Crossing Australia’s Great Health Divide

Teletrials help regional and rural patients access cutting-edge cancer treatments

23/11/20

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n 2020, it is still a stark reality that people living in regional and rural* Australia have shorter lives, higher levels of disease and injury, and less access to and use of health services than their metropolitan counterparts.1 For people diagnosed with any type of cancer, the 5-year survival rate decreases as remoteness increases. In regional and rural areas, people are also more likely to be diagnosed with cancers that have poor survival rates.1

Access to specialist care plays a key role in optimum cancer treatment. In major cities, only 6 per cent of people report not seeing a specialist because they do not have one nearby. Unfortunately, this increases to 30 per cent of people in outer regional areas and 58 per cent in remote and very remote areas of Australia.1

The Victorian Comprehensive Cancer Centre (VCCC) further reports that less than 5 per cent of regional cancer patients participate in any clinical trials, noting that there has been a correlation between clinical trial participation and improved cancer survival.2

There are many barriers to participating in cancer clinical trials for people from regional and rural Australia. These include the time and cost of travelling to the trial area and the need to spend time away from family — which are significant sacrifices for those who often have increased costs as a result of living with cancer and who wish to spend precious time with the people closest to them.

Driving diversity and inclusion in clinical trials

Working to improve the health outcomes of populations that are disproportionately affected by serious diseases has long been a global and local focus of leading biopharma company, Bristol Myers Squibb. In each country where it operates, the company is determined to find innovative ways of supporting the communities who are at greatest risk of inequitable access to healthcare. In Australia, this has led the company to explore new ways of increasing regional and rural participation in clinical trials.

Acutely aware of the need for people living in rural and regional areas to access clinical trials closer to home, the Clinical Oncology Society of Australia (COSA) Rural and Regional Group developed the Australasian teletrials model. The model builds on existing tele-oncology, enabling clinicians at a larger primary site to enrol, consent and treat patients in clinical trials by partnering with smaller regional and rural trial sites. The primary and satellite sites are then connected through telehealth models of care.3

A first for immuno-oncology clinical trials in Australia

In 2018, Bristol Myers Squibb became the first pharmaceutical company in Australia to conduct an immuno-oncology trial in regional Australia utilising the COSA teletrials model. Immuno-oncology or immunotherapy is a type of cancer treatment that uses the body’s immune system to fight cancer. The Checkmate-648 Oesophageal Squamous Cell Carcinoma Study utilising the teletrials model compares treatments for one of the two main forms of oesophageal cancer: squamous cell carcinoma. In Australia, an estimated 1587 new cases of oesophageal cancer of all types will be diagnosed in 2020 with a 5-year survival rate of just 22 per cent.4

Patients have been very enthusiastic about contributing to future generations of oncology patients through their involvement in research.

They feel empowered when the option to participate in a clinical trial is available to them.

—Dr Suresh Varma, Principal Investigator, Checkmate-648 Study, Townsville Hospital

The Checkmate-648 Study began in November 2018, with three clinical trial sites activated in Australia. Due to the small number of patients living with advanced disease and able to participate in clinical trials, there were five Australian patients enrolled. Markedly, three of the  participants were from regional Queensland. Townsville Hospital was an original regional trial site and the inclusion of Cairns Hospital as a teletrial site was successful in recruiting a further patient from this Far Northern Queensland city.

Dr Suresh Varma, Principal Investigator for Checkmate-648 at Townsville Hospital explained, “Prior to the teletrials model, it would be usual to include only one North Queensland site in a clinical trial. Townsville and Cairns are some 346 kilometres apart, and so this patient would previously have needed to travel a vast distance to participate in the trial. The new model allows patients from a much wider geographical area to have equitable access to clinical trials and provides the opportunity to access new treatments for their advanced cancer that they may not have previously been available to them.”

“Patients have been very enthusiastic about contributing to future generations of oncology patients through their involvement in research,” continued Dr Varma. “They feel empowered when the option to participate in a clinical trial is available to them. Even if they choose not to take part, patients understand that the team here is committed to gaining increased access to clinical trials for all Australians including those from regional, rural and remote regions, who previously may not have had the option.”

Potential benefits of increasing regional and rural access to clinical trials

Increasing access to clinical trials for cancer patients in regional and rural Australia may potentially:

  • provide patients with early access to new treatments, therapies and technologies
  • enable better understanding and management of health conditions, especially of rarer cnacers not as frequently encountered by health professionals working in these areas
  • help connect patients and healthcare professionals in a meaningful way, allowing each to learn form one another
  • foster collaboration between academic and clinical researchers
  • generate income for health services involved in the trial
  • enhance professional development for health professionals through partnerships and new oportunities developed in the trial network

Adapted from Western Alliance Health Research Ltd and the Medical Journal of Australia.

Expanding the commitment to regional and rural patients

The global COVID-19 pandemic has put a magnifying glass on social and health disparities throughout the world. Globally, the company has committed a combined US $300 million from Bristol Myers Squibb and the Bristol Myers Squibb Foundation to reach underserved populations and address racial inequity, which includes investment in more accessible and equitable clinical trials to drive better patient outcomes. Here in Australia, the team at Bristol Myers Squibb focused on addressing these disparities while continuing to build clinical trial diversity.

The company will expand the reach of its clinical trial programs in regional Australia and is utilising the teletrials model in its Checkmate-76K Study, which compares treatments for the prevention of recurrent disease after surgery for stage IIB/C melanoma. The study, which aims to enrol 104 patients will include regional sites across Queensland, Victoria and New South Wales.

Neil MacGregor, Managing Director of Bristol Myers Squibb Australia and New Zealand, said “Including regional Australian sites and the teletrials model in our clinical trial program plays a major role in increasing our clinical trial footprint. We expect this investment will provide a gateway for Australia’s geographically diverse populations to access more clinical trials and, as an extension, improve outcomes for those living in rural and regional areas and across all populations impacted by the diseases we research and the patients who need our medicines.”

Footnotes and references

 

*In this article, we have used the term ‘regional and rural’ to refer to any area outside Australia’s major cities.

1.     Australian Government. Australian Institute of Health and Welfare (AIHW). Web report: Rural & remote health. Last updated 22 October 2019. Available from https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/contents/summary. Accessed November 2020.

2.     Swannell, C, Medical Journal of Australia. Media release: Teletrials bring benefits for regional cancer patients. 31 August 2020. Available from https://www.mja.com.au/journal/2020/teletrials-bring-benefits-regional-cancer-patients. Accessed November 2020.

3.     Victorian Comprehensive Cancer Centre (VCCC). Teletrials. Available from https://www.viccompcancerctr.org/what-we-do/clinical-trials-expansion/teletrials/. Accessed November 2020.

4.     Australian Government. Cancer Australia. Oesophageal cancer. Oesophageal cancer statistics in Australia. Available from https://www.canceraustralia.gov.au/affected-cancer/cancer-types/oesophageal-cancer/statistics. Accessed November 2020.