Connecting South Carolina:

The Gibbs/Hollings Cancer Center An NCCCP/NCI Designated Center

Connection

Anita L. Harrison, MPHAssociate Director, Administration

Hollings Cancer Center

History in the Making

• Good working, informal relationship for greater then a decade

• Relationship was greatly strengthened in 2004 with the partnership to establish a Center of Excellence in GI Malignancies

• Further formalized in 2005 as Gibbs Cancer Center at Spartanburg Regional Health System joined the Hollings Cancer Center Clinical Trials Network

• A Memorandum of Understanding executed in 2009 to outline a roadmap of future joint initiatives

Joint Initiatives• In progress: Joint Biospecimen Repository –

Working with Gibbs to launch biospecimen collection efforts, utilizing a common IT system, TissueMetrix

• START- “Survivor Taking Action in Recovery Today”

• R21- Optimizing Survivorship and Surveillance after Treatment for Colon Cancer

• R01- Patient Navigation to Improve the Surgical Resection Rate among African Americans with Early Stage, Non-Small Cell Lung Cancer (NSCLC) in South Carolina

• Everyone involved needs to understand both the community/private practice and the academic perspectives/approaches and find common paths to win:win situations

• Institutional leadership has to be supportive (beyond Cancer Center)

• Designated point people at both institutions to ensure “next steps” is key

• Overcome geographical barriers

Lessons Learned

NavIGATENavigation to Increase Guidance and Awareness of Trials for Thoracic and Esophageal Cancers

A NCI Cancer Center Supplemental Grant (CCSG) to support collaborative pilot projects with NCI Community Cancer Centers

Program (NCCCP) Sites

Background

• Less than 2.5% or 21 patients of the 835 new lung and esophageal cases seen at the three partner sites in 2008 enrolled to a therapeutic clinical trial

• Of those who enrolled, only 1 was African American

Project Objectives• Examine if the integration

of a lay navigator can improve the rate of therapeutic enrollment and protocol compliance

• Further understand factors contributing to the lack of enrollments, particularly among underserved and minority patients

Lay Navigator

Physicians Nurses

Study Coordinators

Project Launch

• Lay navigators who were part of the minority community were identified in each of 3 centers

• Trial portfolio was synchronized among all 3 sites and continues to be monitored

• Lay navigators completed comprehensive didactic training and shadowing experience

Cultural Competency Training

Study personnel from all 3 sites participated in cultural competency standardized patient training (6 modules were developed as part of project)

Project Overview • Pre & Post intervention

surveys collected

• Lay navigator contributions:– Identify patient needs and

connect patients to available resources

– Provide education and patient reminders to enhance adherence to trial treatment plan

– Serve as patient advocate and facilitate communication with treatment care team

Pt. eligible for Therapeutic Clinical Trial

Pt. asked to participate in NavIGATE

If yes, pt. meets navigator

Healthcare team discuss treatment options including clinical trial, (navigator included)

Navigator meets with patient and shows NCI clinical trials video

Patient communicates the treatment regimen decision

Preliminary Results

• 24 patients have been eligible and consented to the NavIGATE trial

• 17 patients consented to a therapeutic clinical trial

• 11 patients were eligible to enroll in a therapeutic clinical trial

• 4 African Americans have enrolled in a therapeutic clinical trial

Lay Navigator Barrier Plans• 40 lay navigator barrier

plans documenting patient interventions for 16 participants

• Intervention categories included:– Communication with medical

personnel– Insurance and/or financial

concerns– Transportation issues– Perceptions and beliefs about

treatment– Attitudes toward providers– Fear and emotional issues– Literacy

“Learned that patient was taking study medication incorrectly…relayed information to the physician and nurse”

“Arranged transportation so patient could make clinic appointments”

“Patient dealing with poor nutrition and performance status… worked with nurse and helped refer patient to nutritionist in aims to keep patient on trial”