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Dedication to patient care is the cornerstone of any oncology practice with research a vital factor in the planning of treatment and prevention. In keeping with their mission to improve cancer research in the community setting, the West Clinic’s research company, the Accelerated Community Oncology Research Network (ACORN), which facilitates initiatives at the local and national level, is actively working toward bridging the gap in healthcare disparities for minorities by enrolling more than double the national average of blacks in cancer-related clinical trials.

“We have integrated research across the clinic so it’s part of everyone’s job,” explained Lee Schwartzberg medical director of West Clinic and president of ACORN. “Everyone has a stake in that – the staff and docs buy in (to that) and patients see the dedication clinic wide.”

The National Cancer Institute (NCI) has reported that only a small percentage of blacks participate in cancer-related clinical trials, about 7.46 percent, down from 7.9 percent, even though the burden of cancer falls disproportionately upon blacks and other medically underserved groups like the elderly, those of low socioeconomic status, Latinos and American Indians.

In fact, although cancer deaths have declined for both whites and blacks living in the United States, blacks continue to suffer the greatest burden for each of the most common types of cancer. For all cancers combined, the mortality rate is 25 percent higher for blacks than for whites, which is mostly attributed to lack of medical coverage and early detection screenings. For example, while more white women develop breast cancer, more black women die from it. Easily detectable through screenings, cervical cancer is diagnosed more in minority women than whites.

As noted by the NCI, there is often a lack of information about the potential benefits of participating in clinical trials. In addition, there aren’t enough trials in community settings where people affected by disparities often live. The design of clinical trials themselves can also be a barrier because the eligibility criteria are very rigorous, are standardized, and may exclude patients with multiple health problems, many of whom are minorities. The Agency for Healthcare Research and Quality reported that studies often fail to recruit the planned number of participants nor do they include an adequately diverse population to ensure broad generalizability of results. Schwartzberg said it’s important to balance the scientific merit of a study with a broader inclusion strategy. The possibility of trust issues is also considered.

“At West, there is a bond of trust between patient and doctor,” Schwartzberg said. “Patients are encouraged to participate in clinical trials and there is not an immediate denial because the trust is built up by the therapeutic relationship.”

In 2007, approximately 20 percent of ACORN’s patients were African-American. In at least one clinic, that number climbed to 32 percent.



Oncotype Testing Changing the Way Breast Cancer is Treated

With sophisticated technology providing a window into genetic uniqueness, research is advancing treatment tools that greatly improve patient benefits. One such tool used in coordinating breast cancer treatment is oncotype testing, a non-invasive test that measures multiple genes in estrogen receptive positive breast cancer tumors. At the West Clinic, oncologists utilize the Oncotype DX test through Genomic Health. Medicare and most insurance companies cover the test. By measuring the levels of particular genes in ER-positive patients, this test calculates the probability of cancer recurrence using a scoring system to determine whether or not to treat patients with chemotherapy in addition to their hormonal regimen. A patient whose recurrence score is high will be more seriously considered for chemotherapy whereas a low recurrence score indicates the probability that chemotherapy is unnecessary.

This test is particularly helpful in older patients, when chemotherapy is not as ideal as with someone who is younger.

“If I have a patient that’s a little bit older who may have a tumor that’s on the border of where I would treat versus not treat with chemotherapy, and maybe she’s got a couple of medical problems and I’m a little bit hesitant, I’ll send the tumor for oncotype testing,” explained oncologist Dr. Johnetta Blakely. “If it’s a low score, then I treat that patient with just hormonal therapy. If it’s a high score, then I know I need to bite the bullet and treat her because she has a high risk for recurrence.”

While the intermediate risk is the gray area, studies show that the women who benefit most from chemotherapy are those in the high risk group. For stage one breast cancers that are somewhat high risk, such as the tumor larger than a centimeter or there are other signs that make an oncologist nervous, “we know in that group of women that there is a large percentage that won’t benefit from chemotherapy,” Blakely said.

“It’s only a small percentage of ER-positive patients that need chemotherapy,” she continued. “So essentially for years and years we’ve been over treating just because there was no way to say ‘you need it but you don’t.’”

The FDA has also approved the test for node negative breast cancer, and ongoing studies are looking at the use of oncotype testing in lymph node-positive breast cancer and future applications such as with colorectal cancer.

“We know that each cancer is different and each cancer patient is different,” said Blakely. “I truly think this is huge because this is where we really want to go in terms of tailor made treatment protocols for each patient.”



May 2008

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