When it comes to cancer care, all things are not equal.
That’s especially true for people living in rural and regional areas, where issues such as access and resources affect a range of factors including quality of life and cancer survival rates.
In 2018, the VCCC Alliance, supported by funding from the Victorian Government, led an innovative program to enable broader access to cancer clinical trials across regional areas, unimpeded by geographical location and local healthcare architecture. Four years down the track, this has been a game-changer. The resulting Teletrials networked partnership strategy overcomes many of the barriers and obstacles to clinical trial participation for people living in regional and remote areas, providing improved equity of access to cutting edge interventions.
Even better, the first clinical trial using that new strategy has now delivered both proof of concept for Teletrials AND trial results that are practice-changing nationally and internationally.
That trial - TARGET-TP - was an open-label multi-centre, phase 3 trial which recruited 328 patients with cancer, of whom nearly half the patients lived remote from the primary metropolitan centre. Importantly, the intent of the trial was to validate a ground-breaking risk score, designed to then deliver targeted thromboprophylaxis and mitigate the risk of cancer associated thromboembolism (TE) - which remains a frequent and largely preventable complication with significant adverse clinical and economic consequences.
Participants in the trial were risk-stratified to low or high TE risk then randomised to thromboprophylaxis or control for the prevention of cancer-associated TE.
Local clinicians and patients from regional services were connected to the metro based-Principal Investigator at Peter Mac for successful conduct of TARGET-TP. This demonstrated the pragmatism and utility of a risk score for real-time decision-making, with the sensitivity to identify high TE risk patients who benefit most, and low risk who avoid unnecessary exposure to anticoagulants. TARGET-TP started recruitment in mid-2018 with the Teletrial element implemented mid-2019, completing accrual within two years (cohort = 328).
The networked design enabled metro and regional professional partnerships for conduct of the study and more broadly for clinical care and research strategies. This supported the particular local population and health services, creating opportunity for shared healthcare analytics, education, research and professional development.
With the implementation of Teletrials strategy there were negligible drop-out rates in the trial, significant reduction in trial burden for patients and families, professional connectivity for care delivery and no trial violations with regard to the Teletrials strategy.
TARGET-TP, which was led by Associate Professor Kate Burbury, Consultant Haematologist at Peter Mac and Co-Chair of the VCCC Alliance Teletrials (TT) program, alongside Dr Marliese Alexander, validated an enhanced, potent and pragmatic risk-directed approach to the prevention of cancer-associated TE, contributing to reducing a substantial adverse health burden for patients and the healthcare system.
The results of TARGET-TP were presented recently as an oral in plenary session at a major international conference (ICTHIC) and as a poster presentation at ASCO.
“This study is potentially transformative.”
“This study is potentially transformative,” said Associate Professor Burbury. “Cancer associated clots are a major cause of death in patients, yet they are a largely preventable complication. Our targeted approach among ambulatory patients with lung or gastrointestinal cancer initiating a new systemic cancer therapy, was not only effective and safe, but pragmatic, economical and implementable across healthcare organisations as routine care.
“We hope that this risk score and targeted approach will be implemented world-wide into routine care – to finally eradicate one of the most common causes of mortality and morbidity in patients with cancer.”
Regional/rural patients (46% of total cohort) would not have accessed and experienced the benefits of this trial without Teletrial methodology.
As a pilot for Teletrials, the study provided proof-of-concept of the Teletrials strategy and networked partnerships, and informed the development of frameworks, toolkit and education modules for national reach and use. An economic analysis is underway for publication to a peer-reviewed journal which shows an overwhelmingly positive outcome of the Teletrial conduct for patients and health services.
From strength to strength
This strategy underpins a state-wide model for building capacity in rural and regional Victoria so every Victorian can access the most innovative cancer care through clinical trials. In addition, the strategy enhances trial conduct through appropriate and rapid recruitment and retention of applicable patients. This helps to achieve the scientific goals of clinical trials, optimising resources and investment and progressing appropriate therapies and interventions for broader access.
The Teletrials strategy is now going from strength to strength, and VCCC Alliance continues to contribute to this work through our own programs and the Victorian Teletrials Taskforce - a state-wide effort expanding Teletrials implementation across the state and all trial portfolios, to improve patient outcomes.
The TARGET T-P trial was led by Peter MacCallum Cancer Centre and funded by a grant from the Victorian Cancer Agency.