New Hope for Cancer Patients
Increased access to clinical trials can potentially save more Georgians’ lives.
Cancer. It’s perhaps one of the most feared words in the English language. A cancer diagnosis can be devastating to patients and their families, but in Georgia there is new hope in the fight against the state’s second leading cause of death.
The state is ranked 25th in cancer incidence and 23rd in cancer death in the U.S., according to the Centers for Disease Control and Prevention. Prostate cancer accounts for 30% of new cancer cases among males in Georgia, with the highest concentration in the southwest part of the state. Breast cancer represents 30% of all new cancer cases in females across the state, with the highest concentration in Metro Atlanta. The second most common cancer among males and females is lung cancer, which is diagnosed most frequently in rural areas.
To help lower those numbers, in September, a statewide cancer research consortium was awarded a six-year, $11-million grant from the National Cancer Institute (NCI) to enroll more Georgians in potentially groundbreaking and life-saving clinical trials.
The Georgia NCI Community Oncology Research Program (NCORP) is a collaboration among Northside Hospital Cancer Institute in Atlanta, the Nancy N. and J.C. Lewis Cancer and Research Pavilion at St. Joseph’s/Candler in Savannah and the Georgia Center for Oncology Research and Education (Georgia CORE) in Atlanta. Northside and St. Joseph’s/Candler are the state’s two largest community oncology clinical trial programs.
Based on their track record in community-based oncology research, four additional cancer programs are part of the partnership. They are Piedmont Columbus Regional’s John B. Amos Cancer Center in Columbus, Harbin Clinic in Rome, Peyton Anderson Cancer Center at Navicent Health in Macon, Cancer Services at Northeast Georgia Medical Center (NGMC) in Gainesville and Pearlman Cancer Center at South Georgia Medical Center in Valdosta.
“This is our second NCORP grant, which shows how successful we were the first go-round,” says Northside Hospital Cancer Institute’s Dr. Guilherme Cantuaria, who has served as the principal investigator for the partnership since its inception. “There are several NCORP organizations across the country, and the NCI selection team evaluated the Georgia NCORP capabilities as outstanding; we are one of the leading organizations.”
In 2014, Northside Hospital Cancer Institute was awarded a five-year, nearly $6-million NCI grant to conduct cancer clinical trials and cancer delivery studies in local communities across the state. By providing access to these trials and studies, more Georgians can be treated by the latest advances for fighting cancer.
By the end of the program’s fifth year, seven out of 10 Georgians were within reach of new prevention, control and treatment trials. Georgia NCORP was one of only 32 community sites selected to receive continued NCI cancer research funding. To date, the Georgia NCORP partnership has enrolled 2,530 cancer patients in clinical trials.
From August 2019 to February 2020, 412 people participated in Georgia NCORP studies. Currently, there are 83 studies open across the network.
“These trials are asking very, very important questions, like is this treatment better than another one, but also looking at cancer care delivery in general, including quality of life issues, symptom management and closing the disparity gap in outcomes,” Cantuaria says. “These studies will have great potential for improving cancer outcomes and reducing disparities in care.”
Tina Berry, oncology project manager at Northside Hospital Cancer Institute, says standard of treatment is the result of clinical research.
“The types of trials that are being offered through this program are not Phase I trials to see if people can tolerate it,” she says. “A lot of the trials are refining and evaluating the best scenario for good, long-term disease control and quality of life.”
Historically, clinical trials were offered at academic institutions, which limited the diversity of the patient populations. If a university in Atlanta was doing a clinical trial, rural Georgians may not have access to the trial. In addition, in academic trials, participants are often generally healthier than the overall population. When a clinical trial only has patients from certain demographics, the applicability of the research results is limited, too, Berry says.
“For example, if you don’t have African Americans from rural Georgia in the trial, the results may not accurately reflect the impact of the therapy on those populations,” she says. “This network reaches out and provides the support to provide these clinical trials in the patient’s community.”
Despite fierce competition in the healthcare market, the hospitals of Georgia NCORP see each other as partners for a bigger cause: Doing something for the greater good and for cancer patients in the state of Georgia.
“Patients on clinical trials receive a lot of attention, which ultimately results in high-quality cancer care,” Berry says. “The patient of today is creating the programs of tomorrow. They’re paying it forward.”
“The way that we structured this NCORP network is to be able to provide clinical trials in various parts of the state so that cancer patients would be able to get National Cancer Institute research in their own communities,” says Nancy Paris, president and CEO of Georgia CORE. “When we thought about this conceptually, what we wanted to do was to ensure the widest group of Georgians could receive the latest and most promising cancer treatments available nationally. The reason that’s important is not all Georgians are alike.”
Northside, which holds the NCI grant, contracts with Georgia CORE to serve as a bridge between it and the affiliate hospitals and to coordinate research efforts, allowing all participants to remain independent and operate autonomously.
“Everybody has a stake in this,” Paris says. “It makes it possible for the oncologists and cancer centers to work together because we coordinate the research effort. We bring people together on common ground.”
“There is a great need for integrated cancer care and research in both urban and rural areas in Georgia; the most efficient way to accomplish this is through the Georgia NCI Community Oncology Research Program,” says Dr. Howard Zaren, medical director of the Lewis Cancer and Research Pavilion at St. Joseph’s/Candler in Savannah. “[We] work collaboratively to advance cancer care. The result is that the latest clinical research for all types of cancer is provided by local oncologists to patients in every corner of the state.”
According to Paris, published literature says adult participation in cancer clinical trials is about 5% nationally, but that rate drops to just 2% of patients from rural and minority populations. That means researchers may not be understanding how cancer affects diverse groups and diverse individuals, she says, leading to inequities in access to the latest cancer care for rural and minority populations.
“Our statistics indicate that we’re six times above the national average in minority accrual [the number of participants in a trial],” Paris says. “We know we have a ways to go, but we’ve made some incredible improvements together.”
By joining forces, Georgia NCORP has created a network of 100 physicians with access to dozens of studies available at 41 locations across the state, including NGMC.
“We probably have about 25 trials active and underway, and we’ve had as many as 40 in the past,” says Dr. Charlie Nash III, lead Georgia NCORP investigator at NGMC. “The trial in which we are racking up all the numbers in is TMIST, and that’s a screening trial for breast cancer patients.”
In the TMIST trial, Nash and his team are among researchers nationally looking at the effectiveness of two existing screening techniques used for detecting breast cancer, as well as researching whether one technique is superior to the other.
“This has never really been scientifically studied before, so this is going to be a very important trial to help decide, to shed light on, which modality would seem to have the most effectiveness and which is the most cost effective,” Nash says. “The 2D mammogram has been the standard of care for many years, then came 3D images.”
Radiology groups across the country were quick to adopt 3D imaging as the latest and greatest. It also happens to be more expensive than its predecessor, Nash says.
“Basically, the technology leapt ahead of the science,” he says.
In Columbus, Dr. Andrew Pippas at the Amos Cancer Center is researching the effects of chemotherapy on several different patient populations.
“We have trials that discuss issues of sexuality and fertility in premenopausal women who are getting chemotherapy,” he says. “As oncologists, we didn’t do a really good job looking at fertility before, but a 30- to 35-year-old woman wants to know if she can have more babies, if she can get pregnant after chemotherapy, and this study addresses that head on.”
Another study at the Amos Cancer Center is looking at nerve damage caused by chemotherapy and biomarkers that might predict it.
“We know that in African-American women there is a two times increase in nerve damage from chemo, and we have two studies looking at why that is. Are there biomarkers for that?” Pippas says. “The other study is looking at all women to see if we can develop a predictive model for neuropathy from chemo; we’re also looking at the effects of chemo on the heart in a study to see if we can prevent [heart damage].”
All of these are important trials when it comes to looking at survivorship and cancer control, Pippas says.
“We are very much pleased we can open those trials,” he says. “Our Georgia NCORP structure allows us to study things that aren’t sexy. We look at the societal and psychosocial issues surrounding cancer care. We’re also looking at cost of care and how people are concerned about the expenses of treatment and how that may keep them from seeking treatment, and we’re looking at tobacco cessation. Can we do that better?” Pippas says. “If I have a patient from one of the rural areas around Columbus from a population group with disparate outcomes who’s getting superlative care, that to me is a good day at work.”
A brand new addition to Georgia NCORP is caring for the state’s youngest cancer patients. Navicent Health in Macon started enrolling patients in pediatric oncology trials last May.
“There was a huge population in Middle and South Georgia that didn’t have access to a pediatric oncology program,” says Dr. Sushmita Nair, pediatric hematologist oncologist at Navicent Health. “There was one in Augusta, one in Savannah, and nothing else. These patients, if they wanted the latest clinical trials and treatments, they would have to go all the way to Atlanta.”
Since becoming affiliated with the Children’s Oncology Group (COG), Navicent can offer the latest clinical trials to patients in Middle Georgia. COG is an international consortium of institutions supported by the National Cancer Institute that treat children’s cancer.
“If patients are able to get the best treatment, the outcomes will be better; thus, we are making a difference,” Nair says. “Prior to becoming COG-affiliated, we still saw patients, but we were using tried and tested treatment methods. We couldn’t use the latest treatments.”
The biggest difference Nair says she has seen since trials began at her hospital is to those families that want to be on clinical trials, but don’t have the means to go all the way to Atlanta. Navicent currently has six trials open.
“I feel like these trials should be offered in the community setting,” she says. “Before, many patients decided not to be on trials solely because they were not accessible. It’s always better to be in a program that offers clinical trials because those are the latest treatments.”
In the new world created by COVID-19, where solidarity is more important than ever, the researchers and oncologists of Georgia NCORP are united and focused on improving the survival rate and quality of life for cancer patients close to home.