Precision medicine has revolutionized cancer treatment. By utilizing drugs that target specific genetic defects in a patient’s tumor, or by examining the genetics of the cancer to determine which treatments work best, this personalized approach reduces side effects. You can provide your patients with the least and most effective treatments.
But that’s only true for patients who can get these treatments. With nearly 2 million people diagnosed with cancer each year in the United States and a growing number of FDA-approved drugs designed to treat cancers with specific genomic alterations, these targeted therapies are Access varies widely, with only about half of those targeted, said Sherry Ellis, Ph.D., associate professor of population health at the University of Kansas Medical Center.
“You can have a drug that works 100% for everyone,” says Ellis. “But if it doesn’t reach the intended population, it’s 0% effective.”
Cancer patients in rural areas are more likely than non-rural patients to die from the disease and are particularly struggling to access targeted therapies. They tend to live far from facilities with the expertise and resources to provide this level of care. Many rural patients do not have adequate insurance. And most patients are treated in smaller hospitals and oncology clinics that lack the staff and resources dedicated to precision oncology and the rapid process changes needed for these new discoveries. does not support
Ellis is trying to change that. This summer, she was awarded her $1.2 million R01 grant from the National Cancer Institute (NCI) for her TEAMSPORT (Multi-TEAM Systems Framework Precision Oncology Reflex Testing), designed by her and her colleagues. ) tested an intervention known as TEAMSPORT’s goal is to create a standardized approach to the sequencing of genomic tests underlying precision medicine targeted therapies and adapt it for use at the regional cancer centers where most cancer patients in the United States are treated That’s it.
“What we did in our study was design interventions to fit into rural care delivery settings,” says Ellis. “My goal is to make sure that the care provided in local communities is as good as the care provided in the larger community.”
Science that delivers science
Studies of this kind are rare. Less than 1% of his research on cancer genomics deals with how to actually deliver genomic medicine to patients. And it’s based in a relatively new field known as implementation science. Just as there is a science for creating tests to assess which drugs are most effective in treating someone’s cancer, so are those tests and the treatments they suggest used in everyday clinical practice. There’s also science to make sure it’s built in. That’s the role of the implementation scientist.
Implementation scientists are also working to improve care delivery processes, such as reducing the time it takes for patients to receive detailed diagnosis and treatment.
“Prior to precision oncology, a patient undergoes a biopsy or surgery to remove the tumor, which is examined by a pathologist to stage the tumor, thereby determining what treatment the patient should receive and administering treatment. I visited an oncologist to get started, and now in this new era of therapy, if an oncologist finds that they need to have a genomic test, it will take several more weeks and possibly more to get the results of that test. can take months,” Ellis said. “So it just lengthens the time it takes for these truly concerned patients to actually get treatment. Our intervention is designed to help patients make treatment decisions more quickly.”
We also ensure that these treatment decisions are consistent with ever-changing national guidelines and recommended approaches.
Dr. Andrew Godwin, Deputy Director of the University of Kansas, said: Director of Cancer Center, Kansas Institute for Precision Medicine, Director of Genomic Diagnostics, Co-Principal Investigator of TEAMSPORT. “But not all oncologists and pathologists have the same level of knowledge and training in molecular oncology. It was to see if we could standardize our approach to treating patients in a timely manner.”
it’s a team sport
To routineize genomic testing and reduce result turnaround time, the TEAMSPORT intervention incorporates standardized national guidelines-based “reflective” (automated) genomic testing into the workflow of the pathology department rather than the oncology department. It is Ellis noted that oncology providers are often not permanent providers in rural communities, but pathology groups usually are. However, since pathologists are responsible for preparing the tumor tissue and determining what type of cancer it is, they may be better suited to order and administer examinations of these tissues. I have.
Another key objective of TEAMSPORT is to create an environment where surgical, pathology, and oncology teams work in shared goals rather than working in silos.
“While we are good at training cancer care providers in our area of expertise, in order to communicate and implement everything we know about a patient’s cancer across a team of providers, We rarely train them how to work across teams,” Ellis said. He said.
Initially, TEAMSPORT will be implemented at the University of Kansas Health System in Kansas City. Ellis hypothesizes that this intervention will increase the number of patients undergoing this genomic test by 25%, while reducing the time it takes for most patients to less than 10 days.
According to Ellis, the next step is to implement TEAMSPORT more broadly in cancer centers in the region and beyond. The overall result should be a reduction in disparities in clinical outcomes for cancer patients in rural areas.
“The University of Kansas Medical Center is very well positioned to be a national leader in this kind of effort. and implementing scientist Simon Craddock Lee, Ph.D., MPH. “We have a relative opportunity to optimize care delivery here in the Kansas City area and adapt it to rural Kansas. We can move forward.”