Linking Community Screening Programs to Cancer Centers Boosts Trial Diversity: Susan Vadaparampil, PhD, MPH

There are notable disparities in cancer incidence and outcomes by race, ethnicity, age, and location, according to Susan Vadaparampil, PhD, MPH, of Moffitt Cancer Center, in this interview clip from the recent Institute for Value-Based Medicine® event in Tampa, Florida, titled “Pioneering the Next Era of Oncology Care.”

She also highlights care access, geography, and cost as key barriers to clinical trial enrollment, while linking community screening programs with cancer centers can help improve trial diversity. Vadaparampil further discussed these topics during the panel, “From Vision to Reality: Building Diversity in Clinical Trials.”

This transcript was lightly edited; captions were auto-generated.

Transcript

Which populations are experiencing rising cancer incidence or worse outcomes, and how well are current clinical trials reflecting those realities?

That's a great question and something that we actually pay a lot of attention to at our center. In our catchment area, the 23 counties of West and Central Florida, the populations that experience worse cancer outcomes include Black individuals, Hispanic individuals, but also people who live in rural areas, as well as senior adults.

In our Black population, there's higher incidence of prostate, breast, colorectal, as well as liver cancer. For example, in our Hispanic population, there's higher incidence of liver and stomach cancer. In our rural population, cervical cancer is among the leading causes of cancer among women. Of course, with our senior adults, age is the biggest risk factor for cancer, so we see differences in outcomes for many cancers in our senior adult population.

What are the main barriers preventing patients from entering the clinical trial ecosystem?

I'd say there are 3 main barriers. The first barrier is access to high-quality primary care, where risk assessment and screening consistently take place, along with high-quality oncology care.

A second barrier is geographic. That is, are these facilities located near where folks live? The third, and a major one, is cost, so whether that's insurance or other ways of paying for both primary care as well as oncology services.

Under-screening in communities with historically lower screening rates can limit trial diversity. How can referral pipelines better link community screening programs with institutions to improve enrollment?

That’s a great question. When we think about community screening programs, they come in a lot of flavors. One that we've really focused on is our federally qualified health centers (FQHCs). There are about 1400 of these in the US, and they serve under- or uninsured populations. For example, 1 out of every 15 elderly residents receives care at a federally qualified health center. Several million people who are insured by Medicaid receive care at FQHCs.

We participated, along with about 21 other sites in the US, in a program that was designed to link federally qualified health centers with cancer centers to help reduce that burden once somebody has an abnormal screening result, making sure that the follow-up happens and then care at the center. By creating those relationships based on screening but ensuring that entire continuum of care, we've been able to really bring in different populations to our center than we might otherwise have.