From Trials to Pathways: Rethinking Access in Oncology Care

Oncology medicine is a continuously evolving field that is expanding access to clinical trials and medically integrated dispensing as well as translating best practices between communities. These core themes were all discussed by an esteemed panel of specialized oncologists at the Boston Regional Institute for Value-Based Medicine® evening on February 5, 2026.

Why Clinical Trial Diversity Is Central to Advancing Equitable Cancer Care

The first panel addressed the lack of diversity in clinical trials. Moderator Amir Fathi, MD, director of the Leukemia Program at Massachusetts General Hospital (MGH), emphasized that accessibility remains a significant barrier in equitable care, especially for those who are unable to commute to testing sites.

Panelist Karl D’Silva, MD, assistant professor of medicine at the University of Massachusetts Chan School of Medicine, concurred with Fathi, adding that awareness of and education about clinical trials, especially in immigrant populations, serve as hurdles in access to equitable care.

Because of these challenges, many clinical trial populations are not representative of the national patient population, which can limit generalizability across larger patient populations.¹

“[If] your data do not resemble the larger US population, it limits your impact. It limits your applicability, and it, to a certain extent, diminishes a lot of that,” Fathi said in an interview with The American Journal of Managed Care (AJMC), sister publication to Evidence-Based Oncology^®. “[But] understanding where you stand in terms of the hospital you work at, the catchment areas, or the diversity of your patient population is very important. That may impel you to collaborate with other centers that might have a broader population.”

More recent efforts to diversify enrollment through awareness and expanded resources include patient navigator support, efforts that help patients navigate the health care system, especially considering clinical trials.

When discussing navigator systems to bridge patient care from screening to diagnosis to treatment, D’Silva exemplified the nurse navigation at Chan that seamlessly guides patients through the pipeline to ensure quality oncological care after diagnosis.

Although nurse navigators are not present in every clinical setting, they are significantly more beneficial in cross-specialty navigation, Konstantin Dragnev, MD, interim director of Dartmouth Cancer Center in New Hampshire, said during the discussion.

“Having a nurse navigator during that time makes a big difference for the patient,” he said. “They can already start talking to somebody who understands cancer, tell them what to expect, [alleviating] some of the stress and fear from that uncertainty.”

Another demographic, aside from race or ethnicity and socioeconomic status, that is often missing from clinical trials is younger adults. Often, younger patients with cancer are less represented in clinical trials despite the rise in this group developing cancer, such as colorectal cancer.²

“Younger patients are usually more health literate and aware of the clinical trial options, and they would be more open to discussion,” Umit Tapan, MD, a thoracic medical oncologist at Boston Medical Center (BMC), said during the discussion. “But again, these are working individuals, and clinical trials have to be designed in a way that they will allow patients to take time off from work and assist with the transportation.”

To further encourage younger and more demographically diverse patients to participate in clinical trials, Fathi brought up clinical trials that focus on oral or subcutaneous therapies. In conversation with his patients, Tapan said they are more open to clinical trials with oral plus subcutaneous therapies compared with oral therapies plus chemotherapies. However, Dragnev pointed out that although the administration of the therapy may be appealing, visit frequency also plays a role in patients’ willingness to participate.

Another hurdle, pertaining to all demographics of cancer patients, is social media. Health disinformation is becoming more prevalent, and the panelists addressed the dangers of spreading false health information.³ Patients discussing their health with artificial intelligence (AI) may also deter them from clinical trials, making health care providers’ conversations slightly more difficult, panelists said.

“It depends on what they ask the AI, as long as you create a narrow search to get the right information; otherwise, it gives you a lot of information, which is more garbage,” D’Silva said, concluding the discussion.

How Medically Integrated Dispensing Is Reshaping Oncology Practice

Medically integrated dispensing (MID) may address a prominent barrier in clinical trial accessibility, specifically in the discussion on oral vs intravenous therapies. MID comprises a team of pharmacy specialists who are onsite at a clinic or in a hospital setting dedicated to patient care. MID is an alternative to outsourcing patients to pharmacies; instead, they receive their medications during their stay.

“One of the big concerns that we were running into is their patients couldn’t afford the co-pays or get their medication from some of these outside pharmacies,”Sita Bhatt, PharmD, BCOP, oncology pharmacy specialist and clinical coordinator at BMC, said during the discussion, explaining why MID was implemented at BMC.

Bhatt also explained how pharmacists at BMC use 340B pricing, a federal program that requires pharmaceutical companies to sell discounted medication to eligible safety-net hospitals to improve patient access. Through this program, MID can “help us to mitigate these co-pays and different things so our patients are actually able to get their medications, and we can ensure continuity and transition of care with prescribing these medications,” she said.

Compared with an external pharmacy, MID allows pharmacists direct access to emergency medical records (EMRs) so they can evaluate a patient’s condition. Pharmacists can then treat patients in real time from a preventive standpoint as opposed to reacting to a patient’s condition after the fact.

Using EMRs with MID gives physicians and pharmacists, or providers from the patients’ care team, access to their records to ensure continuity of care.

“EMRs allow us to have this closed-loop communication,” Sam Abdelghany, PharmD, executive director of oncology pharmacy at Yale Cancer Center in Connecticut, said during the panel. “It’s not good enough that I have followed up with patients and have collected information if it’s not visible to everybody on the team…. We have this closed-loop communication so clinicians can see the results of our toxicity assessment, adherence, or any barriers, and everybody is aware in real time.”

MID also serves as another source of revenue, keeping patient dollars circulating in the facility that is actively taking care of them, moderator Corey McEwen, PharmD, MS, director of oncology pharmacy services at MGH, said during the panel discussion.

“From the patient perspective, we know these therapies aren’t cheap,” he said. “We have pharmacists who are specifically dedicated to navigating these financial burdens for the patient, whether it’s accessing patient assistance programs, helping complete applications for financial assistance, or anything that would help support this patient getting the treatment that they need.”

Another hurdle that patients experience with external pharmacies is care contracts. Bhatt explained that sometimes, due to language barriers or costs, patients sign care contracts linked to external pharmacies, which make prescription refills difficult.

“You have this gap from sending the prescription to [the external pharmacy], [them] receiving and processing it, and pulling the insurance information for the patient, [which] can take up to a week for them to then contact the patient to then get them started,” Bhatt said. “Whereas, in our integrated specialty pharmacies, I’m able to do same-day certifications for these patients.”

The Expanding Role of Oncology Pathways in Value-Based Care

Balancing safety, efficacy, and patient-specific factors is essential when establishing treatment pathways in oncology. During this discussion moderated by David Jackman, MD, medical director for clinical pathways and new business initiatives at Dana-Farber Cancer Institute (DFCI) in Boston, Massachusetts, panelists highlighted specific cases to underscore the nuances when establishing oncology pathways. He started the conversation by asking the panelists how new regulatory pathways are adopted and what data are used to support the decision.

Jacob Sands, MD, medical director of clinical pathways and new business initiatives at the Lowe Center for Thoracic Oncology at DFCI (Lowe), gave a specific example of how he and his team select the best therapy to use in a clinical setting. In small cell lung cancer, the FDA’s approval of lurbinectedin in the second line showed a 35% response rate, with a median 3.5-month progression-free survival (PFS) and a 9.3-month overall survival.⁴ In comparison, tarlatamab-dlle in the third line had an overall response rate of 40%.⁵

Sands briefly mentioned the cost discrepancies between the 2 drugs and how these pathways should not prioritize the most valuable drug regarding cost but the safest and most efficacious drug. “If it were you, would you want a drug that has demonstrated the most impressive outcomes we’ve seen of anything beyond the first-line setting?” he asked. “Or would you say [because it] hasn’t been proven [in] the second line yet, I’d rather get that chemo drug that showed a median PFS of 3.5 months and an overall survival of 9.3 months?”

For multiple myeloma (MM), Yuxin Liu, MD, physician and instructor of medicine at Harvard Medical School, said the strategy is similar across oncology. They are, more often than not, going to choose proven pathways that are efficacious and safe.

“I think in the newly diagnosed myeloma setting, we do have some structure. There is very good precedent for what our basic induction regimens are and what our new standards are, including quadruplet therapies,” she said during the panel discussion. “You have one basis to start on, and then from there, in the relapse setting, that’s where everything balloons…. Prior exposures, treatment refractoriness, and then patient characteristics guide people into different nodes and then newer treatments.”

Michael Serzan, MD, a medical oncologist at DFCI, said that safety and efficacy may be more important than cost, especially when they encounter reimbursement or prior authorization challenges. “I’d love to incorporate more of that cost into our pathways,” he said during the discussion. “As a pathways director, we go through this, and we put the numbers out there, and they’re calling numbers, and then they add it to the pathways.”

Strengthening Academic-Community Partnerships to Improve Access and Outcomes

Partnering with major academic oncology centers and translating those practices to the setting requires a foundation of communication. Rooting practices in communication helps to bridge the gap between the tools of academic practices and how to practically address the needs of those in the community, panelists explained.

“Surgical expertise, for example, comes from academic institutions,” Anasuya Gunturi, MD, PhD, chief of oncology and medical director of cancer care associates and palliative care services at Lowell General Hospital in Massachusetts, said in an interview with AJMC. “It really helps to have somebody who has more experience and who has done these types of treatments in a larger volume to guide us—for example, simply giving us a particular protocol that they follow or the exact dosing or the way they monitor for and manage toxicities.”

When managing strategies in an academic setting compared with a community setting, Andrew Yee, MD, clinical director of the Center for Multiple Myeloma at MGH, emphasized significant contradictions when trying to translate toxicity management into a community setting. “What we actually do in practice deviates substantially from the packet prescribing information,” he said when discussing MM treatment strategies at his institution.

However, despite differences in strategies, communication remains at the forefront. Gunturi emphasized collaboration between community and academic partners for second opinions. “I, as a clinician in the community, have to trust the academic personI’m going to send my patients to, perhaps for a second opinion or for certain treatments that I’m not able to do in the community, [and that they are] going to respect the care that I’m giving to my patients and comanage these patients and not just scoop them up and cut me out of the care team,” she said.

Another challenge that arises when translating care is managing toxicities. For example, newer T-cell engager therapies such as telatinib have a unique safety profile and are often accompanied by new toxicities and should be administered in an inpatient setting.⁶ However, when community centers adopt these therapies, patients have to be localized to an academic center that is logistically feasible and has the tools to manage any toxicities, moderator Biagio Ricciuti, MD, thoracic medical oncologist at DFCI, said in an interview with AJMC.

“We have made progress by fixing some of these toxicities using precise protocols,” Ricciuti explained. “Now this can be more easily given in the community setting, and I’ve seen more and more colleagues in those specific settings delivering those therapies safely to their patients.”

There is also opportunity for mismatch when translating care between academia and community-based practices. However, Julia Rotow, MD, clinical director at Lowe at DFCI, suggested that partnering with multidisciplinary tumor boards can be helpful, especially when subspecialty care is not easily accessible for patients.

“Novel strategies that involve remote molecular tumor boards, remote multisensory tumor boards, can help patients and physicians access subspecialty care when it might not be easily reachable, and that’s a health care slide,” she said during the discussion.

As oncology evolves, innovation alone is not enough. Expanding trial access, refining oncology pathways, and strengthening academic-community collaboration will determine whether advances translate into equitable, value-based cancer care.

References

1. McCrear S, Fathi A. Catchment areas shape diversity and access in oncology trials: Amir Fathi, MD. AJMC. February 9, 2026. Accessed February 23, 2026. https://www.ajmc.com/view/catchment-areas-shape-diversity-and-access-in-oncology-trials-amir-fathi-md

2. McCormick B, Karlitz J. Reversing rising CRC deaths through early detection, patient navigation, and policy changes: Jordan Karlitz, MD. AJMC. February 17, 2026. Accessed February 23, 2026. https://www.ajmc.com/view/reversing-rising-crc-deaths-through-early-detection-patient-navigation-and-policy-changes-jordan-karlitz-md

3. Rodrigues F, Newell R, Babu GR, Chatterjee T, Sandhu NK, Gupta L. The social media infodemic of health-related misinformation and technical solutions. Health Policy Technol. 2024;13(2):100846. doi:10.1016/j.hlpt.2024.100846

4. Singh S, Jaigirdar AA, Mulkey F, et al. FDA approval summary: lurbinectedin for the treatment of metastatic small cell lung cancer. Clin Cancer Res. 2021;27(9):2378-2382. doi:10.1158/1078-0432.CCR-20-3901

5. FDA grants accelerated approval to tarlatamab-dlle for extensive stage small cell lung cancer. FDA. May 16, 2024. Accessed February 23, 2026. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-tarlatamab-dlle-extensive-stage-small-cell-lung-cancer

6. McCrear S, Ricciuti B. Adapting CAR-T and cell therapies for community oncology: Biagio Ricciuti, MD. AJMC. February 13, 2026. Accessed February 23, 2026. https://www.ajmc.com/view/adapting-car-t-and-cell-therapies-for-community-oncology-biagio-ricciuti-md