‘Hub-and-spoke’ initiatives aim to improve minority access to blood cancer clinical trials
The Leukemia & Lymphoma Society will collaborate with three major cancer centers to provide minority and other underserved populations with greater access to blood cancer clinical trials.
“The goal is ultimately to bring the clinical trial and the cancer drugs to the patients, rather than the patients having to travel long distances to participate in clinical trials,” Lee Greenberger, PhD, chief scientific officer of The Leukemia & Lymphoma Society (LLS), said in an interview with Healio.
Underrepresentation of minority patients in clinical trials has been a longstanding and pervasive problem. Barriers to trial enrollment range from geographic challenges to implicit bias among clinicians.
To address this complex issue, LLS has created IMPACT (Influential Medicine Providing Access to Clinical Trials), a $3.75 million research grant program that will fund efforts at Weill Cornell Medicine, Mayo Clinic in Rochester, Minnesota, and Vanderbilt University Medical Center to create “hub-and-spoke” systems for conducting cancer clinical trials. In this model, major cancer centers serve as the “hubs” and trial sites in nearby community-based hospital clinics comprise the “spokes.”
“We’re going to use the expertise of the major medical centers to design the trials and set them up, but they are going to be looking for patients outside those major medical centers,” Greenberger said.
Greenberger spoke with Healio about his goals for the project, the importance of making clinical trials accessible to minority patients, and potentially valuable data that could be acquired by increasing trial diversity.
Healio: What prompted you to develop this initiative?
Greenberger: Minority individuals and those in underserved communities represent less than 10% of patients enrolled in clinical trials. We have been working with the hub-and-spoke model for about the last 5 years. The hub is the major medical center and the spokes are the outlying communities around the hub. For example, a Manhattan hub like Weill Cornell would go out to Brooklyn or Queens, or Mayo Clinic in Rochester might go 50 to 75 miles to the outlying communities. We piloted the program with Dana-Farber, which enrolled some patients at community centers across the United States instead of major medical centers and achieved about a 15% enrollment from the community centers in clinical trials. So, we knew the system could work. We decided a few years ago that we wanted to adapt this to have major medical centers going out into their community settings.
Healio: Will the trials be conducted at the community medical centers?
Greenberger: Yes. Many patients with blood cancer will not have to travel 50 or 75 miles to major medical centers; they can receive the therapy in their community from physicians who will coordinate with and are trained by those centers. We will make physicians in community hospitals aware of what is available and the need to educate patients. LLS is also going to educate patients at those community sites about the importance of clinical trials. For many patients with cancer, clinical trials are the best hope for a successful long-term outcome.
Healio: What advantages will patients derive from this community collaboration with major academic medical centers?
Greenberger: Major medical centers have the educational basis and expert pathology required to treat blood cancers. These are relatively rare cancers, with only 180,000 cases a year in the United States compared with 10 times that for solid-tumor cancers. Some pathologists haven’t seen many of these patients with rare blood cancers. So, having access to major medical centers can help in making determinations, such as the type of blood cancer and treatment options. It also can help educate physicians in the community and increase their knowledge base. Further, it fosters a bond with the major medical centers that are always going to be at the cutting edge of cancer therapies.
Healio: How long are these trials expected to run?
Greenberger: The trials at these three centers are going to run 5 years. We expect to open another request for applications in the summer or fall. We’re going to have a few more hub-and-spoke models, maybe in the West, South or Southwest.
Healio: What will the trials study?
Greenberger: Each of the centers has planned between seven and 15 trials. They will study all types of blood cancers: lymphoma, myeloma, leukemias and more. Having more diversity in clinical trials not only will extend care to patients who have not had access in the past. It also will give us more data on how minorities respond to these new drugs and trials. We will get more information on patient populations that historically have been underrepresented.
Healio: How will the research and medical communities address racial disparities in clinical trial enrollment over the long term?
Greenberger: I think we will accomplish this through multiple mechanisms. Clearly, we need to inform patients that these trials are available, conducted safely and have a history of demonstrating efficacy. We have a patient access group that does this. We also have a program called Myeloma Link that provides outreach and education in Black communities, as incidence of myeloma is about twice as high among Black individuals compared with white individuals. In addition, we have a Spanish-language resource center that educates patients about blood cancers. We also want to educate physicians in local communities who don’t see blood cancers as frequently as physicians at major medical centers. We want to make them more familiar with state-of-the-art treatments, and for them to know they have backup from the major medical centers in making diagnoses and treatment decisions.
Healio: Why do you think there has been increased awareness of racial disparities in health care recently?
Greenberger: When we conceived the program 6 years ago and adapted it 2 years ago, we did not anticipate the COVID-19 pandemic nor the racial issues in Minnesota. It just happened that these things coincided, but I think the racial tension in Minnesota and across the country — as well as COVID-19 underscoring the importance of new treatments and clinical trials — brought attention to the fact that everyone should be able to access quality health care.
For more information:
Lee Greenberger, PhD, can be reached at lee.greenberger@lls.org.
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