Australasian Teletrial Model brings cancer clinical trial access to the bush


By Mardi Chapman

28 Nov 2019

The Australasian TeleTrial Model is creating opportunities for regional patients to access cancer treatment in clinical trials closer to home, a medical oncologist says.

The model is also enhancing workforce capabilities and attracting new investment from industry, according to Professor Sabe Sabesan, director of medical oncology at Townsville Hospital . 

Speaking to the limbic after the recent COSA ASM, Professor Sabesan said improving safe and ethical access to new treatments in regional and rural settings was the main goal of the teletrial model endorsed by COSA.  

“This is all about access and disparity in access and that could also be related to disparity in outcomes in many disease settings including cancer.”

He said despite the improved outcomes seen with clinical trials, Australians’ participation in them was below international benchmarks even in metropolitan settings.

“What these teletrials do is link smaller sites with larger sites through a telehealth model and telehealth governance.”

The linkage of primary and satellite trial sites into trial clusters is proving to be flexible enough to accomodate trials for different cancer types and meet local needs.  

“For example if you have a common disease, Townsville can be a stand alone site and also link to Mt Isa, Mackay, Cairns … so those patients don’t have to come to Townsville. And also you can rotate the primary sites. We could collectively decide that the next trial is based in Cairns or Mackay.”

For rarer diseases, where each site may only recruit one or two patients, a metropolitan hospital could also be the primary or a satellite site. 

“Even the Royal Brisbane and Women’s Hospital can be a satellite to Princess Alexandra Hospital so patients can stay with their oncologist and continuity of care will be maintained.  Patients don’t need to switch hospitals,” he said.  

Professor Sabeson, who is also head of the Townsville Clinical School at James Cook University, said one of the pilot studies in Queensland had already completed, three were ongoing and a fifth trial was about to open.

They included targeted therapy trials and covered cancers including melanoma, lung, breast and oesophageal cancer.

The model could also be extended to cancer prevention studies in primary care, he said. 

Professor Sabesan said one of the identified challenges in the teletrial model was that of coordination.

“Trial cluster coordination seems to be a major workload for the primary sites. So what we want for sustainability is for that coordination work to be outsourced to an entity.”

He said there was support from at least five states for regional clinical trial coordinating centres which could take up tasks such as contracts and regulation.

And there was a planned bid for funding via the MRFF’s upcoming Rural, Regional and Remote Clinical Trial Enabling Infrastructure Fund.

He said inertia was another challenge and state government ownership was very important. 

“Governments are quite interested, but as with any system changes you do have some apathy. And a lot of people in metropolitan areas probably don’t understand the predicament that regional and rural people are in.  They don’t know the impact of travel and disruption to these patients.”

“So that’s where the leadership of these health services comes in. It’s the same with any new thing implemented in the health service; I’ve never found anything implemented without top down and bottom up support.”

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