Debra Friedman, MD, E. Bronson Ingram Chair of Pediatric Oncology and co-leader of the Cancer Health Outcomes and Control Research Program, and Tuya Pal, MD, Ingram Professor of Medicine and associate director for Cancer Health Disparities, are leading an effort to improve cancer care in rural areas with a telehealth initiative supported with a $3.3 million grant from the National Cancer Institute (NCI).
The five-year initiative will allow community clinicians to consult with the VICC HOPE molecular tumor board led by co-investigator Ben Ho Park, MD, PhD, Donna S. Hall Professor of Breast Cancer, associate director for Precision Oncology and co-leader of the Breast Cancer Research Program at Vanderbilt-Ingram Cancer Center (VICC). In addition, rural patients will be offered resources for self-care management.
“Everything we are doing, we are doing through telehealth, so patients and oncologists never have to leave their communities,” said Friedman. “All they need is a computer or a smartphone.”
Death rates from cancer are higher in rural areas (180 deaths per 100,000 persons) compared to urban areas (158 deaths per 100,000 persons), according to the U.S. Centers for Disease Control and Prevention. The NCI invited cancer researchers to design interventions to address the disparity, and Friedman responded.
“I felt like this is the responsibility of Vanderbilt-Ingram Cancer Center because this affects a large part of our catchment area, where we are responsible for improving cancer care delivery,” said Friedman, the lead principal investigator on the grant.
“We have a very large catchment area. We have 123 counties, which include all of Tennessee, part of Kentucky and part of Alabama. Seventy of those counties are rural counties by government designation. Some of those counties are not only rural counties, but rural counties with persistent poverty.”
It’s a team effort between some of VICC’s top cancer experts and community oncologists across Tennessee as well as parts of Kentucky, Alabama and Mississippi. VICC researchers who specialize in specific types of cancers have agreed to serve on the tumor boards and assist community oncologists.
Those researchers include Park, Christine Lovly, MD, PhD, Kristen Ciombor, MD, MSCI, and Marta Crispens, MD.
A site principal investigator is Phillip Edward Lammers, MD, medical director of Clinical Oncology Research for Memphis-based Baptist Memorial Health Care Corporation, which operates rural hospitals in three states. Hospitals in the Vanderbilt Health Affiliated Network (VHAN) that serve rural areas will also have an opportunity to participate.
With the advent of targeted therapies and immunotherapies based on the molecular profiles of tumors, cancer treatment has become more complicated in recent years, presenting challenges for community oncologists who are often tasked with treating all types of cancers.
“A lot of these oncologists in rural areas are generalists; they don’t have the luxury to specialize,” Friedman said.
By using telehealth to consult with faculty at VICC through the molecular tumor board, community oncologists will have access to specialists in specific cancer types.
“We know that so much of cancer therapy now in 2019 is driven by molecular changes in the tumors themselves — the genomics of the tumor — that we want these patients who are in rural areas to have access to the very best therapies for their tumor as someone who is knocking on the door at Vanderbilt-Ingram Cancer Center,” Friedman said.
Genomic panels that help oncologists determine new cancer treatments can be difficult to interpret.
“When you get back these panels, depending on where you send them, the reports are going to list all the mutations found in the tumors,” Friedman said.
“If there is any targeted therapy for any of those mutations, the reports may list that. The problem is some of these mutations are bystander mutations that have nothing to do with the tumor, but they happen to be there, and we know from research that mutation is not what is driving the cancer. So that targeted therapy may not help treat the cancer. You can wind up giving a patient a therapy with side effects and no hope of helping the patient.”
The VICC HOPE molecular tumor board and VICC oncologists will also be available for follow-up consultations with community oncologists, she said.
The self-management component will offer patients from rural areas valuable information on topics such as handling pain, nausea and fatigue during cancer treatment, maintaining nutrition during therapy and how to communicate better with doctors.
The project is unique in combining telehealth interventions for rural community oncologists and their patients and brings the expertise of VICC to its community, Friedman said.