Improving Access to Trials and Reducing Health Disparities at Rutgers Cancer Institute

Mariam F. Eskander, MD, MPH, assistant professor of surgery and a gastrointestinal surgical oncologist at the Rutgers Cancer Institute, and Coral O. Omene, MD, PhD, an associate professor of medicine, breast medical oncologist, and program director for breast cancer disparities research at Rutgers Cancer Institute, discuss some specific practices and policies that have been most effective at their institution and how these may be adopted by other practices.

0:10 | They've done a number of things. A lot of what we've touched on is something that goes on here, which is why we can talk about it so easily because we see it here. It's adopted and practiced here. One of the things is making sure that patients in your health system have access to clinical trials. They have to see the trials open around them and be offered to them for them to be able to think about participating. This is something we've done in our health system, starting with Rutgers Cancer Institute, where the trials come from our research and investigators, and then they're opened up seamlessly into the different community affiliate sites because of the structure in place with one IRB, one SRB, and pharmacy. This makes things easy for that to happen. It takes work for this process and system to work, but once you've done it—and we've seen it over time since it was implemented—it has become just part of the way we do things. You see the curve in trial participation for minority patients, just a linear curve going up over the years, and so it works for them to get on trials. They have to be able to see it and have it offered to them. They need access to them without traveling all the way to the New Brunswick Rutgers Cancer Institute site for it, as Dr. Eskander mentioned before. That's one key way, but there are several others. I'll also let Dr. Eskander pipe in as well.

1:56 | Yeah, absolutely. I think that's an excellent plan. The other thing we've done is really just engage with the community, form community relationships, and try to increase awareness and understanding about clinical trials in the community. Several individuals come to our Community Cancer Action Board, who are community leaders, and they go back to their communities and talk about trials in a different way than perhaps they've been talked about in the past. They're armed with information that they can distribute to the community and have conversations with people. We're always bringing scientists, as Dr. Omena said, through town halls or science cafes, or just making sure community members know what trials we have open. That way, just in case somebody’s not talking to them, or their cousin or mother about a trial that’s open, the awareness is there.

2:56 | If I could just add one point about social determinants of health, because I think Dr. Omene and I have both mentioned it, but I really cannot emphasize enough how important it is to not forget about the neighborhoods that our patients live in and their living conditions at home, because those are the biggest contributors to life expectancy. The care that we give them is probably less of a contributor to their life expectancy. So, I think recognizing the socio-economic barriers that folks might have is extremely important. And I think this relates to our point earlier about patient navigation. It is so important that somebody on the team is checking somebody's social barriers to care and trying to address them as much as possible. I think the solutions over time are going to be more structural. We are going to have to bring clinical trials right to socially vulnerable communities. We are going to have to create ways to be less stressful to patients in terms of cost and time away from work and family obligations. But I think, just as a start, we should be at least doing a screening for social determinants for all our patients and trying to address transportation barriers and as many cost barriers as possible. Insurance is not a barrier here in New Jersey, and it should no longer be a barrier, at least for patients with Medicaid insurance elsewhere now, which is really big. But I think that, and Dr. Omene and I know from some of the research that we have done that some of the effects can be additive.

4:30 | We have data that shows that for Black patients who live in socially vulnerable neighborhoods vs White patients who live in socially vulnerable neighborhoods, the odds of enrolling in a clinical trial for a Black patient in a socially vulnerable neighborhood are 50% less than for a White patient in a socially vulnerable neighborhood. I think that goes to show that things like race and socioeconomic status are intertwined in our country, and that if we support social determinants, we might also be able to increase racial diversity in our trials. So I think these 2 things go hand in hand. If we neglect the social determinants barriers, in addition to the racial and ethnic barriers.

5:13 | Absolutely. Just to add here, there's a statistic that shows that residents of low-income neighborhoods have less access to affordable and quality healthcare facilities that can perform cancer screening tests. It's shown that Black women living in these low-income neighborhoods are twice as likely to be diagnosed with the highly aggressive triple-negative breast cancer compared to those living in high-income neighborhoods. So that just tells you, Black women in low-income neighborhoods are twice as likely to be diagnosed with triple-negative breast cancer than Black women in high-income neighborhoods. That tells you already that this is an important piece that we have to address.