Teletrials bring cutting edge cancer therapies to patients in regional Australia

Oncologists in Victoria are using telehealth to extend clinical trials into regional areas of the state and overcome the inequities that see as few as 5% of regional cancer patients gaining access to the latest treatments via trials.

The so-called teletrial model is now being used to connect a metropolitan site and two regional sites in Victoria and has already recruited 91 patients who have all their trial activity delivered locally, according to researchers at the Victorian Comprehensive Cancer Centre (VCCC), Melbourne.

Writing in the MJA, they say the development of teletrial standard operating procedures should allow the model to be extended nationally to provide wider access to clinical trials for the 32% of Australians who live outside metropolitan areas.

In their article they note that 95% of medical specialists practise in cities, which creates many cancer care access barriers for regional patients and may explain their 7% higher cancer mortality compared with patients in metropolitan centres.

And while a quarter of current clinical trial participants in Victoria (426/1605) live in regional or rural areas, almost all are enrolled at a metropolitan site, they found. This means that patients face travelling long distances to a metropolitan trial site, with the associated costs, need for accommodation and to lifestyle and earnings.

To overcome the distance barriers, the VCCC therefore developed a teletrial implementation framework based on a Clinical Oncology Society of Australia (COSA) model that has been used at other sites in Australia.

“Importantly, the model recognises the potential for heterogeneity across trials and sites, rather than taking a one‐size‐fits‐all approach. Different sites may perform different roles in different trials; for example, taking blood samples, delivering chemotherapy or medication, trial documentation, or imaging,” the authors say.

The VCCC’s flexible teletrials supervision plan also means that some trials may have all elements delivered at the local site, while others may have most delivered locally but specialist services such as radionuclide therapy at the central site.

The model also tackles issues such as indemnity and legal coverage, as well as ethics approval and local governance requirements.

The authors, led by Warnambool-based medical oncologist Associate Professor Ian Collins, says the teletrial model not only offers to improve treatment for disadvantaged regional cancer patients but also many benefits for trial investigators. These include better and faster trial recruitment, improved trial retention, increased participant diversity and improved routine clinical care delivery.

And while outcomes and processes are still being evaluated, teletrials may also offer the prospect of clinical trial cost‐savings, they suggest.

“We acknowledge that this model represents a change to usual process and therefore requires assessment, transparency and strong support and advocacy to overcome barriers to clinical trial participation,” they acknowledge.

“Teletrials do more than just meet trial metrics. They develop synchronous partnering between regional and metropolitan centres, allowing regional equity of access to cutting edge diagnostics and therapeutics while maintaining patients’ care delivery closer to home, thereby avoiding disruption to family, work and social interactions,” they conclude.

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