Expanding Clinical Trial Access for Underserved Patients: Hope Krebill, MSW, BSN, RN

Clinical trial participation remains a critical barrier to advancing equitable cancer care, particularly for patients treated outside of academic medical centers.

In an interview with The American Journal of Managed Care^® (AJMC^®), Hope Krebill, MSW, BSN, RN, executive director of the Masonic Cancer Alliance at the University of Kansas Medical Center, explained that one of the most effective strategies to increase participation is simply asking patients if they are interested. She emphasized that supporting nonmedical costs like transportation and ensuring that trials are available in community care settings are also essential for improving access. According to Krebill, addressing barriers requires academic centers to collaborate with community practices, providing regulatory and staffing support that smaller centers often lack.

AJMC: What strategies have proven effective in helping underserved patients join and stay in clinical trials?

Krebill: The first thing that really helps people join clinical trials is to ask. People are not necessarily always asked to participate in clinical trials, and that can be for a variety of reasons. It could be that a health care provider is worried about the patient's ability to attend the extra appointments, it could be that the provider is really busy, it could be that there's just not a study that matches that patient at that cancer center. There are a lot of ways that impact a patient's ability to participate, but the first one is asking them.

Once we ask, do we have the ability to get them to the appointments that they need to go to? When we start working through study budgets, we think about, what are the unintended costs—the non–health care costs—of participating in that study? That can be built into the study budget, so that is another way we can really help patients get access to trials.

Finally, I would say that making sure that patients have the availability of a trial by opening the trial where they seek care. Eighty-five percent of patients are treated outside of academic medical centers, so they're at a community site. What do we need to do to balance the patients’ and the providers’ availability to that trial?

AJMC: What barriers still need the most attention?

Krebill: It really comes down to creating a structure so that patients and providers have access to the trials where they seek care. A lot of people at this meeting will probably be from academic medical centers, so they have the opportunity to open a variety of studies. If you're a physician at a community cancer center, how are you getting access to that trial?

There are networks like the National Cancer Institute's Community Oncology Research Program that they can have access to, but they still have to file the pieces around the regulatory and the clinical trial staff. And the funding and reimbursement for those trials are not high enough to pay for that time, so it then comes down to academic medical centers partnering with those community cancer centers. By doing that, the academic medical centers can really help with the regulatory burden of those trials, as well as the education and support staff.