Twelve oncology practices were recognized with ASCO's Clinical Trials Participation Awards this year, and each issue of the Journal of Oncology Practice takes a close look at three of the winners. The awards were established 3 years ago to underscore ASCO's commitment to promoting clinical cancer research. Selection for the awards was based on nomination by each of the National Cancer Institute Cooperative Groups and the ASCO Clinical Practice Committee, which identified the practices with the highest rates of accrual to phase III clinical trials over a 3-year period. In 2005, the awards were presented to practices that also had a high rate of accrual of under-represented minorities. In this issue, we recognize the pediatric oncology program at the University of New Mexico Cancer Center, the Kansas City Cancer Center, and Kinston Medical Specialists.
The University of New Mexico Cancer Center
Figure 1.
Jami D. Frost, MD (left), is clinical director and associate professor of pediatric hematology and oncology at the University of New Mexico (UNM) Cancer Center in Albuquerque, New Mexico. This center was the year's only award winner in pediatric oncology, and it is that state's only children's oncology program. In September 2005, it was designated a National Cancer Institute cancer research and treatment center.
UNM Cancer Center is a member of the Community Clinical Oncology Programs (CCOP), which are funded by the National Cancer Institute to encourage community participation in clinical trials.
Acute leukemias are the most common pediatric cancers in New Mexico. “About half the population we see has leukemia,” said Frost. “After that, it is primarily brain tumors.”
Nine years ago, when she started with the practice, the clinical trials program enrolled three or four children. Under her leadership, it now enrolls almost 30 annually, which represents about 88% of eligible patients. The award recognizes not only the increase in trial participation, but the job the center has done in making families aware of the benefits of clinical trials.
“Most of the time, when families hear the word ‘cancer,' they think their child is going to die. Fortunately, because of what pediatric oncology has done with clinical trials, we're able to cure most of them. Overall, we cure 85% of kids with cancer. It's actually very wonderful,” said Frost.
According to Frost, “I usually add that the cure rate is because of families like you, who were willing to participate in clinical trials, and let us learn, over the last 50 years, what the right thing is to do for kids. In childhood leukemia alone, we've gone from 10% survival rates in the 1940s to, in some cases, more than 95% cure.”
Kansas City Cancer Center
Figure 2.
Marcus Neubauer, MD, is an oncologist with Kansas City Cancer Center (KCCC) in Overland Park, Kansas, a suburb of Kansas City. Last year, KCCC saw 9,800 new patients, and enrolled 347 patients onto a clinical trial. This year, the center is projected to enter 376 patients in clinical trials.
Neubauer is one of 27 medical oncologists at the practice, and he helps oversee the trials program. When he started with the practice in 1993, the practice enrolled approximately 20 to 30 patients per year in clinical trials. That number rose to 100 by 1998, and 326 by 2002. Neubauer credits several factors.
“We have the U.S. Oncology research network, in addition to our community oncology program, and we've developed a very robust research program,” he said.
Clinical research is very much a focus of this center. “We think it's important for our patients, and gives them more choices for treating their cancer. We also believe it is our obligation to help advance the field of cancer care to achieve better outcomes for our patients,” said Neubauer. He observed that the center has developed a very sophisticated approach to research, and works hard to get patients on trials.
As for enrolling underserved populations, Neubauer says that the practice does not actively recruit minorities—it just treats people with cancer who come through the door. “Regardless of race, creed, or color, we try to put cancer patients on trial if we think it's going to be in their best interests to do that,” he said. He did, however, note that some trials have Spanish-language consent forms. “Other than that, there isn't anything special we do to recruit underserved patients. We just try to give them the same care we'd give anybody else, including exposure to clinical trials as they are available.”
Along with large accrual numbers, KCCC has a formal oversight program. Physicians and administrators meet twice a month to discuss any problems, issues, or concerns related to the clinical trials. “That oversight allows us to put out a quality research product, and instills a real sense of responsibility,” he said.
“Our practice looks at research as a primary thought, not an afterthought,” Neubauer concluded.
Kinston Medical Specialists
Figure 3.
When Kinston Medical Specialists of Kinston, North Carolina, won the 2005 Clinical Trials Participation Award, Peter Watson, MD (left), was the practice's only oncologist. Nevertheless, the practice enrolled almost 50 patients in trials last year.
Kinston is a town of about 25,000 people in rural eastern North Carolina. The practice also operates a satellite clinic in an adjoining county.
According to Watson, most of the trial enrollees are high priority patients (i.e., the elderly and minorities). “That's pretty much our clientele,” he said. He is committed to clinical trials, despite hurdles ranging from lack of manpower to patients saying they don't want to be experimented on.
“When I came here in 1988, there was no oncology program, and there weren't a lot of medical specialists. First, we got a tumor board started, and about a year later, we started radiation therapy. Finally, in about 2000, we got our trials program going. We were able to hire a data coordinator through a grant from our hospital foundation. It has been a gradual process,” he observed.
The local hospital runs a modest fundraising program called “Lights of Love,” whose funds are earmarked for cancer-related activities. This program paid the salary of an administrator in the Kinston clinic for 1 year to get a trials program up and running.
“One of the things that really holds back small practices is just the cost,” said Watson. “The time it takes to keep up with data is just overwhelming. The current reimbursement environment is also very difficult for the community oncologist,” he said.
Between his office practice and the hospital, Watson sees about 250 new patients a year.