology trials available to patients while maintaining safety. Data were collected regarding interventional clinical trial accruals for the calendar years 2019, 2020, and 2021. RESULTS Data demonstrated a sizeable decrease in interventional treatment trial accruals in both 2020 and 2021 compared with prepandemic figures in 2019. No cancer center reported an increase in interventional treatment trial accruals in 2020 compared with 2019, with most centers reporting a moderate decrease. In mid-2022, 15% of respondents reported an increasing trend, 31% reported no significant change, and 54% continued to report a decrease. CONCLUSIONS The pandemic necessitated rapid adoption of trial operations, with the emergence of several best practices, including remote monitoring, remote consenting, electronic research charts, and work-from-home strategies for staff. The national infrastructure to conduct trials was significantly affected by the pandemic, with noteworthy resiliency, evidenced by improvements in efficiencies and patient-centered care delivery but with residual capacity challenges that will be evident for the foreseeable future.
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Affiliation(s)
- Thomas J George
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Tara L Lin
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Tricia Adrales Bentz
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Stefan Grant
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Melissa A Nashawati
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Bhanu Pappu
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Helen Peck
- Wilmot Cancer Institute, University of Rochester Medicine, Rochester, NY, USA
| | - Alex Zafirovski
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | | | | | | | - Janie Hofacker
- Association of American Cancer Institutes, Pittsburgh, PA, USA
| | - Kendra Cameron
- Association of American Cancer Institutes, Pittsburgh, PA, USA
| | | | - Theresa L Werner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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9
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Schnack H, Lubasch JS, Zinkevich A, Pawel A, Uthoff SAK, Ansmann L, von Kutzleben M. [Health Services research in Germany in Times of COVID-19: How Does the Pandemic Influence Research Processes, Methods and the Personal Situation of Researchers? An Online Survey]. DAS GESUNDHEITSWESEN 2023; 85:495-504. [PMID: 37315565 PMCID: PMC10442905 DOI: 10.1055/a-2055-0904] [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: 06/16/2023]
Abstract
The COVID-19 pandemic has a massive impact on social life, the healthcare system, and also on health services research. However, the effects of the pandemic on research processes, methods, and the personal situation of researchers has not been investigated so far. Guided by the question of how research processes and methods are adapted to the challenges posed by COVID-19 and how researchers perceive the impact of the pandemic on their personal situation, an online survey of health services researchers was conducted from June to July 2021. The results showed that a large proportion of research projects have had delays due to recruitment and/or data collection issues. Two-thirds of the respondents who had already collected data since the beginning of the pandemic (March 2020) were unable to collect data in the originally planned form and relied primarily on digital data collection methods. The analysis of the open-ended survey responses showed that the pandemic had a massive impact on all phases of the research process: key challenges included difficult field access, problems in achieving planned sample sizes, and concerns about data quality. Regarding their personal situation, researchers perceived the reduction of personal contacts, and the resulting lack of visibility as negative, while at the same time they benefited from the easy digital contact possibilities. Overall, the study provides an initial assessment of how the COVID-19 pandemic affected health services research and researchers. It shows that after the initial "shock" of the first lockdown in March 2020, pragmatic and often innovative ways were found to carry out projects under the pandemic conditions. However, the increased use of digital communication forms and data collection methods brings numerous challenges, but also methodological impulses.
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Affiliation(s)
- Helge Schnack
- Abteilung Organisationsbezogene Versorgungsforschung, Department
für Versorgungsforschung, Fakultät für Medizin und
Gesundheitswissenschaften, Carl von Ossietzky Universitat Oldenburg, Oldenburg,
Germany
| | - Johanna Sophie Lubasch
- Abteilung Organisationsbezogene Versorgungsforschung, Department
für Versorgungsforschung, Fakultät für Medizin und
Gesundheitswissenschaften, Carl von Ossietzky Universitat Oldenburg, Oldenburg,
Germany
| | - Anna Zinkevich
- Abteilung Organisationsbezogene Versorgungsforschung, Department
für Versorgungsforschung, Fakultät für Medizin und
Gesundheitswissenschaften, Carl von Ossietzky Universitat Oldenburg, Oldenburg,
Germany
| | - Amelie Pawel
- Abteilung Organisationsbezogene Versorgungsforschung, Department
für Versorgungsforschung, Fakultät für Medizin und
Gesundheitswissenschaften, Carl von Ossietzky Universitat Oldenburg, Oldenburg,
Germany
| | - Sarah Anna Katharina Uthoff
- Abteilung Organisationsbezogene Versorgungsforschung, Department
für Versorgungsforschung, Fakultät für Medizin und
Gesundheitswissenschaften, Carl von Ossietzky Universitat Oldenburg, Oldenburg,
Germany
| | - Lena Ansmann
- Abteilung Organisationsbezogene Versorgungsforschung, Department
für Versorgungsforschung, Fakultät für Medizin und
Gesundheitswissenschaften, Carl von Ossietzky Universitat Oldenburg, Oldenburg,
Germany
| | - Milena von Kutzleben
- Abteilung Organisationsbezogene Versorgungsforschung, Department
für Versorgungsforschung, Fakultät für Medizin und
Gesundheitswissenschaften, Carl von Ossietzky Universitat Oldenburg, Oldenburg,
Germany
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10
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Chlan LL, Tracy MF, Ask J, Lal A, Mandrekar J. The impact of the COVID-19 pandemic on ICU clinical trials: a description of one research team's experience. Trials 2023; 24:321. [PMID: 37165383 PMCID: PMC10172070 DOI: 10.1186/s13063-023-07355-4] [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: 11/30/2022] [Accepted: 05/05/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Disruptions to clinical trials conducted in the intensive care unit (ICU) due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2; coronavirus disease 2019 [COVID-19]) pandemic included fewer new trials activated and more trials stopped. While a number of ongoing, non-COVID-19 clinical trials remained open to enrollment, the direct impact of the pandemic on ICUs instilled chaos in this already challenging environment. The numerous challenges need to be reported so investigators can proactively plan and manage these myriad challenges. Thus, the purpose of this study was to describe the impact of the COVID-19 pandemic on screening and accrual for a non-COVID-19 parent clinical trial enrolling critically ill ICU patients receiving mechanical ventilatory support. METHODS A descriptive, retrospective design using quantitative data from detailed screening logs and qualitative observations with field notes from a parent clinical trial were used to address the objectives. The primary aims of the two-site parent clinical trial (n = 190) are to test the efficacy of self-administration of sedative therapy by mechanically ventilated ICU patients on anxiety and delirium occurrence. ICUs from two academic medical centers [names removed for blinding] plus a community hospital in Minnesota were screened daily for alert patients (Richmond Agitation Sedation Scale [RASS] - 2 to + 1), following commands, hemodynamically stable with sufficient hand grip strength to depress a push-button device. Screening data were summarized based on the primary reason patients were not enrolled (screen failures, declinations of consent). Descriptive statistics (frequencies, percentages), chi-square, and Fisher's Exact test were used to describe the data and to determine any differences among distributions of screening failures and recruitment declinations during the defined pre-pandemic (August 27, 2018-March 15, 2020, 2976 screened patients) and pandemic timeframes (March 16, 2020-February 28, 2022, 3912 screened patients). Qualitative data from varied sources such as screening logs, institutional email communications, staff field notes, and research team meeting minutes were summarized into themes. RESULTS Despite significantly fewer screen failures due to hypotension, cognitive impairment/dementia, coma, or chemical paralysis with 938 additional patients on the screening log, more were accrued pre-pandemic (n = 55) than during the pandemic period (n = 45); declination reasons were non-significant. Pandemic burdens experienced by study personnel, ICU care providers, and patients/families were revealed that attributed to decreased accrual. CONCLUSIONS While the parent clinical trial remained opened, cumulative factors adversely impacted the trial during the pandemic period with fewer patients accrued. The human toll of the pandemic on research staff, clinicians, and patients/family members demands that investigators be proactive in managing these challenges to conduct ICU clinical trials successfully, including careful oversight of human and financial resources. TRIAL REGISTRATION ClinicalTrials.gov NCT#02,819,141 Registered 29 June 2016.
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Affiliation(s)
- Linda L Chlan
- Department of Nursing, Division of Nursing Research, Mayo Clinic College of Medicine & Science, Rochester, USA
| | - Mary Fran Tracy
- School of Nursing, University of Minnesota, Minneapolis, USA
| | | | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, USA.
| | - Jay Mandrekar
- Division of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, USA
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11
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Global Health System Resilience during Encounters with Stressors - Lessons Learnt from Cancer Services during the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2023; 35:e289-e300. [PMID: 36764875 PMCID: PMC9842532 DOI: 10.1016/j.clon.2023.01.004] [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] [Received: 05/14/2022] [Revised: 10/04/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
AIMS The protracted COVID-19 pandemic has overwhelmed health systems globally, including many aspects of cancer control. This has underscored the multidimensional nature of cancer control, which requires a more comprehensive approach involving taking a wider perspective of health systems. Here, we investigated aspects of health system resilience in maintaining cancer services globally during the COVID-19 pandemic. This will allow for health systems to be resilient to different types of system stressors/shocks in the future, to allow cancer care to be maintained optimally. MATERIALS AND METHODS Using the World Health Organization health system framework (capturing aspects of service delivery, health workforce, information, medical products, vaccines and technologies, financing and governance and leadership), we carried out a comparative analysis of the impact of COVID-19 and the synthesis of the findings in responses in cancer care in 10 countries/jurisdictions across four continents comprising a wide diversity of health systems, geographical regions and socioeconomic status (China, Colombia, Egypt, Hong Kong SAR, Indonesia, India, Singapore, Sri Lanka, UK and Zambia). A combination of literature and document reviews and interviews with experts was used. RESULTS Our study revealed that: (i) underlying weaknesses of health systems before the pandemic were exacerbated by the pandemic (e.g. economic issues in low- and middle-income countries led to greater shortage of medication and resource constraints compounded by inadequacies of public financing and issues of engagement with stakeholders and leadership/governance); (ii) no universal adaptive strategies were applicable to all the systems, highlighting the need for health systems to design emergency plans based on local context; (iii) despite the many differences between health systems, common issues were identified, such as the lack of contingency plan for pandemics, inadequate financial policies for cancer patients and lack of evidence-based approaches for competing priorities of cancer care/pandemic control. CONCLUSION We identified four key points/recommendations to enhance the resilient capacity of cancer care during the COVID-19 pandemic and other system stressors: (i) effective pandemic control approaches in general are essential to maintain the continuity of cancer care during the emergency health crises; (ii) strong health systems (with sufficient cancer care resources, e.g. health workforce, and universal health coverage) are fundamental to maintain quality care; (iii) the ability to develop response strategies and adapt to evolving evidence/circumstances is critical for health system resilience (including introducing systematic, consistent and evidence-based changes, national support and guidance in policy development and implementation); (iv) preparedness and contingency plans for future public health emergencies, engaging the whole of society, to achieve health system resilience for future crises and to transform healthcare delivery beyond the pandemic.
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12
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Cooper L, Jose N. Despite negative perceptions of clinical trial conduct during the coronavirus disease 2019 (COVID-19) pandemic, are decentralized clinical trial methods here to stay? ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:159. [PMID: 36923074 PMCID: PMC10009564 DOI: 10.21037/atm-23-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Lisa Cooper
- Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Nadina Jose
- Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
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13
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Leung TH, Ho JC, El Helali A, Vokes EE, Wang X, Pang H. New reporting items and recommendations for randomized trials impacted by COVID-19 and force majeure events: a targeted approach. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:2. [PMID: 36760246 PMCID: PMC9906209 DOI: 10.21037/atm-22-2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/13/2022] [Indexed: 01/06/2023]
Abstract
Background Appropriate analyses and reporting are essential to the reproducibility and interpretation of clinical trials. However, the coronavirus disease 19 (COVID-19) pandemic and other force majeure events, like the war in Ukraine, have impacted the conduct of clinical trials. Methods The number of clinical trials potentially impacted were estimated from clinicaltrials.gov. To identify reporting items considered vital for assessing the impact of COVID-19, we reviewed 35 randomized phase III trials from three top oncology journals published between July and December 2020. For validation, we reviewed 29 phase III trials published between January and December 2021. Results Our results show that the number of clinical trials being potentially impacted in cancer, cardiovascular diseases, and diabetes is at least 1,484, 535, and 145, respectively. The magnitude of disruption is most significant in oncology trials. Based on the review of 35 trials, a modified checklist with ten new and four modified items covering pandemic's impact on trial conduct, protocol changes, delays, data capture, analysis and interpretation was developed to ensure comprehensive and transparent reporting. Our validation shows that six out of seven applicable reporting items were reported in less than 21% of the articles. Conclusions Our recommendations were proposed to improve the reporting of randomized clinical trials impacted by COVID-19 and force majeure events that are broadly applicable to different areas of medical research.
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Affiliation(s)
- Tiffany H. Leung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - James C. Ho
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Aya El Helali
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Everett E. Vokes
- University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University of Medicine, Durham, NC, USA
| | - Herbert Pang
- Department of Biostatistics and Bioinformatics, Duke University of Medicine, Durham, NC, USA
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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14
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Dunne W, Adebayo N, Danner S, Post S, O'Brian C, Tom L, Osei C, Blum C, Rivera J, Molina E, Trosman J, Weldon C, Ekong A, Adetoro E, Rapkin B, Simon MA. A Learning Health System Approach to Cancer Survivorship Care Among LGBTQ+ Communities. JCO Oncol Pract 2023; 19:e103-e114. [PMID: 36475752 PMCID: PMC10166358 DOI: 10.1200/op.22.00386] [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: 06/01/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals who receive primary care services at community health centers are often referred to external specialty care centers after cancer diagnosis, upon which primary care services are disrupted and may be discontinued because of gaps in communication between primary and oncologic care providers. This qualitative study evaluated barriers and facilitators to effective care coordination for LGBTQ+ patients with cancer and the utility of a novel cancer care coordination tool to mitigate identified barriers. MATERIALS AND METHODS Semistructured interviews with LGBTQ+ cancer survivors, caregivers to LGBTQ+ persons, clinical team members who provide care to LGBTQ+ patients, and members of community-based organizations that work with LGBTQ+ patients were conducted. Interview analysis was a multistage process, wherein a constant comparison approach was used. Transcripts were reviewed and coded using Atlas.ti Cloud. RESULTS A total of 26 individuals were interviewed: 10 patients, four caregivers, 10 clinical care team members, and two community organization representatives. Interview analysis yielded insight regarding (1) LGBTQ+ patient experiences engaging with primary and oncologic care at the clinic level and (2) perceptions of patient-provider and provider-provider communication and coordination. CONCLUSION Interview findings indicate a need for further development of interventions aimed at improving care coordination, patient experience, and outcomes in the cancer care continuum for LGBTQ+ patients. Learning health systems, like the one studied, show great potential for contributing to the development of such interventions.
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Affiliation(s)
- Will Dunne
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nihmotallahi Adebayo
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sankirtana Danner
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sharon Post
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine O'Brian
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura Tom
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Cassandra Osei
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | - Julia Trosman
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Center for Business Models in Healthcare, Glencoe, IL
| | - Christine Weldon
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Center for Business Models in Healthcare, Glencoe, IL
| | | | | | - Bruce Rapkin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Melissa A. Simon
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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15
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Hopkins JO, Braun-Inglis C, Guidice S, Wells M, Moorthi K, Berenberg J, St. Germain D, Mohile S, Hudson MF. Enrolling Older Adults Onto National Cancer Institute-Funded Clinical Trials in Community Oncology Clinics: Barriers and Solutions. J Natl Cancer Inst Monogr 2022; 2022:117-124. [PMID: 36519815 PMCID: PMC9753219 DOI: 10.1093/jncimonographs/lgac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 12/23/2022] Open
Abstract
In April 2021, the National Cancer Institute (NCI) Division of Cancer Prevention collaborated with the NCI Division of Cancer Treatment and Diagnosis to produce a virtual workshop that developed recommendations for enhancing NCI-sponsored clinical trial accrual of older adults. Prior to the workshop, a multidisciplinary group of stakeholders (eg, community oncologists, advanced practice practitioners, clinic and research staff, and patient advocates) gathered information related to accrual of older adults to clinical trials from the literature. Subsequently, a survey was conducted to detail NCI Community Oncology Research Program members' perspective on accrual barriers for this population; 305 individuals responded to the survey. Barriers to clinical trial accruals included comorbidity-attributed trial ineligibility, transportation and time issues, concern that the proposed regimen is too toxic for older adults, patient or family caregiver declined participation, and lack of trials relevant to older patients. Identified solutions included broadening clinical trial inclusion criteria, increasing the number of clinical trials specifically designed for older adults, simplifying consent forms, improving recruitment materials for older adults and their families, and facilitating transportation vouchers. At the workshop, participants, including stakeholders, used prior literature and survey results to develop recommendations, including interventions to address clinician bias, implement geriatric assessment, and promote clinician and staff engagement as mechanisms to improve accrual of older adults to clinical trials.
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Affiliation(s)
- Judith O Hopkins
- Novant Health Cancer Institute/SCOR National Cancer Institute Community Oncology Research Program (NCORP), Kernersville, NC, USA
| | - Christa Braun-Inglis
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI, USA
| | - Sofia Guidice
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Meg Wells
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Kiran Moorthi
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Berenberg
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI, USA
| | - Diane St. Germain
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Supriya Mohile
- Correspondence to: Supriya G. Mohile, MD, Departments of Medicine and Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY 14642, USA (e-mail: )
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16
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Zhu Y, Sun Y, Jin Y, Tao T, Yi L, Li X. Impact of the COVID-19 pandemic on clinical trials: a cross-sectional questionnaire study in China. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1154. [PMID: 36467359 PMCID: PMC9708462 DOI: 10.21037/atm-22-777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022]
Abstract
Background The number of Chinese clinical trials has continued to grow throughout the coronavirus disease 2019 (COVID-19) pandemic, but we know little about clinical trial team members' perceptions and attitudes toward the impacts of the pandemic. This study aimed to assess the impact of the COVID-19 pandemic on clinical trials in China from the perspective of research staff to provide a deeper understanding and some recommendations for the ongoing and upcoming clinical trials during the pandemic. Methods A nationwide cross-sectional questionnaire was distributed to respondents throughout mainland China between September 2021 and October 2021. The participants assessed the impact of the COVID-19 pandemic on clinical trials based on a 5-point Likert-type scale, and exploratory factor analysis (EFA) was used to confirm the factor structure. Descriptive statistical analysis and the Mann-Whitney test were used to discover the differences between different groups. Results A total of 2,393 questionnaires from 272 hospitals were collected in mainland China. Factor analysis resulted in 4 factors, with a cumulative explained variance of 64.93%, as follows: subject enrollment, patient care, study supplies and data management, and research milestones and quality management. The research team members, predominantly represented by clinical research coordinators (CRCs), basically agreed with all but 3 preset scenarios of the impact of COVID-19 on clinical trials. Most respondents did not agree that the pandemic was associated with more serious adverse events (SAEs), missed reports of safety events, or any increase of unscheduled unblinding. In addition, significant differences were revealed in different age, gender, and role groups of respondents based on their views on the impact of the pandemic. Conclusions The current pandemic situation has had a negative impact on clinical trials, especially in terms of subject recruitment and protocol compliance, yet research team members feel confident that some of the effective measures proposed in the study can moderate the negative impact.
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Affiliation(s)
- Yanhong Zhu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yanjun Sun
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Yan Jin
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Tiantian Tao
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Ling Yi
- Department of Drug Clinical Trials Institution, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China.,Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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17
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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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18
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Haynes RM, Sirintrapun SJ, Gao J, McKenzie AJ. Using Technology to Enhance Cancer Clinical Trial Participation. Am Soc Clin Oncol Educ Book 2022; 42:1-7. [PMID: 35486887 DOI: 10.1200/edbk_349671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The COVID-19 pandemic presented many challenges to health care systems, including oncology clinical research programs. There were substantial negative effects on oncology clinical trial screening, enrollment, and study activities that forced institutions and regulatory bodies to develop innovative solutions to maintain robust and equitable participation in these trials. Digital pathology innovations at Memorial Sloan Kettering Cancer Center have streamlined the diagnostic life cycle for patients with cancer, and the seamless integration of digital pathology services with next-generation sequencing and other molecular pathology services have accelerated the time to diagnosis and receipt of molecular results. Timely access to these results, coupled with Memorial Sloan Kettering Cancer Center's knowledge engine OncoKB, enhances patient clinical trial coordination precisely and efficiently. At the Sarah Cannon Research Institute, centralized remote clinical trial matching and screening, virtual molecular tumor boards, and centralized molecular interpretation support services have empowered clinic staff to identify more efficiently potential participants in clinical research, despite the COVID-19 pandemic. In addition, the U.S. Food and Drug Administration Oncology Center of Excellence has been involved in several efforts to address challenges for patients with cancer during the COVID-19 pandemic, including writing guidance documents and participating in efforts to modernize clinical trials. The enclosed personal experience of a patient with cancer currently participating in an oncology clinical trial emphasizes the need for continued decreasing of barriers to study participation. Clinical trial advances that were accelerated by the pandemic will ultimately help patients with cancer and the greater oncology health care community.
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Affiliation(s)
- Rudene Mercer Haynes
- Breast cancer survivor, clinical trial participant, and partner at Hunton Andrews Kurth LLP, Richmond, VA
| | | | - Jennifer Gao
- U.S. Food and Drug Administration, Oncology Center of Excellence, Silver Springs, MD
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19
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Pennell NA, Szczepanek C, Spigel D, Ramalingam SS. Impact of Workforce Challenges and Funds Flow on Cancer Clinical Trial Development and Conduct. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35439037 DOI: 10.1200/edbk_360253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The conduct of clinical cancer research has faced considerable challenges in recent years, and the situation has only been exacerbated by the global pandemic. The growing complexity of clinical trials and rising administrative burdens had been causing greater expense and difficulty in recruiting and retaining an appropriately trained workforce even before the well-publicized increase in turnover caused by the pandemic. Longstanding issues such as restrictive inclusion criteria and complicated trial designs have negatively affected already low clinical trial accrual rates, limited sites capable of opening studies and enrolling patients, and worsened disparities in trial participation. Opposing these elements are efforts by ASCO and other organizations to increase affordability, access, and equity in clinical trial enrollment. To provide diverse perspectives on how these challenges are affecting cancer research as we emerge from the pandemic, we asked a panel of experienced clinical research leaders from both academic and community cancer centers to answer questions they felt most pressing about the business of conducting clinical research today and where they felt the field was moving in the near future.
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20
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Murillo R, Fernández-Deaza G, Zuluaga M, Lewison G, Usgame-Zubieta D, Usgame-Zubieta ID, Manrique MM. Cancer Research in the Time of COVID-19: A Colombian Narrative. Front Public Health 2022; 9:750755. [PMID: 35059373 PMCID: PMC8764311 DOI: 10.3389/fpubh.2021.750755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/08/2021] [Indexed: 12/13/2022] Open
Abstract
Cancer research is deficient in Colombia and efforts and resources diverted due to the COVID-19 pandemic could worsen the situation. We explore the impact of the pandemic on cancer research funding, output, and conduct. We sought information at national level and used the experience of an academic reference center to contrast the impact at institutional level. We searched databases and official documents of national governmental institutions, trial registries, hospital registries, and the Web of Science. We interviewed principal investigators (PIs) to retrieve information on the conduct of cancer research. A decline in resource availability and new proposals was observed at the national level with a shift to COVID-19 related research. However, at institutional level there was no decline in the number of cancer research proposals. The predominance of observational studies as opposed to the preponderance of clinical trials and basic science in high-income countries may be related to the lower impact at institutional level. Nevertheless, we found difficulties similar to previous reports for conducting research during the pandemic. PIs reported long recovery times and a great impact on research other than clinical trials, such as observational and qualitative studies. No significant impact on research output was observed. Alternatives to ensure research continuity such as telemedicine and remote data collection have scarcely been implemented given limited access and low technology literacy. In this middle-income setting the situation shows a notable dependency of international collaborations to develop research on COVID-19 and cancer and to overcome challenges for cancer research during the pandemic.
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Affiliation(s)
- Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia.,Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - María Zuluaga
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Grant Lewison
- King's College London, Institute of Cancer Policy, Guy's Hospital, London, United Kingdom
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21
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Rolfo C, Meshulami N, Russo A, Krammer F, García-Sastre A, Mack PC, Gomez JE, Bhardwaj N, Benyounes A, Sirera R, Moore A, Rohs N, Henschke CI, Yankelevitz D, King J, Shyr Y, Bunn PA, Minna JD, Hirsch FR. Lung Cancer and Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Identifying Important Knowledge Gaps for Investigation. J Thorac Oncol 2021; 17:214-227. [PMID: 34774792 PMCID: PMC8579698 DOI: 10.1016/j.jtho.2021.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
Patients with lung cancer are especially vulnerable to coronavirus disease 2019 (COVID-19) with a greater than sevenfold higher rate of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19, a greater than threefold higher hospitalization rate with high complication rates, and an estimated case fatality rate of more than 30%. The reasons for the increased vulnerability are not known. In addition, beyond the direct impact of the pandemic on morbidity and mortality among patients with lung cancer, COVID-19, with its disruption of patient care, has also resulted in substantial impact on lung cancer screening and treatment/management.COVID-19 vaccines are safe and effective in people with lung cancer. On the basis of the available data, patients with lung cancer should continue their course of cancer treatment and get vaccinated against the SARS-CoV-2 virus. For unknown reasons, some patients with lung cancer mount poor antibody responses to vaccination. Thus, boosting vaccination seems urgently indicated in this subgroup of vulnerable patients with lung cancer. Nevertheless, many unanswered questions regarding vaccination in this population remain, including the magnitude, quality, and duration of antibody response and the role of innate and acquired cellular immunities for clinical protection. Additional important knowledge gaps also remain, including the following: how can we best protect patients with lung cancer from developing COVID-19, including managing care in patient with lung cancer and the home environment of patients with lung cancer; are there clinical/treatment demographics and tumor molecular demographics that affect severity of COVID-19 disease in patients with lung cancer; does anticancer treatment affect antibody production and protection; does SARS-CoV-2 infection affect the development/progression of lung cancer; and are special measures and vaccine strategies needed for patients with lung cancer as viral variants of concern emerge.
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Affiliation(s)
- Christian Rolfo
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York
| | - Noy Meshulami
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York
| | - Alessandro Russo
- Medical Oncology Unit, Azienda Ospedaliera Papardo (A.O. Papardo), Messina, Italy
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip C Mack
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York
| | - Jorge E Gomez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nina Bhardwaj
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amin Benyounes
- Thoracic Oncology, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Rafael Sirera
- Unidad Mixta TRIAL, Centro Investigación Príncipe Felipe-Fundación Investigación, Hospital General Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red Cáncer, CIBERONC, Madrid, Spain; Department of Biotechnology, Universitat Politècnica de València, Valencia, Spain
| | - Amy Moore
- LUNGevity Foundation, Bethesda, Maryland
| | - Nicholas Rohs
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York
| | | | - David Yankelevitz
- Department of Radiology, Mount Sinai Health System, New York, New York
| | - Jennifer King
- GO(2) Foundation for Lung Cancer, Washington, District of Columbia
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Bunn
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - John D Minna
- Division of Hematology and Oncology, Department of Internal Medicine, The Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas; Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fred R Hirsch
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York.
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22
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Chawla A, Nguyen TT, Snyder RA, Boughey JC. ASO Author Reflections: The "New Normal" in Cancer Clinical Trials in the Post-Pandemic Era. Ann Surg Oncol 2021; 28:7317-7318. [PMID: 34333709 PMCID: PMC8325543 DOI: 10.1245/s10434-021-10545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Akhil Chawla
- Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rebecca A Snyder
- Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC, USA
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