Cancer Clear and Simple
Welcome to 'Cancer Clear and Simple,' the podcast dedicated to simplifying cancer. Join us as we discuss the world of cancer, breaking down complex concepts for our listening audience. One of our goals is to equip individuals and families dealing with cancer by providing clear, and concise insights. Through personal stories, expert interviews and practical tips, listeners are enabled to make informed decisions. Whether you're a patient, caregiver, or just simply wanting information, tune in to 'Cancer Clear and Simple' for a easy-to-follow guide on understanding and coping with cancer.
Cancer Clear and Simple
Dr. Monica Patel │ Clinical Trials: Not a Last Resort
Dr. Monica Patel, medical oncologist at UW Health, shares her expertise on clinical trials in cancer care and the importance of ensuring equitable access for all communities. She challenges common misconceptions while providing practical guidance for patients considering clinical trials as part of their treatment journey.
• Clinical trials test new ways to prevent, find, and treat cancer, ensuring treatments are safe and effective
• Most clinical trials are available as first-line treatments, not just as a last resort
• Participation is completely voluntary, and patients can leave a study at any time
• Provider bias, system barriers, and patient concerns all contribute to inequitable access
• Building trust requires education and engagement with communities historically excluded from research
• Research teams provide additional support through the entire clinical trial process
• Diverse representation in trials ensures new treatments work effectively for everyone
• Patients should ask about risks, benefits, and how trials compare to standard care
• Family members can provide valuable support in navigating complex trial information
If you have questions about cancer clinical trials, ask your doctors about available options, even if they don't bring them up first. For more information, visit uwhealth.org/cancertrials or clinicaltrials.gov.
Today on Cancer. Clear and Simple. I'm excited to welcome Dr Monica Patel, medical oncologist at UW Health and assistant professor at the University of Wisconsin-Madison. Dr Patel specializes in treating gastrointestinal cancers and also leads efforts at the Carbone Cancer Center to expand clinical trial participation, especially for communities that have historically been left out of research. She brings both expertise and heart to her work and I can't wait for you to hear her insights. Dr Patel, thank you so much for joining me today. I'd love to start out by hearing a little bit about your journey. What first drew you into medicine and eventually into the field of oncology?
Speaker 2:So thanks so much for having me here today, joshua. So, in terms of why I wanted to pursue a career in medicine, ever since I can think of when I was young, I wanted to be a doctor. I think based on personal experiences with family members, the desire to really make a difference and to connect with people, and those are some of the reasons why I wanted to pursue a career in oncology.
Speaker 1:And you were inspired to go into research. Can you talk a little bit about that interest?
Speaker 2:So my specific research interest is really in trying to make sure that there's equitable participation in clinical trials, and so that all started when I was both in medical school and in training, really seeing that people have different access to care, and so we really need to make sure that everyone has equitable access to care as well as clinical trials, which are an important part of cancer treatment.
Speaker 1:Okay, and was there a specific moment or experience that shaped your commitment to health care access or inclusive research practices?
Speaker 2:So over the past few years since I've been here, I've actually had a few pre-menopausal women falsely excluded from clinical trials. Clinical trials were written in such a way that they have such strict eligibility and exclusion criteria where these younger women couldn't enroll on studies, and these people really needed better access to treatments, and so really I think these experiences have further driven my work in this field to make sure that everyone has access to these cutting edge therapies that we need in cancer treatment.
Speaker 1:And to kind of add on to that, I would like to just hear that clearly about being premenopausal is something that can be an interference with participating in a clinical trial.
Speaker 2:So it shouldn't be, but sometimes it can lead to that. So what happens is we don't want some of our pregnant women exposed to treatments that can affect pregnant women or their potential future babies, and so they're excluded from the studies, and so to test for pregnancy, usually they get urine pregnancy tests or blood tests. Some of these tests can actually be falsely positive in people with cancer, and so for that reason, I've had multiple patients excluded from studies, and so we need to make sure that we are writing clinical trials, and clinical trials are written in a way where we're ensuring that patients are safe but not falsely excluded.
Speaker 1:That is very helpful because I was thinking on the side of just very close to being in that phase of menopause versus somebody that is just of childbearing age and capability so thank you for that.
Speaker 2:Yeah, so I was referring to anyone, basically, who has not attained menopause, essentially, so childbearing age as well.
Speaker 1:Can we break it down for the audience a little bit? Can you explain exactly what a clinical trial is and why they're such a critical part of cancer treatment and innovation?
Speaker 2:Absolutely so. In oncology, clinical trials are studies that test new ways to prevent, find and treat cancer. They really help us ensure that new treatments are safe and effective and they help us improve future treatments. So, as a genocidal oncologist seeing cancer, pre-cancer, advanced erectile cancers, among many others clinical trials are incredibly important to improving treatments for people.
Speaker 1:So many people hear clinical trial and maybe think of it in a negative way. What are some of the biggest misconceptions you come across and how do you address them?
Speaker 2:That's a great question and I find that many people do make these comments that they think clinical trials are really a last resort. What we know is that study participation is for everyone and it's not just for people without treatment options, and another important thing is that treatment's voluntary. So some people think that once they actually participate in a clinical trial or start enrollment in a clinical trial, that they have to stay in the study. But I want to emphasize that participation is voluntary. People can leave a study at any time and sometimes people's doctors might actually recommend that the study continuation doesn't make sense for that person. So we always do what's right for the participant at any given time.
Speaker 1:When people think of things as a last resort or being risky options. Can you walk through how people can get to a place of better understanding?
Speaker 2:I think it's tough because often in cancer treatments the most clinical trials that are available for people are often as a first treatment. So I think trust is very important. Understanding of what a clinical trial is is very important, but for providers it can be tough because often clinical trials most clinical trials are available as a first treatment, so we don't always have that kind of time to you know, over over a period of time. I should say, to wait if we're considering clinical trials. Does that answer your question or no? Are you wondering something different?
Speaker 1:Can you elaborate just a little bit more on the timing and that piece, because I was unaware that that's where most clinical trials are potentially being offered is kind of as a first line, versus okay, we've tried and we tried, let's try this.
Speaker 2:Yeah, so it's not always true. But for example, let's say a person is meeting me with a new diagnosis of a stage four or advanced or metastatic pancreas cancer. The most clinical trials that are typically available are as a first treatment, and those are typically the best chance for getting on a clinical trial. The further number of treatments that people have often there's fewer and fewer options, and this goes far past sort of me. But the idea is that the most likely to be effective treatment is often the first one that a person receives, particularly one in the advanced setting.
Speaker 2:That's not always true in the localized setting. So there may be people who are candidates for treatment, you know, in the localized setting and then again later on. But specifically when people have an advanced cancer, I see that it's the first treatment where we have the most clinical trials, and as we get to a second, third, fourth treatment, we don't always have trials available. So then if people are waiting, you know, as a last resort, at that point there may not even be any studies available. The other thing I want to say is the way we get treatments are with clinical trials. So all treatments have come from a clinical trial, so it's not just a last resort.
Speaker 1:Thank you for pointing that out, because that's something I find myself trying to traverse and verbally kind of. You know, pain relievers have gone through clinical trials, and that's what I try to think of or say is that's, that's generally true, correct.
Speaker 2:Generally, yes, especially in cancer care. All of our treatments come from studies or clinical trials.
Speaker 1:OK, that's, that's a different way of thinking about it. That's helpful for me. Okay, that's a different way of thinking about it. That's helpful for me. And so you've been involved in work aimed at improving clinical trial access and inclusion. Why is it so important to have diverse populations, especially those historically underrepresented, in these?
Speaker 2:studies. All patients have access to the cutting edge treatments that are provided on clinical trials, and the only way to know these treatments are actually safe and effective for everyone is if we're including everybody all the patients who get these cancers in our studies, and so I think it's incredibly important to have all populations represented in trials.
Speaker 1:Thank you. So just scientifically, I hear that you're speaking from it from a best practice kind of standpoint, but me, from where I'm at, I'm appreciative that scientifically we need things to work out numerically for a majority of outcomes, and so that also applies in this way as well, correct?
Speaker 2:That's true exactly. We need everybody to be in the research so that we know that it actually is safe and effective for everyone. Gotcha, and we wanna make sure that cutting edge treatments, these new treatments that can potentially lead to better outcomes, that everyone has access to them, regardless of who they are.
Speaker 1:Okay, so let's dig into the barriers to participation, whether it's mistrust or a lack of information. What are some of the most common challenges you've seen, especially in communities of color or rural areas?
Speaker 2:I think what I commonly hear is that people are always quick to assume that there's a participant or patient-related barriers, and that's true of the puzzle. I think it's very important to think about this in three pieces. So we think about physician or provided-related barriers as one of them. We know that you know we're humans. Their implicit bias plays a role, and it may play a role in who actually gets offered a clinical trial. So it's incredibly important for everybody to be offering trials to potential patients, regardless of who they are, their backgrounds. As I've mentioned before, there's systems-related barriers, so, such as how clinical trials are written. You know where they're actually available, how is the eligibility and exclusion written. So those are some pieces to think about and exclusion written.
Speaker 1:So those are some pieces to think about. What are researchers and institutions like UW doing to build trust and expand?
Speaker 2:awareness around clinical trials.
Speaker 2:I think a major focus for us is to actually increase education, both for those walking into our cancer center but also in the community about clinical trials.
Speaker 2:You mentioned some of your work that you're engaged in the community community about clinical trials. You mentioned some of your work that you're engaged in the community educating about clinical trials. I think that's incredibly important because, regardless of if a person you know has cancer or a loved one with cancer, if it's 10 years from now and they've heard of a clinical trial and they know what it is and they know about the potential benefits, they might encourage their loved one to actually participate. So I think education is huge, and not only on the patient or participant or loved one side, but also the providers, like I mentioned. So making sure that we're educating providers on trials this issue in particular not all patients can actually get on studies for multiple reasons and really making sure that our providers offer studies to all potentially eligible patients, regardless of their backgrounds, and really working with their patients that they're seeing to come up with what makes sense for that patient in terms of treatment and a trial.
Speaker 1:Are there specific strategies you found effective when it comes to engaging communities that have historically been left out of clinical research?
Speaker 2:So what I've learned is I think it's incredibly important and helpful to actually engage faculty and staff who are really embedded in these communities. I think people who already know the communities, who have developed that trust. Having their support, learning from them, really having them engage their communities to me makes the most sense. Also, receiving feedback from our community advocacy boards has been incredibly helpful in my experience, and so I think those are some strategies that I've learned since I've been here over the past five years that, to me, have been very helpful.
Speaker 1:Yes, these community advocacy board spaces I'm finding are good avenues to have good representation from across the state but also being able to have others that are in the know, as I like to think. In your view, how does increasing participation from underrepresented groups impact cancer care more broadly, not just for today but for the future?
Speaker 2:at cancer care more broadly, not just for today but for the future. So in the past five years I've been here, I've seen patients get access to new and better cancer treatments and so, like I mentioned, we really need to make sure that all people have access to these treatments, and for many of these treatments to actually get approved and become standard of care it could take many years. So we need to make sure that on studies and on clinical trials, we're including everyone so that everyone has access to these new and potentially improved treatments, and to make sure that the results of the studies apply to everybody in our population.
Speaker 1:Nice For someone who's been offered a clinical trial as a treatment option. What questions should they be asking?
Speaker 2:So first off, I think, just the details of the clinical trial. What are the risks of doing the study, what are the benefits, how does the clinical trial compare with what's already the standard of care? And I think it's incredibly important for patients who are potentially interested in clinical trials to actually take the second step and not only talk with their doctors, but actually the research teams to review all these details of the clinical trial. The informed consent is incredibly important for those who are interested, and so that provides a lot of information. And if there are family members or loved ones who can be there for that discussion because there are a lot of pieces to this, it can be overwhelming I think that can be even more helpful.
Speaker 1:And in between question is can you be more descriptive when you're talking about roles on a research team? I am learning that I was sorely mistaken on how many people can be involved and just care for one person, so please indulge me a little bit, please.
Speaker 2:Yeah, no, absolutely so. You know I can only speak for my experiences, but typically when I'm thinking about a clinical trial, it's very complex process For me to even think of the study. I typically, you know, review all the details of the patient who's coming into my practice or care. Sometimes I review them with our nurse navigator team who can screen patients for clinical trials ahead of time to say, hey, is this a good study for this patient? Do they potentially look eligible? Then, once I actually introduce the study and a person seems interested in it, then I say, hey, do you want to meet with with our research team? Because that's really the next step and typically the research team involves a research coordinator. Sometimes it can involve a nurse, and typically they actually meet with the patient after my meeting, go through the informed consent in great detail with the patient and that sort of outlines all of the details as part of the study and typically that person if a person actually engages in research and enrolls in a study continues to follow them over time.
Speaker 1:Yes. So thank you, because, just in terms of like having somebody who may be a continuous feature or a role in a person's care, I'm liking that I'm hearing you point out that that's happening with clinical trials and being able to yeah, in my mind, make sense of these things.
Speaker 2:Absolutely. I think the benefit of the clinical trial is actually the number of people who are on a person's team. It's not just the doctor, you know, there's a clinic nurse, there's a research team and there's so many pieces or levels of support, I should say, and more eyes on a person to make sure that not only is the treatment safe, but that they have someone who can help them at any time.
Speaker 1:How can caregivers or loved ones support someone who's trying to make that decision?
Speaker 2:I think it's a tough decision. This is all incredibly complex. You know, usually we don't have a lot of time to wait to make these decisions because often treatment needs to start sooner than later. So I think caregivers and loved ones can really try to be as engaged in the process you know, try to come to the visit, help support their loved ones in making the decisions that are sort of what they want at that rate of time. But really helping break down all the information and helping them support, make these decisions, I would say is the best thing that they can do.
Speaker 1:Thank you. What are some resources or trusted places people can turn to if they want to learn more or explore clinical trials on their own?
Speaker 2:So we have a great resource. It's wwwuwhealthorg. Slash cancer trials Refer people to clinicaltrialsgov. So I would say that those are two publicly available resources that provide a lot of information about clinical trials.
Speaker 1:That sounds good to me, and so we're, I think getting close to our wrap up and just wanted to provide some more inspiration and invite some further learning. What gives you hope when you think about the future of cancer research and access to care?
Speaker 2:I've already seen this in the last five years since I've been here, but I think there's a hope for a better tomorrow in cancer care where we have better, more effective treatments, and I'm really optimistic for our future that we continue to make great strides in cancer treatments.
Speaker 1:Awesome If you could leave our listeners with one message about clinical trials. What would it be?
Speaker 2:I would say that if people have any questions about cancer clinical trials, I'm absolutely happy to be a resource and if you are a patient or a loved one of someone with cancer, make sure to ask your doctors about clinical trials, even if they don't bring them up with you. Ask them what role do they have, you know? Is there a role? Are they already available? The more you ask, the more you know we can share information about.
Speaker 1:We'll follow that up by saying you can find Dr Patel easily by going to cancerwiscedu. And with that, dr Patel, thank you so so much for sharing your expertise and your passion with us today. Your work reminds us how important it is that advances in cancer care truly reach every community and to our listeners. Thank you for spending time with us on Cancer, clear and Simple.
