52 “There’s No Place Like Home”: Best Practices Bringing Cutting-Edge Breast Cancer Treatments Closer to Home

Background

The breast oncology landscape is expanding rapidly and the opportunity for all patients to participate in the latest developments can be life changing. Real-world circumstances can make access to cutting-edge breast cancer treatment challenging.

Objective

The Commission on Cancer (CoC) set a benchmark of 2% for clinical trial enrollment for community hospitals. Improving clinical trial accrual at community hospitals can offer state-of-the-art treatments while also alleviating health inequalities. We aimed to maximize enrollment by implementing a streamlined recruitment workflow, bringing cutting edge breast cancer treatment options directly to the community.

Methods

Our workflow implements a team approach. The clinical research nurse (CRN) attends weekly tumor board meetings and patient rounds to identify potential trial candidates. Providers also participate in weekly disease-specific meetings at Columbia University Irving Medical Center (CUIMC), where pertinent studies at all CUIMC sites are discussed. Prospective and enrolled patients are reviewed at NewYork-Presbyterian Westchester’s clinical research meetings with the CRN and clinical research coordinator (CRC). The CRC and CRN prescreen weekly patient reports generated from the electronic medical record, and maintain a comprehensive tracker of open studies, enrolled patients, declinations, and potential candidates. Once a candidate is identified, the provider is notified, and if appropriate, an eligibility review is conducted. Eligible patients are informed about the trial and those interested receive a copy of the consent form to review. Patients declining participation are asked to participate in a DCP-001 survey, which captures reasons for declining. For studies available only at CUIMC, the CRN coordinates with the clinical trial intake specialist and the CUIMC study investigator.

Results

This systematic team workflow approach helps to expand trial access to community-based oncology practices and accelerates access to the latest innovative therapies for patients with breast cancer. Our workflow ensures that 5% to 8% of our annual analytic caseload enrolls in trials, surpassing the CoC requirement of 2% for community centers. In addition, this approach earned our center a Silver Award from the National Cancer Institute for clinical trial accrual. Notably, approximately 57% of eligible patients offered a trial opted to participate, strongly reflecting patient interest in having access to advanced cancer therapies. Specifically looking at breast cancer trial enrollment, 53% to 87% of CoC accruals are for breast cancer treatment.

Conclusion

Best practices increased patient enrollment into cutting edge breast cancer therapy by accelerating patient access and awareness. Tailoring patient education towards more individualized, innovative targeted breast cancer treatment will benefit patients and potentially improve survival. Community hospitals hold the key to closing this gap.