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Expanding cancer clinical trial access at VA

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James Folsom

 

U.S. Army Veteran James Folsom thought he was in perfect health. Since he had smoked for 50 years, his provider at the Indianapolis VA Medical Center screened him for lung cancer and diagnosed him with stage 2 lung cancer.

“I did not have any symptoms,” Folsom said. “I would have carried on with my regular day, every day.”

Folsom underwent surgery, and his tumor was genetically sequenced. The results of his sequencing matched him with a cancer clinical trial for treatment. He received treatment for a year, with regular scans throughout the course of the trial. At every scan, the results looked more and more promising.

“If anybody is considering taking a trial, I suggest you go ahead,” Folsom said. “Take it from me, it saved my life. There’s a lot of living to be done.”

The trial James participated in, the Adjuvant Nivolumab in Resected Lung Cancers (ANVIL) study, was run by the National Cancer Institute (NCI). VA is working closely with NCI to expand access to clinical trials across VA, helping more patients like Folsom access life-changing studies.

Interagency partnership expands clinical trial access

Cancer clinical trials are research studies that explore new ways to treat cancer and improve quality of life for patients. An interagency collaboration between VA and NCI is increasing access to cancer clinical trials across VA. Formed in 2018, the NCI and VA Interagency Group to Accelerate Trial Enrollment (NAVIGATE) was developed to address barriers to clinical trial recruitment across the VA health care system. NAVIGATE provides programmatic support to VA Medical Centers (VAMCs) to increase the number and variety of clinical trials available to VA patients.

“NAVIGATE has greatly increased the cancer clinical trials available to Veterans within the VA system,” said Sara Schiller, MPH, national program manager for NAVIGATE.

In addition to increasing Veteran enrollment in cancer clinical trials, NAVIGATE also creates a national network of VA sites that work together to solve common problems sites face when conducting clinical trials and create best practices. With the NAVIGATE program, VA is building the capacity for participating VAMCs to offer more NCI clinical trials in the future.

“For every single study, you have to complete a great deal of paperwork and follow specific procedures. This creates a burden on a small staff,” said Dr. Herta Chao, MD Ph.D., deputy director at the West Haven VA Comprehensive Cancer Center and Principal Investigator (PI) for the NAVIGATE site at VA Connecticut Healthcare System. “Having additional research coordinators really helps, as does the mutual support between NAVIGATE sites.”

Since launching in 2018, NAVIGATE has opened 170 trials with 354 patients enrolled across their 12 sites. Of the patients recruited so far, approximately 25% have come from minority populations. Having Veterans and under-represented minorities volunteer to be part of clinical trials is important because the results of the research will be applicable to more people.

Creating the future of cancer care

Nationally, fewer than 1 in 20 cancer patients enroll in cancer clinical trials. According to the Cancer Action Network, 20% of cancer clinical trials fail due to insufficient patient enrollment. Patient enrollment is, therefore, critical for advancing the development of new treatment options.

“Cancer clinical trials today create standard treatments for tomorrow,” said Dr. Daphne Friedman, an oncologist and expert in blood cancers at the Durham VAMC, and PI for a VA NAVIGATE site.

When diagnosed with cancers, patients are presented with a variety of treatment options. Clinical trials are one important treatment option that patients should consider. Trials can provide access to cutting-edge – and sometimes lifesaving – treatment options.

“One of my patients, with a rare and aggressive salivary gland tumor that spread to his skull base, has been on an immune therapy trial for four years and is now stable. NAVIGATE has enabled more Veterans with cancer to get access to state-of-art clinical trials,” said Chao.

For those hesitant to enroll in clinical trials that explore treatments, there are other options for Veterans to volunteer. Clinical trials explore critical questions that can influence cancer care and patient well-being. One NCI study is collecting information and blood samples from patients who are receiving cancer treatment and contracted COVID-19 infection. This study will help fill current gaps in knowledge regarding cancer patients’ susceptibility to COVID-19 and the severity of the infection.

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