TELETRIALS

ANZUP to pilot Teletrials Model in 2020

In 2019, ANZUP has made crucial headway with implementing a teletrials model, with the UNICAB trial set to pilot the model in 2020 .

The ANZUP teletrial model is being developed, with guidance and advice provided by the Clinical Oncology Society of Australia (COSA), who have released supervisory plans as well as national guide for implementation . ANZUP has also consulted with the Victorian Comprehensive Cancer Centre (VCCC) to discuss the various logistical processes involved in setting up a clinical trial within different types of models .

UNICAB is a single agent trial looking at evaluating the study drug cabozantinib in patients with locally advanced or metastatic non-clear renal cell carcinoma . Due to the simple study design of the trial, coupled with the fact that the study drug is an oral drug with no complicated nor involved shipping and storage conditions, the UNICAB trial was picked as the first ANZUP trial able to pilot the ANZUP teletrial model . Currently, a feasibility assessment has been sent to the particular hospital identified as a potential good fit to run the teletrial model servicing a catchment area of approximately 380,000 people across the border of two States . This hospital will act as a Primary hospital, taking on the responsibility of the satellite hospital/s within the regional trials network it belongs . It will aim to deliver treatment and oversight to these hospitals expanding access to the UNICAB trial in communities that would not likely have had any other opportunity to participate, and whereby would need to have travelled long distances to larger hospitals to gain access .

Access to specialist cancer care services is a significant issue faced by residents of rural, remote, Indigenous and some regional communities in countries with large rural and outer metropolitan populations .

The lack of access to specialist services may be due to a lack of specialist oncologists locally, limited scope of practice of other rural health professionals and/or overall rural workforce shortages . Poor access to such specialised health care services could be one of the contributors to the disparity in survival and disease related outcomes that exist between metropolitan and non-metropolitan patients, although the authors acknowledge this issue is complex and may also relate to other factors such as behavioural or cultural factors .

Clinical trials offered to people diagnosed with cancer may include new and experimental drug therapies or imaging technologies, minimally invasive diagnostic or surgical techniques, or supportive care interventions . However, as with access to specialist care, patients living outside of major metropolitan centres face many barriers in accessing clinical trials . Barriers to participation include the limited availability of trial sites closer to home and the increased cost and inconvenience of travel to major centres where the trials are taking place .

The core principles of the teletrial model are:

1 . To increase accessibility to trials thereby reducing the need for people with cancer to travel to larger centres to attend study related visits and undertake study related procedures . Using tele-oncology models, there is an opportunity for patients from rural or regional sites to be recruited, consented, treated and attend follow-up visits –a hub-and-spoke approach between a primary trial site and a satellite site .

2 . To develop collaboration and networking between regional/rural and metropolitan centres, and between tertiary centres even within the same metropolitan setting, with the aim of delivering greater engagement in research activity, improving adherence to evidence based practice, improving the rate of recruitment of patients into clinical trials, reducing the disparity in cancer outcomes for geographically dispersed populations, building clinical trial capacity, and providing trial-related training .

The implications of telemedicine and teletrials, and the consideration of how to engage and support rural and remote communities in research in genitourinary cancers, is of crucial importance to ANZUP as we work towards our mission of improving both treatments and outcomes for those with a GU cancer diagnosis over a vast demographic and geographic representation across Australia .

Information derived from: https://www.cosa.org.au/groups/regional-rural-oncology/activities/