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Recruitment of Mexican American Women with Breast Cancer to Clinical Trials in a Community Practice Setting

Gary W. Unzeitig, M.D., F.A.C.S.

Laredo, Texas

Why clinical trials?

• A means to stay on the cutting edge academically

• Provide community access to services that patients would otherwise have to travel great distances to receive

• Acknowledgement as a regional expert in my field

Clinical research in the community

• Most patients are cared for in the community• Provides potential access to new therapies

locally• Provides a “real world” patient population

and setting for studying new therapies• Helps physicians keep current with

standards of care and familiar with emerging approaches to treatment

Barriers in the community

• Economic

• Infrastructure

• Hospital engagement

• Physician engagement

• Patient concerns

• Trial complexity

6 Ways to Minimize financial barriers

• “Buy in” from the hospital, clinic, or practice• Contracts• Efficient management • Become better at what you do; the more you

do, the better you’ll get• Recognize what your site does well and what

it cannot do• Better trials/ better menus

Keys to Success

• Hospital/practitioner cooperation

• Community supportCommunity support• Efficient infrastructure• Personal commitment• Good trial menu

Founded in 1755 by Don Tomás Sanchez

Population: 217,000

Population of Nuevo Laredo, Mexico: 500,000 Laredo

Demographics

Laredo US

Median age 26 35.3

Median income $34,958 $60,374

% Hispanic 94.5% 15.1%

Trial Menu

• 15 open clinical trials, 10 breast cancer

• 95% enrollment/acceptance of eligible patients offered enrollment

2009 ASCO Clinical Trials Participation Award

2009 ACOSOG top accruing site

Laredo Culture

• Mexican culture– Family – Inherent trust in their doctor– Religion– Sense of community

• The comadre hotline….

Community awareness

• Regular interviews with patients on clinical trials on both English and Spanish TV stations and newspapers

• Community programs on different common cancers always include saludos (praise and thanks) for the patients who have participated in trials

• Phone calls always follow any public discussion of clinical trials from patients asking why they weren’t offered enrollment

Screening and enrollment

• Most common breast clinic patient referrals – Palpable lump or abnormal imaging

• Possible clinical trail eligibility and benefits discussed at initial meeting – pre-diagnosis

• Once eligibility confirmed, trial is discussed in detail with scheduled f/u visit to answer questions with patient and family members

• All consenting/trial discussion is done by MD

And for Laredo cancer care?

• Patients benefit by access to better treatment options• Patients want to contribute towards improving cancer

care• Doctor’s Hospital has become the provider of choice

for cancer care in the community• Personally, I feel that I am making a difference for the

better in the care of my patients and toward future cancer care.

Maria F Gonzalez

TailoRx

Maria B. Medina

ACOSOG 1031

Oralia Martinez

CALGB 40101 Annette Olsen-Fazi,

PhD

NSABP-B40

Idalia Treviño

ACOSOG 0011

Diana Hamblin

ACOSOG 1031