Health
Pioneering Progress: New Mexico’s Path to Better Cancer Outcomes
New Mexico Statewide Cancer Clinical Trials Network reviewed state’s cancer clinical trials and celebrated advances in cancer care at June Scientific Retreat
Chandylen Nightingale, PhD, MPH, Wake Forest University, was the keynote speaker at the NMCRA Scientific Retreat
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For nearly 20 years, the New Mexico Cancer Care Alliance (NMCCA) ensured that New Mexicans in all parts of the state had access to cancer clinical trials. That network of health care organizations has modernized its processes. It also strengthened its focus and mission on delivering clinical trials and clinical research to prevent, detect, and treat cancer and to improve patient outcomes, experiences and access to cancer care using culturally sensitive approaches.
The rebranded organization, now called the New Mexico Cancer Research Alliance (NMCRA), held its first in-person scientific retreat on June 21. Attendees at the event represented The University of New Mexico Comprehensive Cancer Center, Presbyterian Healthcare Services, Lovelace Health System and Memorial Medical Center and the Veteran’s Administration Hospital System.
Summary
- The New Mexico Cancer Care Alliance (NMCCA) has rebranded as the New Mexico Cancer Research Alliance (NMCRA) to strengthen its focus on delivering cancer clinical trials to New Mexicans.
- Through the NMCRA’s unique collaboration, every New Mexican has access to cancer clinical trials.
- Cancer clinical trials test new treatments and new methods of delivering and improving cancer care
A “Gem” to Improve Cancer Care
The NMCRA is an incredible gem for the people of New Mexico,” says Carolyn Muller, MD, FACOG, NMCRA Director. “Clinical research improves the lives of cancer patients by focusing on better ways to prevent, detect and treat cancer and to optimally deliver cancer care.”
Cancer Clinical research is conducted through clinical trials, which test new treatments and new methods of delivering and improving cancer care. Some trials test whether new drugs are more efficacious than the currently used “standard” drugs. Some test new drug combinations.
Other cancer clinical trials test better ways to screen for cancer or lessen symptoms from cancer or cancer treatments. Still other trials test different methods of delivering care to different people, such as individuals from different racial or ethnic communities or those who live in rural or underserved communities.
The United States Food and Drug Administration (FDA) oversees all clinical trials in the US. It ensures that all clinical trials are conducted safely and with the full understanding and consent of those who choose to take part in them. It also ensures that clinical trials are “designed, conducted, analyzed and reported according to federal law and good clinical practice (GCP) regulations.”
The FDA enforces a four-phase process of testing through which new treatments are approved for use. Each phase has its own set of requirements that treatments must meet in order to progress to the next phase.
Professional medical organizations, such as the American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) create guidelines for cancer related clinical practice based on the strength of scientific evidence that results from clinical trials. These standards reflect the latest scientific research and best-known practices for delivering care.
The current standard treatments and care practices in effect today went through scientifically rigorous clinical trials to become the standards. When new clinical trials show a drug, treatment or method to be more effective than the current standard, the practice of cancer care changes.
Muller says that the results of several practice-changing clinical trials were presented at the most recent American Society for Clinical Oncology (ASCO) national conference. Some New Mexico patients took part in those clinical trials.
“Our patients had an opportunity to benefit from the clinical trial treatments, and they also helped future patients receive better care,” says Muller. “They are true heros!”
“Cancer research is the key to progress in our battle against cancer,” says Dr. Heyoung McBride, MD from Lovelace Cancer Center, Radiation Oncology. “It is only through high quality research that we can advance our understanding of biological processes involved in cancer and improve outcomes for patients and loved ones suffering from cancer,” she says.
Daunting Challenges
New Mexico’s small population is spread over a large area: the state ranks fifth in land mass but 36th in population. Offering clinical trials to people throughout the state thus presents a daunting challenge.
Because of their scientific nature, clinical trials demand more than strict adherence to a detailed plan, called a protocol, that every person on the trial must follow. Trials also require evidence that each person has followed that protocol. Should anyone deviate from the protocol – for example, if someone must come off the protocol because of a new health issue or a serious side effect – a note of that situation must also be recorded and reported, especially for safety purposes.
A cadre of expertly-trained research teams are needed to manage clinical trials. Some of these people are trained to ensure that participants in each clinical trial meet all the criteria for joining that trial. Others explain the protocols to potential participants. And many others enter clinical trial data, manage databases, report results to oversight entities, and track patient responses and side effects.
Few, if any, independent doctor’s offices could manage clinical trials on their own. Even some larger health care organizations in the state would struggle under the vast administrative burden. UNM, as the only NCI designated Comprehensive Cancer Center in NM, serves as the academic hub for the NMCRA. And the NMCRA brings cutting edge clinical trials and clinical research from the National Cancer Institute, lead investigators and other stakeholders to the NMCRA member health systems.
Through the NMCRA’s unique collaboration, UNM’s clinical research expertise is shared with all affiliated cancer treatment providers in the state. The UNM Cancer Center’s Clinical Research Office supports many of the core functions of the NMCRA.
This collaborative effort between the academic and community health systems partners has led to sustained funding support from the National Cancer Institute’s National Community Oncology Research Program (NCORP).
“The NCORP Program delivers state-of-the-art national cooperative group clinical treatment, prevention and screening trials to New Mexico,” Muller says. She also notes that many clinical research leaders in New Mexico across the NMCRA not only serve on the national committees that help to shape the future of these trials but also make sure that New Mexicans can access these trials.
“Health systems in New Mexico value cancer clinical trials,” says Muller.
William Adler, MD, at Memorial Medical Center in Las Cruces, sees the benefits of clinical trials for New Mexicans, He says, “Memorial Cancer Center has made clinical research trials a priority for nearly 15 years. The availability of these national and international studies allows patients to stay at home with their families and still have access to the leading edge of cancer care. The cancer program at Memorial Medical Center has received national recognition for its clinical trial research activities. As the umbrella organization, NMCRA has made cancer clinical research possible in southern New Mexico.”
Malcom Purdy, MD, at Lovelace Cancer Center Medical Oncology agrees. He says, “The Lovelace Cancer Center has participated in clinical trials with the University of New Mexico for close to 40 years. These have included groundbreaking studies which have advanced patient care and cancer treatment, especially in breast cancer. Unlike clinical trials for other conditions, clinical trials for cancer patients take the best of what we know now and add to that care, so all participants receive excellent care. I always tell my patients that participation in a clinical trial gives the best care.
Access for All
As the many affiliates of the NMCRA know, offering the best cancer care isn’t good enough; that care must reach the people who need it.
In addition to the large cancer care providers, smaller oncology practices throughout the state are also NMCRA affiliates. They provide cancer clinical trials to people in some of the most underserved and remote areas in New Mexico.
And the National Cancer Institute (NCI) also recognizes the need to bring cancer care and cancer research to people who have not taken part in clinical trials in the past or who may face significant barriers to joining then now.
Through the NCORP grants, the NCI has created “a national network that brings cancer clinical trials and care delivery studies to people in their own communities.” The UNM Cancer Center is one of the Minority/Underserved NCORP sites, and NCI cancer clinical trials are delivered through the NMCRA
The NCI is also focusing on cancer care delivery. Cancer care delivery research studies how different processes, models, concepts and approaches can improve the quality of cancer care, patient outcomes, and access to care.
Chandylen Nightingale, PhD, MPH, Assistant Professor in the Department of Social Sciences and Health Policy, Division of Public Health Sciences, at Wake Forest University School of Medicine spoke at the recent NMCRA scientific retreat and shared her research and insights and the importance of cancer care delivery research.
“It is imperative for New Mexico’s cancer patients to have access to innovative treatments that will hopefully move cancer care forward,” says Ethan Binder, MD, at Presbyterian Healthcare Services Hematology/Oncology. “The NMRCA is a wonderful collaborative effort that truly tailors cancer research for New Mexicans.”
Some of the NMCRA Member Institutions
The University of New Mexico Comprehensive Cancer Center
The University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institute-designated Cancer Center in a 500-mile radius. Its more than 120 board-certified oncology specialty physicians include cancer surgeons in every specialty (abdominal, thoracic, bone and soft tissue, neurosurgery, genitourinary, gynecology, and head and neck cancers), adult and pediatric hematologists/medical oncologists, gynecologic oncologists, and radiation oncologists. They, along with more than 600 other cancer healthcare professionals (nurses, pharmacists, nutritionists, navigators, psychologists and social workers), provide treatment to 65% of New Mexico’s cancer patients from all across the state and partner with community health systems statewide to provide cancer care closer to home. They treated approximately 14,000 patients in about 100,000 ambulatory clinic visits in addition to in-patient hospitalizations at UNM Hospital. A total of nearly 400 patients participated in cancer clinical trials testing new cancer treatments that include tests of novel cancer prevention strategies and cancer genome sequencing. The more than 100 cancer research scientists affiliated with the UNMCCC were awarded $35.7 million in federal and private grants and contracts for cancer research projects. Since 2015, they have published nearly 1000 manuscripts, and promoting economic development, they filed 136 new patents and launched 10 new biotechnology start-up companies. Finally, the physicians, scientists and staff have provided education and training experiences to more than 500 high school, undergraduate, graduate, and postdoctoral fellowship students in cancer research and cancer health care delivery. Visit www.UNMHealth.org/cancer.
Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. Presbyterian is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state’s largest private employer with more than 13,000 employees.
Lovelace Health System (Lovelace) recently celebrated its 100th anniversary, marking a century of caring, change and progress while continuously improving the practice of medicine.
Lovelace is comprised of Lovelace Medical Group/New Mexico Heart Institute, Lovelace Women’s Hospital, Lovelace Medical Center, Heart Hospital of New Mexico at Lovelace Medical Center, Lovelace Westside Hospital, Lovelace Regional Hospital and Lovelace UNM Rehabilitation Hospital. Across its six hospitals, 33 health care clinics and seven outpatient therapy clinics, Lovelace has 619 inpatient beds and employs a team of more than 3,450, including over 280 health care providers. Lovelace continues to invest in our community, providing more than $81 million in unfunded care and supporting local nonprofit and community organizations with more than $357,000 in charitable contributions and community support in 2022. From the first and only hospital in New Mexico dedicated to women’s health to the state’s only hospital devoted exclusively to cardiovascular care, Lovelace is a leader in meeting the healthcare needs of this region. To learn more about our state-of-the-art treatment options, innovative health care providers and award-winning quality initiatives, visit lovelace.com.
Memorial Medical Center is a 199-bed full-service acute care hospital located in Las Cruces, New Mexico and serving a five-county region of Southern New Mexico. Our mission is simple: Making Communities Healthier. We are a part of the LifePoint Health family of hospitals, which means we aim to create a place where people choose to come for healthcare, physicians and providers want to practice, and employees want to work. Learn more at mmclc.org.
Source: Michele W. Sequeira, MS, MBA, MWC & University of New Mexico Comprehensive Cancer Center
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Lifestyle
Clinical Trials Expand Patients’ Treatment Options
Clinical trials play a crucial role in developing effective treatments for chronic health conditions. They evaluate safety and efficacy, but low enrollment delays drug approvals, limiting patient options.
(Family Features) For health conditions with no cure, effective treatments are the next best option. However, in order to make medical interventions including new drugs, devices, vaccines and lifestyle modifications available, they must undergo a thorough evaluation process to demonstrate their benefits.
Clinical trials are an important part of this process because they provide data for researchers on the effectiveness of various treatments and interventions. However, many myths about clinical trials deter people from enrolling. In fact, more than 70% of clinical trials are delayed at least one month due to unfulfilled enrollment, according to the “Journal of Medical Internet Research.”
Delays create barriers to the drug approval process and result in fewer available treatments for chronic conditions like Crohn’s disease and ulcerative colitis. The experts at the Crohn’s & Colitis Foundation offer these facts about the importance of clinical trials:
- More patients can benefit from clinical trials While hundreds of participants may take part in a trial, the results can lead to new care and treatment options for an entire patient community.
- Clinical trials lead to better and improved medications. For a new treatment to be approved, it needs to demonstrate a meaningful benefit to patients, such as improved outcomes, treating a wider range of symptoms, fewer side effects or more convenience for patients.
- They provide information. Clinical trials provide evidence of a treatment’s effectiveness and safety that can be used to guide patient care.
- Trials test safety and efficacy. Clinical trials are conducted in four phases. During the first phase, the main objective is to assess the safety of a new treatment. Experimental treatments only advance to the next stages if they pass certain safety and efficacy standards
. - They help prevent bias. In a randomized controlled trial, the effects of treatment with a new drug are compared with that of a control group – either a placebo (a treatment that looks identical to the new drug but contains no active medicine) or the current standard of care. Treatment assignments are “randomized,” which means neither the trial doctors nor the participants choose which treatment each participant will receive.
How Clinical Trials Work
Before a clinical trial begins, a research team develops a clinical trial protocol. This is the research plan that describes who can join the trial, which treatments the participants will receive, what questions the researchers will try to answer, how long the trial will last and how participant privacy and safety will be protected.
Conducting clinical research relies on volunteer trial participants. Those interested in joining a clinical trial meet with clinical research professionals to discuss the trial, treatments, eligibility requirements and expectations.
Joining a Trial
If you are interested in participating in a clinical trial, do some research. Your doctor may not be aware of or proactively tell you about trials you may be eligible to join. If you find a clinical trial you may be interested in joining, discuss the trial with your doctor and other health care professionals on your research team.
Foundations supporting chronic conditions can be a good source of information. For example, you can learn more about trials affecting individuals with inflammatory bowel disease by exploring the Clinical Trials Community at crohnscolitisfoundation.org.
Photo courtesy of Shutterstock
SOURCE:
Crohn’s & Colitis Foundation
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Lucas A. Berenbrok, University of Pittsburgh; Michael Murphy, The Ohio State University, and Sophia Herbert, University of Pittsburgh
Neighborhood pharmacies are rapidly shuttering.
Not long ago, Walgreens, one of the nation’s biggest pharmacy chains, announced plans to close 1,200 stores over the next three years. That’s part of a larger trend that has seen nearly 7,000 pharmacy locations close since 2019, with more expected in the coming years.
Many community pharmacies are struggling to stay open due to an overburdened workforce, shrinking reimbursement rates for prescription drugs and limited opportunities to bill insurers for services beyond dispensing medications.
As trained pharmacists who advocate for and take care of patients in community settings, we’ve witnessed this decline firsthand. The loss of local pharmacies threatens individual and community access to medications, pharmacist expertise and essential public health resources.
The changing role of pharmacies
Community pharmacies – which include independently owned, corporate-chain and other retail pharmacies in neighborhood settings – have changed a lot over the past decades. What once were simple medication pickup points have evolved into hubs for health and wellness. Beyond dispensing prescriptions, pharmacists today provide vaccinations, testing and treatment for infectious diseases, access to hormonal birth control and other clinical services they’re empowered to provide by federal and state laws.
Given their importance, then, why have so many community pharmacies been closing?
There are many reasons, but the most important is reduced reimbursement for prescription drugs. Most community pharmacies operate under a business model centered on dispensing medications that relies on insurer reimbursements and cash payments from patients. Minor revenue comes from front-end sales of over-the-counter products and other items.
However, pharmacy benefit managers – companies that manage prescription drug benefits for insurers and employers – have aggressively cut reimbursement rates in an effort to lower drug costs in recent years. As a result, pharmacists often have to dispense prescription drugs at very low margins or even at a loss. In some cases, pharmacists are forced to transfer prescriptions to other pharmacies willing to absorb the financial hit. Other times, pharmacists choose not to stock these drugs at all.
And it’s not just mom-and-pop operations feeling the pinch. Over the past four years, the three largest pharmacy chains have announced plans to close hundreds of stores nationwide. CVS kicked off the trend in 2021 by announcing plans to close 900 pharmacy locations. In late 2023, Rite Aid said that thousands of its stores would be at risk for closure due to bankruptcy. And late in 2024, Walgreens announced its plans to close 1,200 stores over the next three years.
To make matters worse, pharmacists, like many other health care providers, have been facing burnout due to high stress and the lasting effects of the COVID-19 pandemic. At the same time, pharmacy school enrollment has declined, worsening the workforce shortage just as an impending shortfall of primary care physicians looms.
Why pharmacy accessibility matters
The increasing closure of community pharmacies has far-reaching consequences for millions of Americans. That’s because neighborhood pharmacies are one of the most accessible health care locations in the country, with an estimated 90% of Americans living within 5 miles of one.
However, research shows that “pharmacy deserts” are more common in marginalized communities, where people need accessible health care the most. For example, people who live in pharmacy deserts are also more likely to have a disability that makes it hard or impossible to walk. Many of these areas are also classified as medically underserved areas or health professional shortage areas. As pharmacy closures accelerate, America’s health disparities could get even worse.
So if your neighborhood pharmacy closes, what should you do?
While convenience and location matter, you might want to consider other factors that can help you meet your health care needs. For example, some pharmacies have staff who speak your native language, independent pharmacy business owners may be active in your community, and many locations offer over-the-counter products like hormonal contraception, the overdose-reversal drug naloxone and hearing aids.
You may also consider locations – especially corporate-owned pharmacies – that also offer urgent care or primary care services. In addition, most pharmacies offer vaccinations, and some offer test-and-treat services for infectious diseases, diabetes education and help with quitting smoking.
What to ask if your pharmacy closes
If your preferred pharmacy closes and you need to find another one, keep the following questions in mind:
• What will happen to your old prescriptions? When a pharmacy closes, another pharmacy may buy its prescriptions. Ask your pharmacist if your prescriptions will be automatically transferred to a nearby pharmacy, and when this will occur.
• What’s the staffing situation like at other pharmacies? This is an important factor in choosing a new pharmacy. What are the wait times? Can the team accommodate special situations like emergency refills or early refills before vacations? Does the pharmacist have a relationship with your primary care physician and your other prescribers?
• Which pharmacies accept your insurance? A simple call to your insurer can help you understand where your prescriptions are covered at the lowest cost. And if you take a medication that’s not covered by insurance, or if you’re uninsured, you should ask if the pharmacy can help you by offering member pricing or manufacturer coupons and discounts.
• What are your accessibility needs? Pharmacies often offer services to make your care more accessible and convenient. These may include medication packaging services, drive-thru windows and home delivery. And if you’re considering switching to a mail-order pharmacy, you should ask if it has a pharmacist to answer questions by phone or during telehealth visits.
Remember that it’s best to have all your prescriptions filled at the same pharmacy chain or location so that your pharmacist can perform a safety check with your complete medication list. Drug interactions can be dangerous.
Community pharmacies have been staples of neighborhoods for more than a century. Unfortunately, current trends in pharmacy closures pose real threats to public health. We hope lawmakers address the underlying systemic issues so more Americans don’t lose access to their medications, health services and pharmacists.
Lucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of Pittsburgh; Michael Murphy, Assistant Professor of Pharmacy Practice and Science, The Ohio State University, and Sophia Herbert, Assistant Professor of Pharmacy, University of Pittsburgh
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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(Family Features) Clinical trials help researchers studying chronic conditions answer important questions about the diseases and their treatment options. However, uncertainty about what to expect and a lack of knowledge about how to get started can prevent patients from joining a clinical trial.
Choosing to take part in a clinical trial means helping a study team figure out if a new method of diagnosis, treatment or prevention is effective. If you live with a chronic condition, such as Crohn’s disease or ulcerative colitis, and want to help find answers for others who share your experience, a clinical trial is an option to consider.
Once you identify a study that interests you, you’ll want to talk with the professionals involved in your ongoing treatment, a clinical research coordinator and your family to gather information necessary to determine whether the clinical trial is a good fit.
To find additional information about clinical trials and begin exploring trials in your area, visit crohnscolitisfoundation.org, and consider these steps for participating in a trial.
1. Talking with Your Doctor
Your gastroenterologist and other care providers can help determine whether a clinical trial is right for you and may be able to help point you toward recommended trials. It’s important to ask if or how your doctor will continue to be involved in your care if you participate in a trial.
2. Finding a Study
If you need help beyond your care team in identifying clinical trial opportunities in your area, organizations dedicated to your condition can be a good resource. For example, the Crohn’s & Colitis Foundation offers an online Clinical Trial Finder for individuals with inflammatory bowel disease.
3. Talking with the Research Coordinator
A clinical trial research coordinator can provide details specific to your circumstances and needs. You can discuss potential benefits and risks, why the trial is being conducted and who is involved in the health care team. You can talk about past treatments and how this study may differ from your previous experiences. Other questions you might ask include what your options are if the trial doesn’t work, any costs you might expect and what your personal commitment will be.
4. Evaluating the Fit for You
Once you have the necessary information, you’ll be able to consider whether you’re ready to move forward with registering for the trial. You’ll want to weigh factors like your time commitment, travel distance and whether the trial will affect your personal or professional obligations.
Photos courtesy of Shutterstock
SOURCE:
Crohn’s & Colitis Foundation
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