Authored by Brian Koffman, MDCM (retired), MSEd
Bottom Line:
By helping with support, logistics, and the cost of travel, Mayo Clinic increased the accrual of blood cancer trials, especially for rural patients.
Who Performed the Research and Where Was it Presented:
On behalf of his colleagues, Jamie Johnston, MA of Mayo Clinic Comprehensive Cancer Center, Rochester, MN, presented this preclinical oral presentation at the American Society for Hematology (ASH) Annual Meeting 2024.
Background:
Clinical trials may be the best therapy choice for some chronic lymphocytic leukemia / small lymphocytic lymphoma (CLL / SLL) patients, but cost and logistical concerns limit enrollment, especially for those in rural locations far from an academic research center.
More than four out of ten of the 20,000 blood cancer patients (including many with CLL / SLL) who were cared for at Mayo Clinic in 2023 live in rural settings. These patients often face increased challenges related to access, cost, and time and distance needed for travel to treatment and fewer clinical trial options.
In 2021, the Leukemia & Lymphoma Society (LLS) offered grants to improve access by launching its IMPACT (Influential Medicine Providing Access to Clinical Trials) grant. Mayo Clinic was one of its earliest grantees. The grant funds major cancer centers to partner with local community oncology centers. The goal is to increase the accrual of patients traditionally underrepresented in clinical trials. That would include those who are:
- from a rural area,
- member of racial and ethnic minority groups,
- and economically disadvantaged.
In this case, Mayo Clinic Rochester, MN, was the “hub” academic center partnering with four Mayo Clinic Health System (MCHS) rural oncology practices, including one across state lines and one almost 100 miles away.
Methods:
There were two modes used to do the trials:
- Trials were offered independently at all the MCHS rural oncology practices.
- A hybrid model where some intake and some services were done at the Rochester hub and some in the community. The hybrid model was used to overcome barriers in the rural practice, including:
- limited support staff,
- inadequate specimen processing equipment,
- insufficient medication storage and shipping capacity,
- MCHS catchment population’s lack of alignment with the Hub trials portfolio
- reduction of excess capacity among healthcare providers due to their existing patient care responsibilities.
“Champions” were selected for each rural site, and a new position of “feasibility specialist” was hired to support the effort, facilitating communications and helping overcome any barriers.
Results:
- Twenty clinical studies, including 14 interventional treatment trials, have been activated, and 108 patients have been enrolled.
- Forty-two of those were in interventional trials; five were in the full activation model (13 accruals) and 15 in the hybrid model (29 accruals).
- Patients averaged 216 miles of travel, with an estimated mileage cost of $142/trip to the hub location.
- Nine of those patients traveled over 260 miles, with an estimated mileage cost of $170/visit to access clinical trials.
- Eight patients in the “hybrid trials” switched some of their care to their local healthcare team, resulting in a reduction of an average of 155 miles per visit
- Seven patients could reduce their travel time by an average of 216 miles/visit, which would save them an estimated $1,420 in driving costs.
- Assuming ten visits for the 108 patients, the total travel saving was $153,360.
- Hotel costs saved were $16,390 for the 11 patients who were estimated to require overnight accommodation.
- The impact of lost workdays on the care partner was not calculated, but there is no doubt there were savings with local treatment, and the convenience and lack of disruptions enabled more to enroll.
Conclusions:
This report points in the direction that with a combination of community and academic collaboration, creative approaches, flexibility, and increased staffing, patients in rural settings can save the patients significant costs and help them avoid the inconvenience of travel involved with clinical trials so that they might enjoy the benefits of interventional research locally. It does take considerable money, resources, and a commitment at both the hub and the rural clinic to make it happen.
Links and Resources:
Listen to Dr. Koffman’s monologue below.
Take a look at the details in the ASH abstract: Bringing Hematological Malignancy Clinical Trials to Patients: Mayo Clinic LLS Impact Experience.
