Committee eliminates barriers, promotes access to clinical trials for all patients

Dana-Farber Cancer Institute is proud to highlight its Unsung Heroes, thanks to longtime partner Arbella Insurance Group, by recognizing staff who work behind the scenes to make the Institute a welcoming place for all. For some, it’s about calming nerves with a smile while directing cars. For others, it’s about selecting the right art that hangs in treatment rooms. For the Clinical Trials Access Committee (CTAC), it’s about ensuring all patients—regardless of age, race, ethnicity, gender, or socioeconomic status—have equal access to the best cancer care.

The mission of the CTAC is simple: promote equity in cancer care and research through clinical trials. The work, however, is much more complex.

“While all of us at Dana-Farber put a lot of time, effort, and thought into ways to improve cancer care, we realize there are still gaps for certain subgroups and demographics, some patients not having the same access as others,” says Nadine McCleary, MD, MPH, senior physician in the Department of Gastrointestinal Oncology at Dana-Farber and member of CTAC leadership. “Our goal, then, is really to understand why. What factors are driving that?”

That’s the main question that prompted Rachel Freedman, MD, MPH, co-chair of the Clinical Trials Access Committee, to lead a task force for the Dana-Farber/Harvard Cancer Center in 2020, the outcome of which was the establishment of the CTAC. When asked to co-chair the committee, Freedman says she couldn’t turn it down.

“I’ve always looked for ways to get involved in efforts focused on improving cancer care delivery for all patients, and in particular those at risk for worse outcomes once they’re diagnosed,” explains Freedman, a senior physician in the Department of Breast Oncology, “so I jumped at the opportunity to help develop Institute-wide initiatives aimed at improving access for our patients and beyond.”

Freedman’s co-chair, thoracic medical oncologist and Chief Clinical Access and Equity Officer Christopher Lathan, MD, MS, MPH, also found his involvement with the committee to be a natural move.

“My focus over my 20 years at Dana-Farber has been on community engagement and making sure all of our patients have access to clinical trials, especially our historically marginalized communities,” says Lathan, who is also the Hadley Family Chair at Dana-Farber. “It has been fantastic to work in collaboration with Dr. Freedman.”

But as both Freedman and Lathan note, their dedicated committee membership spans multiple disciplines, including research administration, clinical researchers, clinicians, patient advocates, project managers, and representation from institutional review boards and regulatory groups, among many others. This approach is what committee leadership—comprised of Freedman, Lathan, McCleary, and Emmy Littlejohn, clinical research project manager at Dana-Farber—believes makes their work so successful.

“There are so many pieces to a patient’s decision pathway, from the time they come to Dana-Farber to seek care all the way through being approached for a clinical trial and making the choice to enroll,” McCleary explains. “I’m proud of the fact we’ve taken our time to think through all those steps.”

Those steps, according to the committee, start with the importance of understanding each patient’s unique background and family history. Here, it’s about avoiding assumption, both on the part of the clinician—remaining unbiased and not assuming certain groups are uninterested—and on the part of the patient—ensuring those who may have witnessed family members diagnosed with cancer decades prior without options for clinical trials do not immediately assume the same for themselves.

Then, the committee considers the barriers that might exist once a patient is aware a clinical trial option exists. They think about systems and processes currently in place at the Institute and what may be implicitly communicated as to who is eligible for such trials, mainly through shared materials like eligibility criteria and consent documents.

“There are barriers to enrollment at every step of the process and we’re dedicated to identifying them,” Littlejohn says. “Things like physically getting to Dana-Farber, being prepared to speak with their care teams and advocate for themselves, screening for trials without premature determination of ineligibility based on medical history, translating documents they need to review into their languages, navigating their appointments in our health care system, and so many others.”

Once barriers are identified, the priority becomes determining how best to eliminate them. As for that important work, the committee has several initiatives already underway. Some highlights include revising the Institutional Review Board protocol templates to broaden eligibility and promote diversity in enrollment, establishing patient assistance funds to support meals, parking, and transportation for trial participants, and working to systematically translate patient-facing documents.

“My maternal grandparents were diagnosed with gastrointestinal cancers in 2005 and 2012 and I wish there were more options available to them at the time of their diagnoses,” Littlejohn recalls. “I am proud to work here every day to open that door for more patients who can take advantage of these lifesaving opportunities.”

Despite how much of their work focuses on ensuring opportunities for Dana-Farber patients to improve their cancer outcomes, Freedman, Lathan, McCleary, and Littlejohn all acknowledge that their work extends far beyond the Institute’s walls. In addition to collaborating internally, they say, it’s important to consider who else should be brought into the discussion outside of the Institute, especially in settings where resources aren’t abundant. “In places that are resource-limited but outcomes-rich, what can we learn from those groups?” McCleary asks.

While all four members of CTAC leadership come from varying backgrounds and specialties, there are two things that unite them: a commitment to broadening access to high-quality cancer care, and a love for Dana-Farber, nurtured over a collective 60 years of service.

“It really is an honor and a privilege to do this work,” McCleary says. “It’s all consuming but so rewarding because of not only the patients that trust us but also all who make the patients feel comfortable, so when they park their car, or walk into reception, or go to the cafeteria, they feel they’re being cared for across the board.”

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